The History of Outcomes Research in Voice Therapy

1
The History of Outcomes Research in Voice Therapy

• Lisa B. Thomas, MA, CCC-SLP
• Division of Communication Disorders

2
History of Outcomes Research in Voice

• Earliest reports 1940s
• Case Studies, Anecdotal reports
• 1980s and early 1990s
• Instrumentation advances
• Dramatic increase in number of efficacy studies
• Primarily survey and retrospective studies. Some
  group studies SS designs emerge.
• Lack of control and research rigor

3
History of Outcomes Research in Voice

• Studies of the 1990s and 2000s
• Instrumentation advances
• Increased rigor in designs
• Lines of research developing
• Ex LSVT, Ramig et al. (1995)

4
Decisions Regarding the Content of the Review
5
Review Process Phase 1

• Medline, CINAHL, PsychINFO, ASHA journals (1980
  present)
• Search terms voice therapy, efficacy, outcomes,
  voice disorders
• 119 citations
• 41 inappropriate population (SD, IPD)
• 46 not related to treatment efficacy, outcomes
• 7 non-English
• 25 studies for review

6
Review Process Phase 2

• Historical search from pertinent readings 38
  additional studies
• Review Process Phase 3
• Review, categorization, and rating of studies
• Butler and Darrah (2001) 5 level rating system

7
Results - Overview
8
Hygiene Therapy Foundations

• Majority of voice disorders due to vocal abuse
  and misuse
• Therapy involves identification and elimination
  of abuses / misuses
• Service provision Didactic training Individual
  or Group
• Examples
• Elimination of throat clearing
• Increase in hydration

9
Hygiene Therapy Evidence

• Direct treatment of voice appears superior to
  vocal hygiene training
• Holmberg et al. (2001)
• Roy et al. (2001)
• Verdolini-Marston et al. (1995)

10
Hygiene Evidence

• Group hygiene training yields change in knowledge
  but no change in behavior
• Nilson and Schneiderman (1983)
• Aaron and Madison (1991)
• Broaddus-Lawrence et al. (2000)
• Timmermans et al. (2004, 2005)
• Chan (1994)

11
Hygiene Evidence

• Hydration reduces phonatory effort
• Hydration increases vocal endurance
• Solomon and DiMattia (2003)
• Verdolini et al. (1994)
• Verdolini-Marston et al. (1990, 1994)
• Yiu and Chan (2003)

12
HygieneConclusions Implications

• Few large scale studies support the therapeutic
  benefit of general hygiene education
• Hygiene should be used only as an adjunct to
  direct forms of treatment.
• Future work
• Designs allowing for study of hygiene alone
• Monitor / quantify compliance
• Increase number of studies on disordered
  populations

13
Symptomatic Therapy Foundations

• Modification of aberrant voice symptoms
• Use of facilitating methods to modify pitch,
  loudness, and / or quality
• Boone (1971) 20 facilitating methods
• Yawn-Sigh
• Chewing
• Pitch alteration

14
Symptomatic Therapy Evidence

• Primarily case reports and anecdotal evidence
• Few group studies
• Majority of methods have only Level IV and V
  evidence
• Many methods have no published evidence

15
Symptomatic Evidence

• Evidence supports biofeedback only
• EMG
• Andrews et al. (1986) Prosek et al (1978)
• Stemple et al. (1980)
• Acoustic / Aerodyanamic
• Yamaguchi et al. (1986) Laukkanen et al. (2004)
• Laryngeal Function
• DAntonio et al. (1987) Rattenbury et al. (2004)

16
Symptomatic TherapyConclusions Implications

• A single line of promising work
• Future Directions
• Potential examination of theoretical bases of the
  methods
• More rigorous research designs

17
Physiologic Therapy Foundations

• Modify physiology underlying the voice disorder
• Holistic management
• Five primary methods related to functional
  disorders
• Examples
• Vocal Function Exercises (Stemple, 1993)
• Confidential Voice (Colton and Casper, 1990)

18
Physiologic Therapy Evidence

• Evidence
• Physiologic / theoretical evidence
• Clinical evidence
• Majority, well-controlled group studies

19
Physiologic Clinical Evidence

• Lines of research showing efficacy of 4 methods
• Accent Method
• Bassiouny (2001) Fex et al. (1994) Smith
  Thyme (1976) Kotby et al. (1991, 1993)
• Vocal Function Exercises
• Stemple et al. (1994) Sabol et al. (1995) Roy
  et al. (2001)

20
Physiologic Evidence

• Resonant Voice Therapy
• Chen et al. (2003) Roy et al. (2003)
  Verdolini-Marston et al. (1995)
• Manual Laryngeal Musculoskeletal Reduction
  Technique
• Roy (1993) Roy et al. (1997) Roy and Leeper
  (1993) Van Lierde et al. (2004)

21
Physiologic TherapyConclusions and Implications

• Orientation came to forefront at time of efficacy
  emphasis
• Evidence supports a shift from symptomatic Tx to
  physiologic Tx

22
Conclusions Implications

• Orientations
• Physiologic methods possess strongest support
• Efficacy of hygiene training inconclusive
• Lack of evidence for symptomatic therapy
• Future Directions / Questions
• Should symptomatic be examined or abandoned?
• Determine ways of examining hygiene more fully
• Consider model lines of research in voice

23
Does Science Support the Art of Voice Therapy?

• Historically an art form
• Shift to science base in 1990s 2000s.
• Instrumentation
• Societal focus on efficacy research
• Current Tx models have scientific support
• Must ensure transfer of science to clinicians

24
Thomas, L.B., Stemple, J.C. (in press). Voice
therapy Does science support the art?
Communicative Disorders Review.
25
(No Transcript)
26
References

• Bassiouny, S. (1998). Efficacy of the accent
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• Broaddus-Lawrence, P., Treole, K., McCaabe, R.,
  Allen, R., Toppin, L. (2000). The effects of
  preventative vocal hygiene education on the vocal
  hygiene habits and perceptual voice
  characteristics of training singers. Journal of
  Voice, 14, 58-71.
• Casper, J. (2000). Confidential voice. In J. C.
  Stemple (Ed.), Voice therapy Clinical studies
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  Publishing.
• Chan, R. W. K. (1994). Does the voice improve
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• Chen, S. H., Huang, J., Chang, W. (2003). The
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  Pacific Journal of Speech, Language and Hearing,
  8, 200-203.

27
References

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28
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29
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30
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31
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32
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