Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group

Wenke, Rachel; Coman, Leah; Walton, Chloe; Madill, Catherine; Theodoros, Deborah; Bishop, Carol; Stabler, Penny; Lawrie, Melissa; O’Neill, J. Robert; Gray, Heidi; Cardell, Elizabeth

doi:10.1016/j.jvoice.2021.02.011

Cited by 11 publications

(7 citation statements)

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“…En 8 de los 13 objetivos analizados, la finalidad resulta medianamente imprecisa. Por ejemplo, en el caso de "(la intervención busca) producir un habla más suave" (Quinn & Swain, 2018), o de "(la intervención buscó) que el participante produjera una voz resonante" (Wenke et al, 2021), o de "(la intervención busca) aumentar la proyección vocal" (Ubrig et al, 2019). En estos casos la finalidad declarada puede ser operacionalizada de varias maneras.…”

Section: Respecto De La Finalidad Del Objetivo Terapéuticounclassified

Estructura de los objetivos terapéuticos en la intervención fonoaudiológica de usuarios con necesidades vocales: una revisión sistemática exploratoria

Crisosto

Flores

2022

Rev. Chil. Fonoaudiol.

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Esta revisión tiene como finalidad identificar y describir la estructura de los objetivos terapéuticos incluidos en aquellas investigaciones que explicitan una intervención fonoaudiológica vocal durante los últimos cinco años. La búsqueda estratégica se lleva a cabo en las bases de datos PubMed, ScienceDirect y Web Of Science y se obtienen 3.974 registros, de los cuales 12 artículos cumplen con todas las condiciones declaradas en los criterios de inclusión. La tendencia mayoritaria en la literatura del área es la omisión de los objetivos terapéuticos y la alusión solo a los procedimientos empleados. En el análisis cualitativo de los objetivos hallados, se evidencia la ausencia de una estructura textual estándar y falta de diferenciación entre los tipos de objetivos, lo que provoca un alto grado de heterogeneidad en su redacción. En relación con la noción de usuario, su rol es más bien secundario y pasivo. Existe insuficiente atención a la determinación de criterios de logro y una escasa operacionalización de los contenidos a abordar en la intervención fonoaudiológica. La enunciación de los contenidos de intervención desde su naturaleza conceptual impide una medición concreta asociada a la tarea terapéutica propuesta debido a su pobre operacionalización. Se concluye que no existe una estructura común en la formulación de objetivos terapéuticos para la intervención vocal.

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Section: Respecto De La Finalidad Del Objetivo Terapéuticounclassified

Estructura de los objetivos terapéuticos en la intervención fonoaudiológica de usuarios con necesidades vocales: una revisión sistemática exploratoria

Crisosto

Flores

2022

Rev. Chil. Fonoaudiol.

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“…Considering there has been no similar study design in the literature, we assumed the first treatment and second treatment resulted in a 3.8 dB improvement in HNR for the primary MTD group as observed in the Nguyen and Kenny study [21]. Mean baseline HNR for secondary MTD was taken from Wenke et al [40] in which baseline HNR was 16.6 dB as their study used participants with both primary MTD and MTD with lesions such as vocal nodules. We assumed the first and second treatments resulted in a 2.9 dB improvement in HNR for the secondary MTD group as observed in their standard treatment protocols [40].…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…Mean baseline HNR for secondary MTD was taken from Wenke et al [40] in which baseline HNR was 16.6 dB as their study used participants with both primary MTD and MTD with lesions such as vocal nodules. We assumed the first and second treatments resulted in a 2.9 dB improvement in HNR for the secondary MTD group as observed in their standard treatment protocols [40]. Standard deviation (SD) of HNR for the formula was set at 4.5 dB according to the study of Wenke et al [40].…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…We assumed the first and second treatments resulted in a 2.9 dB improvement in HNR for the secondary MTD group as observed in their standard treatment protocols [40]. Standard deviation (SD) of HNR for the formula was set at 4.5 dB according to the study of Wenke et al [40]. The calculation resulted in a sample size of 74 (patients).…”

Section: Sample Size Calculationmentioning

confidence: 99%

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Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

Madill

Chacon

Kirby

et al. 2021

JCM

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Background: Although voice therapy is the first line treatment for muscle-tension voice disorders (MTVD), no clinical research has investigated the role of specific active ingredients. This study aimed to evaluate the efficacy of active ingredients in the treatment of MTVD. A retrospective review of a clinical voice database was conducted on 68 MTVD patients who were treated using the optimal phonation task (OPT) and sob voice quality (SVQ), as well as two different processes: task variation and negative practice (NP). Mixed-model analysis was performed on auditory–perceptual and acoustic data from voice recordings at baseline and after each technique. Active ingredients were evaluated using effect sizes. Significant overall treatment effects were observed for the treatment program. Effect sizes ranged from 0.34 (post-NP) to 0.387 (post-SVQ) for overall severity ratings. Effect sizes ranged from 0.237 (post-SVQ) to 0.445 (post-NP) for a smoothed cepstral peak prominence measure. The treatment effects did not depend upon the MTVD type (primary or secondary), treating clinicians, nor the number of sessions and days between sessions. Implementation of individual techniques that promote improved voice quality and processes that support learning resulted in improved habitual voice quality. Both voice techniques and processes can be considered as active ingredients in voice therapy.

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“…Numerous reasons have been put forward for this, including clinician and clinic-related factors, gender, ethnicity, age, employment and perceived vocal severity, complex laryngeal diagnoses, additional medical problems, time commitment for treatment sessions or lack of rapid progress, adequate, if not complete, improvement in symptoms or failure to achieve goals (40)(41)(42). There is greater treatment satisfaction and likelihood of success if the therapeutic goals of treatment are speci c and determined by the patient prior to therapy (43)(44)(45), are functionally orientated and have a more meaningful effect on quality of life (46) with an emphasis on carryover activities into conversation, so they are more relevant to the patient's daily vocal demands (47)(48)(49) and there is maximum improvement is achieved in the minimum time (33).…”

mentioning

confidence: 99%

A Proof-of-Concept Study of The Complete Vocal Technique (CVT), a pedagogic technique used for Performers, in Improving the Voice and Vocal Function in Patients with Muscle Tension Dysphonia (CVT4MDT) delivered by Telehealth: Study Protocol

McGlashan

Aaen

White

et al. 2022

Preprint

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Background: Muscle Tension Dysphonia (MTD) is responsible for up to 40% of patients presenting with voice and throat complaints. It is due to inefficient or ineffective voice production resulting from an imbalance in the control of the breathing mechanism, and uncontrolled constriction of the muscles in the larynx (voice box) or vocal tract (throat space above the vocal cords). Standard treatment is Voice Therapy delivered by a specialist Speech Therapist (SLT-V) often using a video link (telepractice aka telehealth). However, voice therapy has been portrayed as a “black box” and many recognised treatment regimens overlap in their treatment aims and therapeutic goals and have a poor-quality evidence base. The Complete Vocal Technique (CVT) is widely used in Europe by singers and vocal coaches. Practitioners (CVT-Ps) undergo a three-year accredited training programme, and the systematic and structured approach helps healthy singers and other performers optimise the function of the voice to produce any sound required. It also rapidly effective in performers with vocal problems, which are also mainly due to uncontrolled throat constrictions. Although there is a growing evidence base and understanding of how CVT can help singers, there is no evidence that, it can be of benefit to patients with MTD or is different from standard SLT techniques. This proof-of-concept study is designed to evaluate whether CVT can be used to help MTD patients using a multidimensional approach for assessment.Methods/design: A proof of concept study, will recruit 10 people with a clinical diagnosis of primary muscle tension dysphonia (Type I-III) with a VHI score >30, who meet the inclusion/exclusion criteria. Participants will have a multidimensional assessment using a range of validated and non-validated disease-specific questionnaires, statistical analysis of voice and electroglottographic (EGG) recordings and auditory-perceptual evaluations of the voice by Speech Therapy experts in Voice Disorders (SLT-V). They will then receive up to 6 video sessions of CVT-VT delivered using a video link by a CVT-P. The participants will then be reviewed back in clinic at 8 weeks and be reassessed, using further questionnaires and voice recordings. The assessors will be blinded to the testing order of the outcome measures and patients will act as their own controls. In addition, qualitative analysis of the therapy sessions will be made by direct observation of some of the CVT therapy sessions by an experienced SLT-V and review of the Therapist’s treatment log.The main objectives of this Proof-of Concept study are 1) to determine whether CVT-VT is beneficial in the treatment of patients with primary MTD; 2) to determine if and how CVT-VT differs from traditional SLT-VT methods and therefore if it could be a useful additional tool for SLT-VTs in the management of MTD; 3) whether delivery of CVT-VT via a video link is satisfactory to both patients and the CVT-P?Discussion: This study will involve a detailed assessment of the approach to therapy by the CVT-P to determine whether it leads to improvement in the presenting symptoms and voice production, whether it differs from traditional SLT-VT approaches, whether it is acceptable to patients as part of the evaluation as to whether a non-inferiority randomised controlled trial is feasible.Trial registration: The Protocol has been registered on the Clinicaltrials.gov website (NCT05365126 Unique Protocol ID: 19ET004). Registered 06 May 2022, https://beta.clinicaltrials.gov/study/NCT05365126?patient=Muscle%20Tension%20Dysphonia&locStr=Nottingham,%20UK&lat=52.9540223&lng=-1.1549892&distance=50

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Effectiveness of Intensive Voice Therapy Versus Weekly Therapy for Muscle Tension Dysphonia: A Noninferiority Randomised Controlled Trial With Nested Focus Group

Cited by 11 publications

References 61 publications

Estructura de los objetivos terapéuticos en la intervención fonoaudiológica de usuarios con necesidades vocales: una revisión sistemática exploratoria

Estructura de los objetivos terapéuticos en la intervención fonoaudiológica de usuarios con necesidades vocales: una revisión sistemática exploratoria

Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

A Proof-of-Concept Study of The Complete Vocal Technique (CVT), a pedagogic technique used for Performers, in Improving the Voice and Vocal Function in Patients with Muscle Tension Dysphonia (CVT4MDT) delivered by Telehealth: Study Protocol

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