Pre‐ and post‐operative voice therapy (PaPOV): Development of an intervention for patients with benign vocal fold lesions

Abstract

Background: Pre-and post-operative voice therapy may improve voice and quality-of-life outcomes for patients undergoing phonosurgery to remove benign vocal fold lesions (BVFLs). However, what constitutes voice therapy in this population is poorly described, resulting in a poor evidence base, lack of clinical guidelines and unwarranted variation in management. In order to develop the evidence base, a robust, iterative process of intervention development work should precede feasibility testing and effectiveness studies.Methods & Procedures: Guidance for developing complex interventions, drawing on evidence, theory and modelling, was used to inform the development of a pre-and post-operative voice therapy intervention entitled 'PaPOV'. Data from four sources of evidence were synthesized using a published triangulation protocol. Data from a systematic review, national survey of current practice, expert interview study, and patient and public involvement conversations were used to populate a triangulation matrix, outlining components of a PaPOV. Data were coded to reflect areas of agreement, dissonance and silence with each component of the intervention. Based on this evidence, an assessment of convergence for each intervention component could be made. Outcomes & Results:In total, 61 components of the PaPOV intervention were explored. Of these, 27 were categorized as having stability of consensus according to a priori criteria. A total of 34 failed to meet the criteria. This was more frequently due to silence (27) rather than dissonance (seven) in the data. By evidencing areas of agreement and stability of consensus across data sources, the validity of individual findings has been enhanced. Furthermore, the study has exposed specific areas of the intervention that lack consensus and require exploration through further intervention development studies.

Pre- and post-operative voice therapy for benign vocal fold lesions: protocol for a non-randomised, multicentre feasibility trial with embedded process evaluation

“…Work has now been completed to identify the potential ingredients in a best practice voice therapy intervention. This has involved the triangulation [ 25 ] of findings from a systematic review [ 26 ], expert interview study [ 17 ], national survey of current practice [ 27 ], a Delphi consensus study [ 28 ], and extensive Patient and Public Involvement and Engagement (PPIE) activities.…”

Protocol for Pre and Post-Operative Voice therapy (PaPOV) for benign vocal fold lesions: Non-randomised, multicentre feasibility trial with nested process evaluation

“…Work has now been completed to identify the potential ingredients in a best practice voice therapy intervention. This has involved the triangulation (24) of ndings from a systematic review (25), expert interview study (17), national survey of current practice(26), a Delphi consensus study (27) and extensive Patient and Public Involvement and Engagement (PPIE) activities.…”