Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets

et al. 2022

Preprint

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

Section: Qualitative Analysismentioning

confidence: 99%

Section: Qualitative Analysismentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2022

Preprint

“…The outcome is a Pre-and Post-Operative Voice Therapy intervention (PaPOV) which is described in detail, in accordance with the TIDieR checklist(28), and according to the Rehabilitation Treatment Speci cation System (RTSS) for voice (29,30). The PAPOV intervention has been speci cally developed for adults who are undergoing phonosurgery to have benign vocal fold lesion(s) removed.…”

Section: Introductionmentioning

confidence: 99%

Protocol for Pre and Post-Operative Voice therapy (PaPOV) for benign vocal fold lesions: Non-randomised, multicentre feasibility trial with nested process evaluation

Carding

Booth

et al. 2023

Preprint

Background: Management of benign vocal fold lesions (BVFLs) is variable with some receiving surgery, voice therapy or a combination of these approaches. Some evidence suggests that the best outcomes may be achieved when patients are offered pre and post-operative voice therapy in addition to phonosurgery, but what constitutes pre and post-operative voice therapy is poorly described. The pre and post-operative voice therapy (PaPOV) intervention has been developed and described according to the TiDIER checklist and Rehabilitation Treatment Specification System for voice. The PaPOV intervention is delivered by specialist speech and language therapists trained in the intervention and comprises 7 essential and 4 additional components, delivered in voice therapy sessions with patients who are having surgery on their vocal folds for removal of BVFLs. Study Design: Non-randomised, multicentre feasibility trial with embedded process evaluation Method: 40 patients from two sites who are due to undergo phonosurgery will be recruited to receive the PaPOV intervention. Measures of feasibility, including recruitment, retention, and adherence will be assessed. The feasibility of gathering clinical and cost effectiveness data will be measured pre treatment, then at 3 and 6 months post-operatively. An embedded process evaluation will be undertaken to explain feasibility findings. Discussion: This study will assess the feasibility of delivering a described voice therapy intervention protocol to patients who are undergoing surgery for removal of benign vocal fold lesions (BVFLs). Findings will be used to inform the development and implementation of a subsequent effectiveness trial, should this be feasible. TRIAL REGISTRATION This trial has been prospectively registered on ISRCTN, (date 4th January 2023), registration number 17438192 and can be viewed here: https://www.isrctn.com/ISRCTN17438192

“…Direct voice therapy however is not just one treatment method, and many SLT-Vs use a hierarchical and experiential approach drawing on multiple techniques but often with limited evidence to support their adoption [ 28 ]. Problematically, voice therapy has been portrayed as a ‘black box; and many recognised treatment regimens overlap in their aims and therapeutic goals with often limited descriptions of ‘active ingredients’ [ 20 , 28 , 29 ]. In addition, outcome measures are used inconsistently and there are limited reports on treatment fidelity [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

A mixed-method feasibility study of the use of the Complete Vocal Technique (CVT), a pedagogic method to improve the voice and vocal function in singers and actors, in the treatment of patients with muscle tension dysphonia: a study protocol

McGlashan

Aaen

et al. 2023

Pilot Feasibility Stud

Background Muscle tension dysphonia (MTD) results from inefficient or ineffective voice production and is the cause of voice and throat complaints in up to 40% of patients presenting with hoarseness. Standard treatment is voice therapy (SLT-VT) delivered by specialist speech therapists in voice disorders (SLT-V). The Complete Vocal Technique (CVT) is a structured, pedagogic method which helps healthy singers and other performers optimise their vocal function enabling them to produce any sound required. The aim of this feasibility study is to investigate whether CVT administered by a trained, non-clinical CVT practitioner (CVT-P) can be applied to patients with MTD before progressing to a pilot randomised control study of CVT voice therapy (CVT-VT) versus SLT-VT. Methods/design In this feasibility study, we use a mixed-method, single-arm, prospective cohort design. The primary aim is to demonstrate whether CVT-VT can improve the voice and vocal function in patients with MTD in a pilot study using multidimensional assessment methods. Secondary aims are to assess whether (1) a CVT-VT study is feasible to perform; (2) is acceptable to patients, the CVT-P and SLT-VTs; and (3) whether CVT-VT differs from existing SLT-VT techniques. A minimum of 10 consecutive patients with a clinical diagnosis of primary MTD (types I–III) will be recruited over a 6-month period. Up to 6 video sessions of CVT-VT will be delivered by a CVT-P using a video link. The primary outcome will be a change in pre-/post-therapy scores of a self-reported patient questionnaire (Voice Handicap Index (VHI)). Secondary outcomes include changes in throat symptoms (Vocal Tract Discomfort Scale), acoustic/electroglottographic and auditory-perceptual measures of voice. Acceptability of the CVT-VT will be assessed prospectively, concurrently and retrospectively both quantitatively and qualitatively. Differences from SLT-VT will be assessed by performing a deductive thematic analysis of CVT-P transcripts of therapy sessions. Conclusion This feasibility study will provide important data to support whether to proceed with a randomised controlled pilot study focusing on the effectiveness of the intervention compared to standard SLT-VT. Progression criteria will be based on demonstrating a positive outcome in treatment, successful delivery of the pilot study protocol, acceptability to all stakeholders and satisfactory recruitment rates. Trial registration ClinicalTrials.gov website (NCT05365126 Unique Protocol ID: 19ET004). Registered on 06 May 2022.