Amanda Heller-Stark, Lynn Maxfield, Jennifer Herrick, Marshall Smith, Ingo Titze
{"title":"两种半闭塞声道治疗方案的比较研究：随机临床试验","authors":"Amanda Heller-Stark, Lynn Maxfield, Jennifer Herrick, Marshall Smith, Ingo Titze","doi":"10.1044/2024_JSLHR-22-00456","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings.</p><p><strong>Method: </strong>Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (<i>n</i> = 14), 8-week FRT (<i>n</i> = 19), 4-week LMRVT (<i>n</i> = 15), 8-week LMRVT (<i>n</i> = 5), and control (<i>n</i> = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies.</p><p><strong>Results: </strong>A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], <i>p</i> = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], <i>p</i> = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], <i>p</i> = .046), but the 4-week LMRVT result was not statistically significant (<i>p</i> = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], <i>p</i> = .01), but not using a 5-point margin (<i>p</i> = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy.</p><p><strong>Conclusions: </strong>Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"4275-4287"},"PeriodicalIF":2.2000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11567055/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.\",\"authors\":\"Amanda Heller-Stark, Lynn Maxfield, Jennifer Herrick, Marshall Smith, Ingo Titze\",\"doi\":\"10.1044/2024_JSLHR-22-00456\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings.</p><p><strong>Method: </strong>Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (<i>n</i> = 14), 8-week FRT (<i>n</i> = 19), 4-week LMRVT (<i>n</i> = 15), 8-week LMRVT (<i>n</i> = 5), and control (<i>n</i> = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies.</p><p><strong>Results: </strong>A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], <i>p</i> = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], <i>p</i> = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], <i>p</i> = .046), but the 4-week LMRVT result was not statistically significant (<i>p</i> = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], <i>p</i> = .01), but not using a 5-point margin (<i>p</i> = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy.</p><p><strong>Conclusions: </strong>Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.</p>\",\"PeriodicalId\":51254,\"journal\":{\"name\":\"Journal of Speech Language and Hearing Research\",\"volume\":\" \",\"pages\":\"4275-4287\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-11-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11567055/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Speech Language and Hearing Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1044/2024_JSLHR-22-00456\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Speech Language and Hearing Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1044/2024_JSLHR-22-00456","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/22 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY","Score":null,"Total":0}
Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.
Introduction: Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings.
Method: Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies.
Results: A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy.
Conclusions: Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.
期刊介绍：
Mission: JSLHR publishes peer-reviewed research and other scholarly articles on the normal and disordered processes in speech, language, hearing, and related areas such as cognition, oral-motor function, and swallowing. The journal is an international outlet for both basic research on communication processes and clinical research pertaining to screening, diagnosis, and management of communication disorders as well as the etiologies and characteristics of these disorders. JSLHR seeks to advance evidence-based practice by disseminating the results of new studies as well as providing a forum for critical reviews and meta-analyses of previously published work.
Scope: The broad field of communication sciences and disorders, including speech production and perception; anatomy and physiology of speech and voice; genetics, biomechanics, and other basic sciences pertaining to human communication; mastication and swallowing; speech disorders; voice disorders; development of speech, language, or hearing in children; normal language processes; language disorders; disorders of hearing and balance; psychoacoustics; and anatomy and physiology of hearing.
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