The effectiveness of voice therapy on voice‐related handicap: A network meta‐analysis

Abstract

Background Treatment approaches for voice therapy are diverse, yet their differential effects are not well understood. Evaluations of treatment effects across approaches are important for clinical guidance and evidence‐based practice. Objective of review To quantify the evidence of treatment effectiveness on the outcome measure Voice Handicap Index with the 30‐items (VHI‐30) from existing randomised controlled/clinical trials (RCT) of voice therapy using the statistical approach of a network meta‐analysis (NMA) with a random effects model. Type of review Meta‐analysis. Search strategy We searched in MEDLINE (PubMed, 1950 to 2019), Embase (1974 to 2019) and Science Citation Index (1994 to 2019) using five key terms. The inclusion criteria were reports of randomised controlled/clinical trials (RCTs) published in English or German which evaluated the effectiveness of a specific voice therapy treatment using VHI‐30 as an outcome measure in adult participants with non‐organic or organic voice disorders. Studies were excluded if participants had been diagnosed with neurological motor speech disorders or who were vocally healthy. Furthermore, no medical, pharmacological or instrumental (eg voice amplification) treatments were considered. Evaluation method The primary outcome variable was VHI‐30 with a score from 0 to 120. The pre‐post treatment change in VHI‐30 scores was an average score of 13 points related to various VHI‐30 test‐retest results. Results We retrieved 464 publications (ie with duplicates) and included 13 RCTs, which evaluated nine interventions, in the final analysis. The most effective intervention with a significant and clinically relevant effect was Stretch‐and‐Flow Phonation (SFP) (mean pre‐post difference −28.37, 95% confidence interval [CI], −43.05 to‐13.68). Resonant Voice (RV), the Comprehensive Voice Rehabilitation Program (CVRP) and Vocal Function Exercises (VFE) also demonstrated significant improvements. Conclusions Of the nine voice interventions identified with the present NMA, SFP, RVT, CVRP, and VFE effectively improved VHI‐30 scores from pre‐ to post‐treatment. SFP proved to be the most significant and clinically relevant treatment. Further contributions of high‐quality intervention studies are needed to support evidence‐based practice in vocology.

A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies?

“…Within the Carryover group the alpharatio of text reading decreased 1.3 dB (t = 2.722, df = 26, P = 0.011, d = 0.52, 95 % CI [0.31, 2.24]) and the f 0 of spontaneous speech increased 8 Hz (t = -2.400, df = 26, P = 0.024, d = -4.6, 95 % CI [-1.24, -2.4]) compared to the values measured in the initial and post-therapy assessments. At six-month follow-up the Carryover group's mean SPL 56,13,36]) lower than at the beginning of the therapy. There were no significant changes within the Trad group's follow-up assessments compared to the initial situation.…”

“…We can therefore talk about a short period of voice therapy, 35 which has been reported to be widely used. 35,36 To obtain realistic data on the voice quality and the generalization process (i.e., testing how well a participant had acquired a new voice use habit) without the immediate effect of the voice therapy practice, the post-therapy assessments were conducted around a week after the last therapy session. In addition, the teachers came to the assessments directly from their teaching work without any guided voice exercises.…”

Effektivität der Novafon Local Vibration Voice Therapy & Water Resistance Therapy: eine Meta-Analyse

“…Die aktuelle Meta-Analyse ist eine Erweiterung des Kenntnisstandes einer vorherigen Netzwerk-Meta-Analyse von Barsties v. Latoszek et al [11]. Diese Studie zeigte, dass eine Anzahl von 4 effektiven Interventionen aus einem Pool von 8 stimmtherapeutischen Ansätzen für Patientinnen und Patienten mit überwiegend nichtorganischer Dysphonie, auch basierend auf dem VHI, reduziert.…”

“…Im direkten Vergleich erreichten die Methoden von "Stretch-and-Flow-Phonation", "Resonanztherapie", "Comprehensive Voice Rehabilitation Program" und "Vocal Function Exercises" die höchste nachweisbare Wirkung. Obwohl WRT in der Studie von Barsties v. Latoszek et al [11] im Verhältnis zu anderen Therapien eine geringe Wirkung verzeichnete, zeigte die aktuelle Meta-Analyse, dass eine signifikante und wirksame Verbesserung in allen Aspekten des VHI möglich ist. Zwei der 3 Studien von Barsties v. Latoszek et al [11] konnten in die aktuelle Meta-Analyse nicht berücksichtigt werden, da diese Studien keine genauen Angaben zu allen Aspekten des VHI beschrieben oder statistisch ausgewertet haben.…”

“…Zu den Behandlungsmöglichkeiten von Dysphonien gehören die Stimmtherapie [8,9,10,11], die phonochirurgischen [12] und pharmakologischen [13] Behandlungen. Die vorliegende Arbeit konzentriert sich auf Studien, welche die Wirksamkeit der Stimmtherapie als primären Behandlungsansatz untersuchen.…”