Rehabilitation Treatment Specification System: Methodology to Identify and Describe Unique Targets and Ingredients

Stan, Jarrad H. Van; Whyte, John; Duffy, Joseph R.; Barkmeier-Kraemer, Julie; Doyle, Patricia; Gherson, Shirley; Kelchner, Lisa; Muise, Jason; Petty, Brian; Roy, Nelson; Stemple, Joseph C.; Thibeault, Susan L.; Tolejano, Carol Jorgensen

doi:10.1016/j.apmr.2020.09.383

Cited by 47 publications

(44 citation statements)

References 43 publications

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“…A detailed discussion of the rationale, limitations, and advantages of the method used here is beyond the scope of this article. Such details can be found elsewhere (Van Stan et al, 2020).…”

Section: Methodsmentioning

confidence: 99%

“…However, until recently, the RTSS had not explicitly operationalized the concepts of unique and redundant. Therefore, we developed a methodology that formally describes when concepts can be considered unique or redundant (Van Stan et al, 2020). The primary purpose of this study was to use that methodology to produce a comprehensive list of voice treatment ingredients and targets (content validity) that adhere to the RTSS framework (construct validity) and has supramajority (≥ 80% agreement) expert consensus (face validity).…”

Section: Creating Standard Ingredient and Target Labelsmentioning

confidence: 99%

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Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets

Stan

Whyte

Duffy

et al. 2021

Am J Speech Lang Pathol

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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

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Section: Methodsmentioning

confidence: 99%

Section: Creating Standard Ingredient and Target Labelsmentioning

confidence: 99%

Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets

Stan

Whyte

Duffy

et al. 2021

Am J Speech Lang Pathol

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“…Nevertheless, behaviours that generate a therapeutic effect can be difficult to identify in behavioural therapies due to a number of challenges. These include the lack of clarity surrounding rehabilitation ingredients, the fact that rehabilitation treatments often attempt to change multiple interacting patient functions, and a lack of standard nomenclature and definitions for specific treatment ingredients [18]. The treatment of voice disorders is one area in which significant efforts are being made to identify active ingredients in detail.…”

Section: What Is An Active Ingredient In Voice Therapy?mentioning

confidence: 99%

“…This model proposes that treatment components may be classified into direct interventions (subdivided into auditory, somatosensory, musculoskeletal, respiratory, and vocal function), intervention delivery models (extrinsic and intrinsic), and indirect interventions (pedagogy and counselling) with more specific interventions listed under each sub-category [14]. The Rehabilitation Specification System (RTSS) [18] describes a simpler theoretical framework and proposed methodology by which treatments can be described according to a singular treatment target (the patient function that is to be changed by the ingredient(s)); one or more ingredients (what the clinician does to modify the target); and the mechanism(s) of action of the treatment [16]. Both the Taxonomy of Voice Therapy and the broader RTSS provide complex and detailed theoretical models that can inform our understanding; however, these models defining active ingredients are yet to be tested in clinic-based research.…”

Section: What Is An Active Ingredient In Voice Therapy?mentioning

confidence: 99%

“…The explicit vocal target, use of connected speech contexts with a communicative intent, and practise regimes of SVQ are similar to other voice therapies, e.g., CTT (clear speech), but the physiological mechanism by which it is achieved is extremely different. This suggests that the mechanism of action [18] as a concept could be expanded to include the physiological description of movement as well as the acquisition and learning processes.…”

Section: Effects Of Svq Task Variationmentioning

confidence: 99%

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Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

Madill

Chacon

Kirby

et al. 2021

JCM

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Background: Although voice therapy is the first line treatment for muscle-tension voice disorders (MTVD), no clinical research has investigated the role of specific active ingredients. This study aimed to evaluate the efficacy of active ingredients in the treatment of MTVD. A retrospective review of a clinical voice database was conducted on 68 MTVD patients who were treated using the optimal phonation task (OPT) and sob voice quality (SVQ), as well as two different processes: task variation and negative practice (NP). Mixed-model analysis was performed on auditory–perceptual and acoustic data from voice recordings at baseline and after each technique. Active ingredients were evaluated using effect sizes. Significant overall treatment effects were observed for the treatment program. Effect sizes ranged from 0.34 (post-NP) to 0.387 (post-SVQ) for overall severity ratings. Effect sizes ranged from 0.237 (post-SVQ) to 0.445 (post-NP) for a smoothed cepstral peak prominence measure. The treatment effects did not depend upon the MTVD type (primary or secondary), treating clinicians, nor the number of sessions and days between sessions. Implementation of individual techniques that promote improved voice quality and processes that support learning resulted in improved habitual voice quality. Both voice techniques and processes can be considered as active ingredients in voice therapy.

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Rehabilitation Treatment Specification System: Identifying Barriers, Facilitators, and Strategies for Implementation in Research, Education, and Clinical Care

Stan¹,

Holmes²,

Wengerd³

et al. 2023

Archives of Physical Medicine and Rehabilitation

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Rehabilitation Treatment Specification System: Methodology to Identify and Describe Unique Targets and Ingredients

Cited by 47 publications

References 43 publications

Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets

Voice Therapy According to the Rehabilitation Treatment Specification System: Expert Consensus Ingredients and Targets

Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

Rehabilitation Treatment Specification System: Identifying Barriers, Facilitators, and Strategies for Implementation in Research, Education, and Clinical Care

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