Zambon Fabiana, Moreti Felipe, Behlau Mara
Department of Speech-Language Pathology and Audiology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil; Sao Paulo Teachers Union - Sindicato dos Professores de São Paulo - SINPRO/SP, São Paulo, Brazil.
Department of Speech-Language Pathology and Audiology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.
J Voice. 2014 May;28(3):341-8. doi: 10.1016/j.jvoice.2013.11.008. Epub 2014 Feb 1.
OBJECTIVES: To understand the coping strategies used by teachers with vocal complaints, compare the differences between those who seek and those who do not seek voice therapy, and investigate the relationships among coping and voice perceptual analysis, coping and signs and symptoms of voice, and coping and participation restrictions and limitations in vocal activities. STUDY DESIGN: Cross-sectional nonrandomized prospective study with control group. METHODS: Ninety female teachers participated in the study, of similar ages, divided into three groups: group 1 (G1) comprised 30 teachers with vocal complaints who sought voice therapy, group 2 (G2) comprised 30 teachers with vocal complaints who never sought voice therapy, and group 3 (G3) comprised 30 teachers without vocal complaints. The following analysis were conducted: identification and characterization questionnaire, addressing personal and occupational description, recording speech material for voice perceptual analysis, Voice Signs and Symptoms Questionnaire, Voice Activity and Participation Profile (VAPP), and Voice Disability Coping Questionnaire (VDCQ)-Brazilian Version. RESULTS: In relation to the voice perceptual analysis, there was statistically significant difference between the groups with vocal complaint (G1+G2), which had showed voices with mild-to-moderate deviation, and the group without vocal complaint (G1), which showed voices within the normal variability of voice quality (mean for G1 = 49.9, G2 = 43.7, and G3 = 32.3, P < 0.001). G1 had higher mean of voice signs and symptoms (G1 = 8.6, G2 = 6.6, and G3 = 2.0, P < 0.001) and higher scores in almost all dimensions of VAPP (P < 0.001), except for the aspects effect on job and effect on social communication. Individuals with vocal complaints who looked for voice therapy (G1) tended to use more problem-focused strategies and had higher scores in VDCQ (G1 = 45.4, G2 = 38.5, and G3 = 9.5, P < 0.001). The aspects that were correlated with VDCQ in the three groups were degree of vocal deviation, VAPP total score, VAPP partial scores of self-perceived severity of voice problem, effect on daily communication, effect on emotion, and participation restriction for G1; VAPP total score and partial score of effect on daily communication for G2; and all VAPP scores for G3. No correlation was found between voice signs and symptoms and coping. CONCLUSION: Teachers with vocal complaints who looked for voice therapy use more coping strategies. Moreover, they present a tendency to use more problem-focused coping strategies. Voice symptoms prompt the teachers into seeking treatment; however, they are not correlated with the coping itself. In general, the higher the perception of limitation and restriction of participating in vocal activities, the greater the use of coping strategies.
目的:了解有嗓音问题的教师所采用的应对策略,比较寻求嗓音治疗和未寻求嗓音治疗的教师之间的差异,并调查应对方式与嗓音感知分析、应对方式与嗓音体征和症状,以及应对方式与嗓音活动参与限制之间的关系。 研究设计:设有对照组的横断面非随机前瞻性研究。 方法:90名年龄相仿的女性教师参与了该研究,分为三组:第1组(G1)由30名有嗓音问题且寻求嗓音治疗的教师组成,第2组(G2)由30名有嗓音问题但从未寻求嗓音治疗的教师组成,第3组(G3)由30名无嗓音问题的教师组成。进行了以下分析:识别与特征问卷,涉及个人和职业描述;录制语音材料进行嗓音感知分析;嗓音体征和症状问卷;嗓音活动与参与概况(VAPP);以及巴西版嗓音残疾应对问卷(VDCQ)。 结果:在嗓音感知分析方面,有嗓音问题的组(G1 + G2)嗓音表现为轻度至中度偏差,与无嗓音问题的组(G3)存在统计学显著差异,无嗓音问题的组嗓音质量在正常变异范围内(G1均值 = 49.9,G2 = 43.7,G3 = 32.3,P < 0.001)。G1组的嗓音体征和症状均值更高(G1 = 8.6,G2 = 6.6,G3 = 2.0,P < 0.001),并且在VAPP几乎所有维度上得分更高(P < 0.001),除了对工作的影响和对社交沟通的影响方面。寻求嗓音治疗的有嗓音问题的个体(G1)倾向于使用更多以问题为导向的策略,并且在VDCQ中得分更高(G1 = 45.4,G2 = 38.5,G3 = 9.5,P < 0.001)。三组中与VDCQ相关的方面,对于G1组是嗓音偏差程度、VAPP总分、自我感知嗓音问题严重程度的VAPP部分得分、对日常沟通的影响、对情绪的影响以及参与限制;对于G2组是VAPP总分和对日常沟通影响的部分得分;对于G3组是所有VAPP得分。未发现嗓音体征和症状与应对方式之间存在相关性。 结论:寻求嗓音治疗的有嗓音问题的教师使用更多应对策略。此外,他们倾向于使用更多以问题为导向的应对策略。嗓音症状促使教师寻求治疗;然而,它们与应对方式本身并无关联。总体而言,对参与嗓音活动的限制和受限的感知越高,应对策略的使用就越多。
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