Vocal Hygiene Education, Voice Production Therapy, and the Role of Patient Adherence: A Treatment Effectiveness Study in Women With Phonotrauma Purpose To assess the effectiveness of vocal hygiene education (VHE) and voice production therapy (VP) in altering patient perception of vocal handicap in adult women with benign, bilateral phonotraumatic vocal fold lesions and the role of adherence in that perception. Method Sixty-two women were randomly assigned to 6 ... Research Article
Research Article  |   April 01, 2008
Vocal Hygiene Education, Voice Production Therapy, and the Role of Patient Adherence: A Treatment Effectiveness Study in Women With Phonotrauma
 
Author Affiliations & Notes
  • Alison Behrman
    New York University, New York, NY
  • John Rutledge
    Weill Medical College, New York, NY
  • Amanda Hembree
    Westside Voice and Swallowing, New York, NY
  • Sarah Sheridan
    New York University
  • Contact author: Alison Behrman, who can be reached at alisonbehrman@verizon.net.
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Speech, Voice & Prosody / Speech / Research Articles
Research Article   |   April 01, 2008
Vocal Hygiene Education, Voice Production Therapy, and the Role of Patient Adherence: A Treatment Effectiveness Study in Women With Phonotrauma
Journal of Speech, Language, and Hearing Research, April 2008, Vol. 51, 350-366. doi:10.1044/1092-4388(2008/026)
History: Received November 9, 2006 , Revised March 16, 2007 , Accepted August 27, 2007
 
Journal of Speech, Language, and Hearing Research, April 2008, Vol. 51, 350-366. doi:10.1044/1092-4388(2008/026)
History: Received November 9, 2006; Revised March 16, 2007; Accepted August 27, 2007
Web of Science® Times Cited: 41

Purpose To assess the effectiveness of vocal hygiene education (VHE) and voice production therapy (VP) in altering patient perception of vocal handicap in adult women with benign, bilateral phonotraumatic vocal fold lesions and the role of adherence in that perception.

Method Sixty-two women were randomly assigned to 6 weeks of VP (n = 31) or VHE (n = 31), followed by 4 weeks of self-study. The primary outcome measure was the Voice Handicap Index (VHI) score, assessed at baseline, post-therapy, and post–self-study. Patient adherence was assessed as a cofactor.

Results Both groups achieved a decrease in VHI scores from baseline to completion of the study, although the improvement was significantly greater for the VP group. The treatment effect size was large for the VP group and small for the VHE group. More participants adhered to VP than to VHE. Only adherent participants achieved significant improvement. Only adherent participants in the VP group improved with self-study. More than two thirds of the VP group achieved final VHI scores within normal limits, compared with approximately one third of those in the VHE group.

Conclusions VP therapy may be more effective than VHE in addressing patient perception of vocal handicap in adult women with phonotrauma, and self-study may be an important component of therapy. However, adherence is a critical mediator of outcome.

Acknowledgments
This study was supported by NIDCD Grant R03 DC005550-01A1 to the first author. Yolanda Barron-Vaya of the Division of Biostatistics and Epidemiology in the Department of Public Health of Weill Medical College contributed biostatistical expertise. The first author thanks the members of the White Lake Consensus Conference of May 2001, from which this study arose—in particular, the valuable input of Steven Bielamowicz, Janina Casper, Tom Murry, and Lucian Sulica. All of the study participants are also gratefully acknowledged.
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