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17-04-2013 | Speech-language pathology | Article

Patient perception can interfere with voice therapy adherence


Free abstract

medwireNews: Poor adherence to voice therapy for dysphonia is related to motivation or a lack of readiness for behavioral change, finds a study in the Journal of Voice.

"Behavioral issues may be the primary etiologic factor underlying voice disorders," write Leticia Duarte de Almeida (Federal University of Minas Gerais, Belo Horizonte, Brazil) and colleagues.

The researchers conducted a retrospective, observational, and analytical survey of medical records belonging to 176 dysphonic teachers, who were a mean age of 40 years.

The patients were split according to treatment adherence. The "discharge" group included 114 (64.8%) patients who did not complain of vocal fatigue and whose vocal quality was properly adapted to the anatomical and functional conditions of the larynx. The 62 (35.2%) patients making up the "abandonment" group had three consecutive unexcused absences or self-mediated treatment discontinuance.

The groups did not significantly differ in age or number of therapy sessions attended.

The patients' dysphonia was either functional (n = 66, 37.5%) or organic (n = 110, 62.5%), with the latter representing a significant two-third majority of the "abandonment" group.

According to the Vocal Activity and Protocol Profile (VAPP) voice assessment, vocal self-perception, effects at work, effects on daily communication, effects on emotion, and the total score parameters were significantly higher in the abandonment group. Social communication was the only category that did not significantly differ between the groups.

Overall, the abandonment group reported a greater negative impact on the voice-related quality of life (VRQOL) score than the discharge group.

"The intense and excessive vocal demands combined with unfavorable working conditions leads to abusive vocal behaviors and increased risk for dysphonia," write the authors, noting that patients with organic dysphonia require lengthier therapy.

The authors considered patients' motivation for voice therapy as well as their relationship with the therapist as factors that likely affect the incidence of treatment absences in the abandonment group.

Self-perception was another adherence factor noted in the study, with authors finding a more negative view among teachers in the abandonment group. "Individuals with more positive self-perception of VRQOL have more strategies to deal with dysphonia and, therefore, are able to develop improved vocal health related to adherence to voice therapy," they write.

"VAPP is a useful tool to measure patient readiness to adhere to treatment," conclude the authors. "Motivational interviewing is a clinical approach that may facilitate improved adherence."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Peter Sergo, medwireNews Reporter

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