Harvard Medical School, Boston, MA.
Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston.
Am J Speech Lang Pathol. 2021 Sep 23;30(5):2169-2201. doi: 10.1044/2021_AJSLP-21-00076. Epub 2021 Aug 31.
Purpose Clinical trials have demonstrated that standardized voice treatment programs are effective for some patients, but identifying the unique individual treatment ingredients specifically responsible for observed improvements remains elusive. To address this problem, the authors used a taxonomy of voice therapy, the Rehabilitation Treatment Specification System (RTSS), and a Delphi process to develop the RTSS-Voice (expert consensus categories of measurable and unique voice treatment ingredients and targets). Method Initial targets and ingredients were derived from a taxonomy of voice therapy. Through six Delphi Rounds, 10 vocal rehabilitation experts rated the measurability and uniqueness of individual treatment targets and ingredients. After each round, revisions (guided by the experts' feedback) were finalized among a primary reader (a voice therapy expert) and two external readers (rehabilitation experts outside the field of voice). Consensus was established when the label and definition of an ingredient or target reached a supramajority threshold (≥ 8 of 10 expert agreement). Results Thirty-five target and 19 ingredient categories were agreed to be measurable, unique, and accurate reflections of the rules and terminology of the RTSS. Operational definitions for each category included differences in the way ingredients are delivered and the way individual targets are modified by those ingredients. Conclusions The consensus labels and operationalized ingredients and targets making up the RTSS-Voice have potential to improve voice therapy research, practice, and education/training. The methods used to develop these lists may be useful for other speech, language, and hearing treatment specifications. Supplemental Material https://doi.org/10.23641/asha.15243357.
目的 临床试验已经证明，标准化的语音治疗方案对某些患者有效，但确定哪些独特的个体治疗成分是导致观察到的改善的原因仍然难以捉摸。为了解决这个问题，作者使用了语音治疗分类法、康复治疗规范系统（RTSS）和 Delphi 过程来开发 RTSS-Voice（可衡量和独特的语音治疗成分和目标的专家共识类别）。
方法 初始目标和成分源自语音治疗分类法。通过六轮 Delphi 研究，10 名声乐康复专家对个别治疗目标和成分的可衡量性和独特性进行了评分。在每一轮之后，由主要读者（语音治疗专家）和两名外部读者（语音领域之外的康复专家）根据专家的反馈对修订内容进行定稿。当成分或目标的标签和定义达到超多数阈值（≥ 10 名专家中的 8 名同意）时，即可达成共识。
结果 35 个目标和 19 个成分类别被认为是可衡量的、独特的，并且准确反映了 RTSS 的规则和术语。每个类别的操作定义包括成分传递方式的差异，以及这些成分对个别目标的修改方式的差异。
结论 构成 RTSS-Voice 的共识标签和可操作的成分和目标有可能改善语音治疗的研究、实践和教育/培训。用于开发这些清单的方法可能对其他言语、语言和听力治疗规范有用。
