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

Page numbers in italic refer to tables

A–B–A study design 11

abuse, of voice, see voice abuse accent method 19, 20, 21, 31, 33–4 acoustic analysis of speech waveform

40, 40–1, 41, 43, 110–11 connected speech 109–10

in effectiveness study 72–4, 80–3, 83–4

measuring 57–62 reliability 44

acoustic measurement techniques 107–8

inter-subject variability 110 variations across systems 110

aerodynamic measurements 40 amplitude perturbation (shimmer) 41

amplitude perturbation quotient (APQ) 111

in effectiveness study 73–4, 81–3, 84,

95 measuring 61–2

variations across measurement systems 110

AUDED (Audio Editor) speech waveform analysis system 72–3

audit, clinical 4–5

auditory perceptual measurements, see perceptual rating of voice quality

auditory training 31

auditory voice quality ratings, in effec­ tiveness study 69–70, 76–7, 90

breathing

coordination with phonation 31 diaphragmatic 31

case-controlled retrospective studies 10 chewing technique 31

clinical audit 4–5

clinical judgement, v. experimental control 7

clinical practice, and research 6–7 clinical significance 37, 42, 45

clinician, qualities and personality of 97, 99–100

clinician-patient relationship 97, 99–100 cohort studies, prospective 10 computed tomography (CT), scan of

larynx 40

confidential voice therapy 22, 31, 33 confounding 13

controls flawed 13

no-treatment 11, 24–5 counselling 31

non-directive 31 crossover study design 11

data

interpretation and analysis 15–16 quantitative v. qualitative 14–15

dazzle phenomenon 16 diaphragmatic breathing 31 diaries, voice diaries 31 disability, WHO definition 103

dysphonia causes 27–8

laryngeal diagnosis 28 non-organic, see non-organic

dysphonia terminology 28–30 voice quality 28

voice therapy techniques 31

effectiveness, see treatment effectiveness efficacy, see treatment efficacy efficiency, see treatment efficiency electroglottography, see laryngography electrolaryngography, see laryngography electromyographic (EMG) biofeedback

voice therapy 19, 21, 33, 41 endoscopy 52–3

environmental awareness 31 evidence-based practice 5–6

classification of strength of evidence 5, 5–6

lack of 4

systematic reviews 6

experimental control, v. clinical judge­ ment 7

experimental studies 10 explanation 31

false-positive response 35 fibreoptic laryngoscopy 43, 52–4

in effectiveness study 70 fibreoptic nasendoscopy 41, 52 frequency perturbation (jitter) 41

in effectiveness study 73–4, 81–3, 84,

94 measuring 60–1 reliability 45

variations across measurement systems 110

functional dysphonia 29, 29 functional voice disorder 29, 29 fundamental frequency (Fo) measure­

ments 40, 41

see also mean speaking fundamental frequency

glottal attack, see hard glottal attack glottal inverse filtering 58

glottal source waveform 57–8

glottography 41

GRBAS rating scale 49–50

group (multi-subject) studies 10–11, 11–12

advantages 11 disadvantages 12 no-treatment controls 11

prospective, see prospective group studies

treatment v. no-treatment 21–3

handicap, WHO definition 103 hard glottal attack, elimination 31 harmonics-to-noise (H/N) ratio 41,

59–60

health-care budgets, and evidence-based practice 5

hierarchy analysis 31 hunches, clinical 3

hygiene, vocal hygiene programmes 31 hyperfunctional dysphonia 28–9, 29, 30,

34

hyperfunctional voice 29, 30 hypnosis 32

hypotheses, flaws in 12

independent variables 13–14, 27–38 subject/patient characteristics 27–30

indirect laryngoscopy 43, 52–4 in effectiveness study 70, 77–8

integrity, of treatment 14 intensity (SPL) measurements 40 irritant avoidance 31

jitter (frequency perturbation) 41, 60–1 in effectiveness study 73–4, 81–3, 84,

94 measuring 60–1 reliability 45

variations across measurement systems 110

judges, of voice quality 51–2 in effectiveness study 69–70

intraand inter-judge reliability 48, 51, 52, 70

training 51–2

Kruskal-Wallis one-way analysis of variance 74–5

laryngeal musculoskeletal tension 22 manual reduction technique/manipu-

lation 19, 31, 33 laryngeal relaxation 31 laryngeal tone, establishing and

maintaining 31 laryngography 41, 43, 54–6

in effectiveness study 71, 78, 91 reliability 44

laryngoscopy 41, 43, 52–4

in effectiveness study 70, 77–8

lack of uniformity in terminology and diagnosis 106–7

long time average spectra (LTAS) 109 loudness reduction 31

magnetic resonance imaging (MRI), scan of larynx 40

Mann-Whitney test 75

mean speaking fundamental frequency (MSFo) 43

in effectiveness study 71, 78–80, 92 measuring 56–7

reliability 44

measurement techniques 39–41, 46–62 categories 40

correlation between, in effectiveness study 83–4

limited role 106–7 ‘objective’ v. subjective 43–6 selection criteria 42–3 studies of 40–1, 41

see also individual measurement techniques

mechanical dysphonia 29, 30 misuse, of voice, see voice misuse motivation 103–4

multi-subject (group) studies 10–11, 11–12

advantages 11 disadvantages 12 no-treatment controls 11

prospective, see prospective group studies

treatment v. no-treatment 21–3 multiple baseline study design 11

nasendoscopy 41, 52

no-treatment controls 11, 21–3, 24–5

ethical issues 24–5 noise

harmonics-to-noise (H/N) ratio 41, 59–60

spectrographic 41, 58–60

see also signal-to-noise (S/N) ratio non-experimental studies 10 non-organic dysphonia

alternative terminology 28–30 definition 63

direct treatment techniques 64–5 indirect treatment techniques 64 study design problems 23–5

study of voice therapy effectiveness, see non-organic dysphonia, clinical study of voice therapy effectiveness

treatment 63–5

non-organic dysphonia, clinical study of voice therapy effectiveness 22–3, 63–95

acoustic analysis of speech waveform 72–4, 80–3, 83–4

amplitude perturbation (shimmer) 73–4, 81–3, 84, 95

auditory voice quality ratings 69–70, 76–7, 90

data analysis 74–5

frequency perturbation (jitter) 73–4, 81–3, 84, 94

jitter (frequency perturbation) 73–4, 81–3, 84, 94

judges 69–70 laryngography 71, 78, 91 laryngoscopy 70, 77–8 mean speaking fundamental

frequency (MSFo) 71, 78–80, 92 measurement techniques, correlation

between 83–4 method 66–75

outcome measurements 69–74 patient questionnaire 69, 75–6, 83,

87–8, 89 results 75–84

severity ratings 69, 76–7, 83, 84, 90 shimmer (amplitude perturbation)

73–4, 81–3, 84, 95 signal-to-noise (S/N) ratio 73, 80–1,

84, 84, 93

study design 67–9

subjects, inclusion criteria 66–7 telephone/review contact after treat­

ment 83

therapy programme delivery 74 treatment aims and efficacy criteria

65–6

treatment efficacy evidence 84–6 treatment groups 67, 68 unanalysable voice samples 73, 108 unsuccessful patients 84

outcome measures 104–11 acoustic analysis 107–8 acute v. chronic disease 3 choice of 39

multi-dimensional measurement 104–5

patient questionnaires 106 reliability of voice quality judgement

105–6

voice change over time 106–7 see also measurement techniques

outcomes confounded 13

relationship with treatment 9

paperwork, v. patient care 3 patient care, v. paperwork 3 patient characteristics 13–14, 27–30

and clinical effectiveness 99, 102–3 patient comfort, measurement

techniques and 42 patient education 31 patient motivation 103–4 patient power 2

patient questionnaires 43, 47–8, 106 in effectiveness study 69, 75–6, 83,

87–8, 89 response formats 48

patients

interand intra-subject reliability 46 opinions of treatment benefits 46–8 self-assessment scales 46–7

perceptual rating of voice quality 40, 41, 41, 43

in effectiveness study 69–70, 76–7, 90 parameters 49–50

patient’s opinion 46–8

rating scales 41, 48–52 reliability 44–5

see also judges perturbation

amplitude perturbation quotient (APQ) 111

pitch perturbation quotient (PPQ) 111

variations across measurement systems 110

see also amplitude perturbation; frequency perturbation

phonation, coordination with breathing

31

phonatory control, optimal 31 phonatory effort 47 phonetograms 36, 41, 43, 56–7

physiological measurements 40, 41, 41 pitch, establishment of optimal 31 pitch perturbation quotient (PPQ) 111 pitch variation and control 31

placebo treatment, difficulties with 99, 100

prospective cohort studies 10 prospective group studies 18–23, 32

single group 18–20 treatment comparison 20–1

treatment v. no-treatment 21–3 psychogenic dysphonia 29

pushing exercises, for glottal incompe­ tence 19, 31, 33

qualitative v. quantitative data 14–15, 23 quality dimensions 2

quantitative v. qualitative data 14–15, 23 quasi-experimental studies 10 questionnaires 43, 47–8, 106

in effectiveness study 69, 75–6, 83, 87–8, 89

response formats 48

radiography, of larynx 40 randomised controlled trials 6, 10, 11

group studies 12, 97

rating scales, perceptual 41, 48–52 reassurance 31

reduction technique, laryngeal muscu­ loskeletal tension 19, 31, 33

relaxation therapy 18–19, 21, 34

general 31 laryngeal 31

reliability, in voice measurement 44–5 research

and clinical practice 6–7 efficacy v. effectiveness 98 resonance, developing optimal 31 resonant voice therapy 22, 31, 33

retrospective studies 17–18 case-controlled 10

review/telephone contact after treat­ ment 43

in effectiveness study 83

samples small 15

unrepresentative 13 self-hypnosis 32 severity ratings 50

in effectiveness study 69, 76–7, 83, 84, 90

SF-36 questionnaire 47

shimmer (amplitude perturbation) 41 amplitude perturbation quotient

(APQ) 111

in effectiveness study 73–4, 81–3, 84,

95 measuring 61–2

variations across measurement systems 110

signal-to-noise (S/N) ratio 41, 60

in effectiveness study 73, 80–1, 84, 84, 93

significance

clinical 37, 42, 45 statistical 15, 36

single-case studies 10–11, 16–17, 32 advantages/disadvantages 11 design types 11

single-group studies 18–20 single-subject studies 16–17

sound pressure level (SPL) measure­ ments 40

spectrographic classification system 36 spectrographic noise 41, 58–60 statistical analysis 15–16, 23

statistical evidence 23 statistical significance 15, 36 strength, of treatment 14 stroboscopy 41, 43, 53, 54

study design A–B–A design 11

basic methodologies 9–10 case-controlled retrospective studies

10

cohort studies, prospective 10 crossover studies 11

data interpretation and analysis 15–16

dependent variables 14–15 experimental 10

flaws in 12–13

group (multi-subject) design 10–11, 11–12, 18–23

importance of 9–25

independent variables, see indepen­ dent variables

multi-subject (group) design 10–11, 11–12, 18–23

multiple baseline study 11 non-experimental 10 problems 23–5

prospective group studies 18–23 quantitative v. qualitative data 14–15,

23 quasi-experimental 10

randomised controlled trials 6, 10, 11, 12, 97

retrospective studies 10, 17–18 single-case, see single-case studies single-group studies 18–20 single-subject studies 16–17 statistical evidence 23

suggested approach 25

treatment comparison studies 20–1 treatment v. no-treatment group

design 21–3

study methodology, see study design study types, misleading classification 12 subject characteristics, see patient

characteristics systematic reviews 6

telephone contact/review after treat­ ment 43

in effectiveness study 83 terminology

for dysphonia in the absence of organic pathology 28–30

need for accurate definition 27