Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System

Helou, Leah B.; Gartner-Schmidt, Jacqueline L.; Hapner, Edie R.; Schneider, Sarah; Stan, Jarrad H. Van

doi:10.1055/s-0040-1722756

Cited by 26 publications

(4 citation statements)

References 45 publications

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“…Fifth, we expect both constructs to be both malleable and primeable, which would be consistent with other experiences of selfconcept (Markus & Oyserman, 1989;Trafimow et al, 1991;Triandis, 1989). Sixth, as previously argued by Helou and colleagues in the context of meta-therapy (Helou, 2017;Helou, 2019;Helou et al, 2021), we hypothesize that an individual's sense of communicative congruence and communicative dysphoria will influence voice therapy behaviors and outcomes. This hypothesis is supported by literature related to how self-concept functions as a force for action (e.g., Oyserman et al, 2012), the impact of self-efficacy on compliance (Bandura, 1977;Kaplan et al, 1984;van Leer et al, 2008), and the effectiveness of promoting identity-based motivation in intervention models (Oyserman & Destin, 2010).…”

Section: Testable Hypothesessupporting

confidence: 73%

“…The assertion that one's voice, speech, and communication behaviors relate to one's identity is not a novel concept. Previously, writings on meta-therapy have highlighted the importance of "crafting the dialogue" of voice therapy in which the clinician explicitly builds a conceptual framework to facilitate a patient's success in voice therapy (Helou, 2017;Helou et al, 2021). Often, these discussions involve the patient's goals, expectations, strategies, understanding of themselves and the process, as well as their personal identities.…”

Section: Previous Literature On Identity and Communicationmentioning

confidence: 99%

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Communicative Congruence and Communicative Dysphoria: A Theory of Communication, Personality, and Identity

Welch¹,

Helou²

2021

Preprint

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Purpose: We present a theoretical framework that formalizes and defines the constructs of communicative congruence and communicative dysphoria that is rooted within a comprehensive and mechanistic theory of personality. Background: Voice therapists have likely encountered a patient who states that a therapeutic target voice “isn’t me.” The ability to accurately convey a person’s sense of self, or identity, through their voice, speech, and communication behaviors seems to have high relevance to both patients and clinicians alike. However, to date, we lack a mechanistic theoretical framework through which to understand and interrogate the phenomenon of congruence between one’s communication behaviors and their sense of self. Results: We review the initial notion of congruence, first proposed by Carl Rogers. We then review several theories on selfhood, identity, and personality. After reviewing these theories, we explain how our proposed constructs fit within our chosen theory, the Cybernetic Big Five Theory of Personality. We then discuss similarities and differences to a similarly named construct, the Vocal Congruence Scale. Next, we review how these constructs may come to bear on an existing theory relevant to voice therapy, the Trans Theoretical Model of Health Behavior Change. Finally, we state testable hypotheses for future exploration, which we hope will establish a foundation for future investigations into communicative congruence. Conclusion: To our knowledge, the present paper is the first to explicitly define communicative congruence and communicative dysphoria. We embed these constructs within a comprehensive and mechanistic theory of personality and, in doing so, hope to provide a rigorous and comprehensive theoretical framework that will allow us to test and better understand these proposed constructs.

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Section: Testable Hypothesessupporting

confidence: 73%

Section: Previous Literature On Identity and Communicationmentioning

confidence: 99%

Communicative Congruence and Communicative Dysphoria: A Theory of Communication, Personality, and Identity

Welch¹,

Helou²

2021

Preprint

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“…how the ingredients affect the target) (8). To date, published application of the RTSS have demonstrated the ability of the RTSS to map targets and ingredients to a patient population or therapy discipline using previous research (9)(10)(11)(12)(13)(14). Yet understanding clinicians' experiences utilizing the RTSS and any effects it has on clinical rehabilitation practice remains to be understood.…”

Section: Introductionmentioning

confidence: 99%

Embedding the Rehabilitation Treatment Specification System into clinical practice: An evaluation of a pilot teaching programme

Gibson

Sampford

Myers-Ingram

et al. 2022

Preprint

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Background: Deficiency in the provision and quality of treatment specification by rehabilitation clinicians impairs the ability to differentiate effective from ineffective elements of treatment. The standardized language of the rehabilitation treatment specification system (RTSS) has been proposed as a countermeasure. To date, there is no evidence of its use in clinical practice and what effect it may have. This study aimed to assess the ability of a pilot teaching programme to embed the RTSS into the clinical practice of an inpatient oncology physiotherapy team. The objectives were to evaluate the teaching programme’s effect on; participants’ familiarity and perceived benefit of the RTSS, its uptake, participants’ clinical reasoning, and their feelings and attitudes towards adopting the RTSS. This study provides an evaluation of the pilot teaching programme which will subsequently inform a larger iteration in an ongoing Health Education England (HEE) project aiming to disseminate and embed the RTSS into physiotherapy practice to improve physiotherapists’ treatment specification. Methods A 6-week, multi-modal RTSS pilot teaching programme based upon socio-constructivist theory was delivered to 10 inpatient oncology physiotherapists at a large urban UK trust in 2021. Self-reported measures and clinical case note audits were assessed before and after the RTSS teaching programme to evaluate its effect on RTSS familiarity and perceived benefit, uptake, and clinical reasoning. A post-teaching focus group was undertaken. It was qualitatively analysed using an inductive, independent thematic approach to evaluate clinicians’ reflection and adoption. Results Ten participants (8F, 29.4(±3.5) years) with variable clinical experience completed the RTSS teaching programme (six 1-hour lecture/case-based-learning sessions weekly) with 85% mean attendance. Nine yielded complete data for analyses, and 7 participated in the focus group. There was significant improvement in self-reported familiarity and confidence using the RTSS. Furthermore, there was a significant effect of the teaching on self-reported clinical reasoning overall and specifically in knowledge and theory application. But this was not reflected in clinicians’ uptake of RTSS language, nor in the quality of clinical reasoning emergent in their case notes. Qualitative analyses revealed that while clinicians’ conceptual understanding and the relative advantage of using the RTSS in practice was pervasive, they articulated that translating its perceived academic disposition into their clinical practice a challenge. Conclusions: The RTSS teaching programme was shown to be effective in improving self-reported measures of clinical reasoning, despite clinical uptake of the RTSS remaining low. Future iterations should be tested across physiotherapy specialisms and in a greater sample with consideration of pedagogical and cultural measures to support the clinical diffusion of the RTSS including longer teaching periods, introducing pre-teaching e-learning approaches, incorporating how to document RTSS language into clinical case-notes, and designing the teaching to influence clinical leaders.

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“…However, voice therapy modifies patients' vocal behaviors, which are guided by clinician insight and directives. Thus, "buy-in" from both clinicians and patients is likely a vital factor in predicting therapeutic success [7], especially when developing novel voice therapy programs and tools.…”

Section: Introductionmentioning

confidence: 99%

Clinician and Patient Perception of a Voice Therapy Program Utilizing a Variably Occluded Face Mask: A Pilot Study

Gartner‐Schmidt

Belsky

Awan

et al. 2022

Folia Phoniatr Logop

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Objective: The purpose of this investigation was to assess clinician and patient feedback about voice therapy using a variably occluded face mask (VOFM), and to determine if voice therapy augmented via a VOFM would result in favorable changes in patient self-perceived handicap, as well as acoustic and aerodynamic measures. Methods/Design: Pilot, prospective, pre-post single group design. Eleven patients with dysphonia due to primary muscle tension dysphonia (8) or benign vocal fold lesions (3) were recruited. Data collected included patient and clinician feedback of voice therapy using a VOFM, voice handicap index (VHI)-10, acoustic and aerodynamic measures. Data were collected before treatment (baseline) and one-week post therapy. Wilcoxon signed-rank tests were used to compare data pre and post therapy. Results: Statistically significant improvement was observed for the VHI-10 with a median delta of -7. Clinician feedback generally reported that patients like the VOFM, using the VOFM within the first two sessions of therapy, and within less than 10 minutes of use. All clinicians ranked the conversation level of the hierarchy as the most effective level. Three themes emerged from the Therapy Feedback Form: the SOFM was a 1) “Facilitator for Sensation,” 2) a “Physical Tool”; and that there was 3) “No Program Needed” to use the VOFM in voice therapy. There was a statistically significant improvement in CPP (p=0.0329) and CSID (p=0.0164) in sustained vowels. Discussion: This pilot study represents the first investigation into clinician and patient perceptions of using a variably occluded face mask (VOFM). Reported measures via patient perception, as well as clinician perceptions, and some acoustic and aerodynamic measures showed that participants got better with VOFM voice therapy. Last, in general, both clinicians and patients liked utilizing a VOFM in voice therapy.

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Mapping Meta-Therapy in Voice Interventions onto the Rehabilitation Treatment Specification System

Cited by 26 publications

References 45 publications

Communicative Congruence and Communicative Dysphoria: A Theory of Communication, Personality, and Identity

Communicative Congruence and Communicative Dysphoria: A Theory of Communication, Personality, and Identity

Embedding the Rehabilitation Treatment Specification System into clinical practice: An evaluation of a pilot teaching programme

Clinician and Patient Perception of a Voice Therapy Program Utilizing a Variably Occluded Face Mask: A Pilot Study

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