Department of Rehabilitation Medicine, University of Washington, Seattle.
Am J Speech Lang Pathol. 2021 Jun 18;30(3S):1301-1313. doi: 10.1044/2020_AJSLP-20-00100. Epub 2021 Mar 3.
Purpose The purpose of this study was to explore the extent to which communicative participation differs across diagnoses and if there are common predictor variables for communicative participation across diagnoses. Method Survey data on self-report variables including communicative participation were collected from 141 community-dwelling adults with communication disorders due to Parkinson's disease, cerebrovascular accident, spasmodic dysphonia, or vocal fold immobility (VFI). Analysis of covariance was used to determine communicative participation differences between diagnoses, with age, sex, and hearing status as covariates. Sequential entry linear regression was used to examine associations between communicative participation and variables representing a range of psychosocial constructs across diagnoses. Results The VFI group had the least favorable communicative participation differing significantly from Parkinson's disease and spasmodic dysphonia groups. Self-rated speech/voice severity, self-rated effort, mental health, perceived social support, and resilience contributed to variance in communicative participation when pooled across diagnoses. The relationship between communicative participation and the variables of effort and resilience differed significantly when diagnosis was considered. Conclusions The findings suggest that communicative participation restrictions may vary across some diagnoses but not others. People with VFI appear to differ from other diagnosis groups in the extent of participation restrictions. Effort and resilience may play different roles in contributing to communicative participation in different disorders, but constructs such as social support, severity, and mental health appear to have consistent relationships with communicative participation across diagnoses. The findings can help clinicians identify psychosocial factors beyond the impairment that impact clients' communication in daily situations.
目的 本研究旨在探讨沟通参与度在不同诊断之间的差异程度，以及是否存在跨诊断的共同预测变量。
方法 本研究采用问卷调查法收集了 141 名患有帕金森病、脑血管意外、痉挛性发音障碍或声带固定障碍等沟通障碍的社区成年人的自我报告变量，包括沟通参与度。采用协方差分析来确定诊断之间的沟通参与差异，以年龄、性别和听力状况为协变量。采用逐步线性回归分析来检验沟通参与度与跨诊断的一系列心理社会构念变量之间的关联。
结果 VFI 组的沟通参与度最差，与帕金森病和痉挛性发音障碍组有显著差异。跨诊断分析发现，自我报告的言语/嗓音严重程度、自我报告的努力程度、心理健康、感知社会支持和韧性对沟通参与度的变异有贡献。当考虑诊断时，沟通参与度与努力和韧性的关系存在显著差异。
结论 研究结果表明，沟通参与度的限制可能因某些诊断而异，而其他诊断则可能不会。与其他诊断组相比，VFI 患者的参与限制程度可能不同。努力和韧性可能在不同障碍中对沟通参与度的贡献作用不同，但社会支持、严重程度和心理健康等构念似乎与跨诊断的沟通参与度有一致的关系。这些发现可以帮助临床医生识别出除了损伤之外，影响患者在日常生活中沟通的心理社会因素。
