Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, Boston.
MGH Institute of Health Professions, Boston, MA.
Am J Speech Lang Pathol. 2024 Mar 7;33(2):814-830. doi: 10.1044/2023_AJSLP-23-00283. Epub 2023 Dec 19.
Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice.
Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification.
All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient's capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice.
The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research-practice gap.
康复干预描述通常没有明确识别活性成分，或者这些成分如何导致患者功能的变化。康复治疗规范系统（RTSS）提供了识别任何康复治疗的关键方面的指导，并支持在语音治疗中制定标准命名的成分和目标（语音治疗康复治疗规范系统[RTSS-Voice]）。本研究旨在测试 RTSS-Voice 的内容效度，并确定 RTSS-Voice 是否可用于识别日常临床实践中不同临床医生治疗的异同（标准效度）。
来自不同机构的五名言语-语言病理学家为 59 名被诊断患有语音或上气道障碍的患者录制了一次治疗课程的视频。为每个视频创建了规范，并与治疗临床医生和两名 RTSS 专家一起进行了迭代修订，直到每个规范都达成共识。
没有添加任何目标或成分就指定了所有 59 个疗程。有两个常见的目标：（a）增加意愿和（b）减少紧张的语音质量。有三个常见的成分：（a）有关患者执行治疗行为的能力和动机的信息，（b）结果反馈知识，以及（c）改善共鸣和平均气流的发声机会。在治疗声带亢进的过程中，不同临床医生在引入治疗成分的类型和数量、提供的反馈类型以及在自发言语和负性练习中的发声练习方面存在很大差异。
RTSS 和 RTSS-Voice 具有很强的内容效度，因为它们全面描述了 59 次治疗课程。它们还具有很强的标准效度，因为在多个临床医生的日常语音治疗中，识别出了声带亢进的共同点和差异。将 RTSS 原则和 RTSS-Voice 术语转化为临床文档的未来工作可以帮助了解临床医生和患者的变异性如何影响结果，并弥合研究-实践差距。
