Учебники / Evaluating Voice Therapy - Measuring the Effectiveness of Treatment Carding 2000

Evaluating Voice Therapy:

Measuring the Effectiveness

of Treatment

Paul Carding

Whurr Publishers

© 2000 Whurr Publishers First published 2000 by Whurr Publishers Ltd

19b Compton Terrace, London N1 2UN, England, and

325 Chestnut Street, Philadelphia PA 19106, USA

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Whurr Publishers Limited.

This publication is sold subject to the conditions that it shall not, by way of trade or otherwise, be lent, resold, hired out, or otherwise circulated without the Publisher’s prior consent, in any form of binding or cover other than that in which it is published, and without a similar condition including this condition being imposed upon any subsequent purchaser.

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library.

ISBN 1 86156 162 8

Printed and bound in the UK by Athenaeum Press Ltd, Gateshead, Tyne & Wear

Contents

v

Foreword

Evaluating Voice Therapy fills a gap in voice literature. Its author, Paul Carding, is the first Senior Lecturer in Speech and Language Pathology in the UK, and is a leading authority on the outcomes of voice therapy. He has a growing international reputation in this field enhanced by the highly successful courses in the Evaluation of Therapy which he organ­ ises regularly at the University of Newcastle upon Tyne’s Freeman Hospital.

Evaluating Voice Therapy is a timely publication given the current and ongoing interest in evidence-based practice. The volume empha­ sises the multidimensional requirements of good voice evaluation and represents a key text in voice outcomes applicable to all dysphonic patients.

Any professional whose interventions may effect voice quality will find this an invaluable source book. It will also provide a useful grounding for undergraduates in voice therapy and laryngology.

It has been my great pleasure to work with Paul Carding for the past five years. This volume is a fitting tribute to his knowledge, energy and vision for the future of voice therapy.

Janet A. Wilson

Professor of Otolaryngology,

Head and Neck Surgery,

University of Newcastle upon Tyne

vi

Acknowledgements

I would like to thank Dr Gerry Docherty and Mrs Irmgarde Horsley of the Department of Speech, University of Newcastle upon Tyne, for their contribution to the research which underpins this book.

vii

Chapter 1

Why do we need evidence of treatment effectiveness?

As speech and language therapists, we know surprisingly little about whether or not our treatments work. Most of our therapeutic techniques have not been properly evaluated. We have a professional responsibility to establish evidence of treatment effectiveness and, if we do not do this, then others will do it for us (Kluppel-Vetter, 1985). Past experience has shown that this may result in misguided, unrepresentative and harmful research evidence (Frattali, 1998). We need to be proactive in designing studies of treatment effectiveness that are scientifically robust and clini­ cally valid.

There are clinical, financial and patient-centred reasons why we need evidence of the effectiveness of treatment.

Clinical reasons

Clinically, we aim to provide the most appropriate treatment to accom­ plish the best outcome for our patients. To achieve this, the clinician must constantly evaluate his or her own practice and constantly evaluate alter­ native practice. Clinicians who systematically investigate the nature, qual­ ity and outcomes of their treatments are likely to provide high-quality clinical practice.

A clinician who constantly evaluates other intervention options is likely to provide a comprehensive, knowledgeable and eclectic approach to treatment. The clinician is able to compare and contrast treatment programmes with the aim of achieving the best possible outcome for the patient.

Financial reasons

Financially, the profession needs evidence of providing ‘value for money’. In an ever-worsening situation of increased demand for limited resources, health-care purchasers have to rationalise their decisions. They wish to

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