Behrman Alison, Rutledge John, Hembree Amanda, Sheridan Sarah
New York University, New York, NY, USA.
J Speech Lang Hear Res. 2008 Apr;51(2):350-66. doi: 10.1044/1092-4388(2008/026).
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.
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.
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.
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.
评估嗓音卫生教育（VHE）和发声治疗（VP）对患有良性双侧发声性创伤性声带病变的成年女性患者嗓音障碍认知的改变效果，以及依从性在这种认知中的作用。
62名女性被随机分为两组，一组接受为期6周的VP治疗（n = 31），另一组接受为期6周的VHE治疗（n = 31），随后进行4周的自学。主要结局指标是嗓音障碍指数（VHI）评分，在基线、治疗后和自学后进行评估。将患者的依从性作为一个辅助因素进行评估。
两组患者从基线到研究结束时VHI评分均有所下降，不过VP组的改善更为显著。VP组的治疗效应量较大，VHE组的治疗效应量较小。坚持VP治疗的参与者比坚持VHE治疗的参与者更多。只有坚持治疗的参与者取得了显著改善。只有VP组中坚持治疗的参与者在自学过程中有所改善。超过三分之二的VP组患者最终VHI评分在正常范围内，而VHE组约为三分之一。
在解决患有发声创伤的成年女性患者的嗓音障碍认知方面，VP治疗可能比VHE更有效，自学可能是治疗的一个重要组成部分。然而，依从性是治疗效果的关键调节因素。
