Ohlsson Ann-Christine, Dotevall Hans, Gustavsson Inger, Hofling Kerstin, Wahle Ulrika, Österlind Claes
Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Department of Logopedics and Phoniatrics, ENT Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Voice. 2020 Mar;34(2):303.e17-303.e26. doi: 10.1016/j.jvoice.2018.08.023. Epub 2018 Oct 19.
A stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy.
A randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy.
All VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up.
This study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.
语音治疗中的一个障碍是患者如何能够在日常生活中应用新的语音技术。由于在小组环境中患者之间早期交流时存在训练语音到言语的自然场所，所以通过小组语音治疗可能会促进这种泛化过程。本研究的目的是在几个时间点比较个体语音治疗和小组语音治疗的治疗结果，并与未接受语音治疗的患者进行比较。
对77例连续诊断为功能性语音障碍的患者进行了一项随机治疗研究。31例患者分别随机分配至个体治疗组和小组治疗组，15例患者不接受治疗。评估包括标准化语音记录和嗓音音域图（VRP）记录、回答嗓音障碍指数（VHI）以及自我嘶哑和自我嗓音疲劳的视觉模拟量表，以及由言语病理学家进行的感知语音评估。所有组均在治疗前、治疗后立即以及三个月后进行评估。两个治疗组在治疗12个月后也进行了评估。
治疗3个月后及12个月随访时，两个治疗组的所有VHI评分以及嘶哑和嗓音疲劳的自我评分、嗓音质量的感知评估和最大VRP均有显著改善。对照组除自我评定的嘶哑程度降低和最大VRP增加外，无显著变化。治疗组之间的比较显示，12个月时小组治疗后VHI身体亚量表有显著更大的改善，以及在所有测量阶段VHI总分显著更低，12个月时亚量表评分更低。治疗组在自我嘶哑或自我嗓音疲劳方面无差异，在感知嗓音质量或VRP方面也无差异。对照组与治疗组之间的比较显示，治疗组从基线到三个月时VHI总分以及到治疗结束时功能亚量表有显著更大的变化。在三个月随访时，治疗组在VHI总分和身体亚量表方面的得分也显著低于对照组，以及嗓音质量和嗓音疲劳的感知偏差程度更低。
本研究表明行为语音治疗具有长期改善效果，尤其是在小组环境中。结果表明早期向言语转换和后期治疗后测试对于确定语音治疗目标是否实现对患者的重要性。
