A psychosocial intervention for the management of functional dysphonia: Complex intervention development and pilot randomised trial

Journal article


Deary, Vincent, McColl, Elaine, Carding, Paul, Miller, Tracy and Wilson, Janet. (2018) A psychosocial intervention for the management of functional dysphonia: Complex intervention development and pilot randomised trial. Pilot and Feasibility Studies. 4(1), pp. 1 - 12. https://doi.org/10.1186/s40814-018-0240-5
AuthorsDeary, Vincent, McColl, Elaine, Carding, Paul, Miller, Tracy and Wilson, Janet
Abstract

Background: Medically unexplained loss or alteration of voice—functional dysphonia—is the commonest presentation to speech and language therapists (SLTs). Besides the impact on personal and work life, functional dysphonia is also associated with increased levels of anxiety and depression and poor general health. Voice therapy delivered by SLTs improves voice but not these associated symptoms. The aims of this research were the systematic development of a complex intervention to improve the treatment of functional dysphonia, and the trialling of this intervention for feasibility and acceptability to SLTs and patients in a randomised pilot study Methods: A theoretical model of medically unexplained symptoms (MUS) was elaborated through literature review and synthesis. This was initially applied as an assessment format in a series of patient interviews. Data from this stage and a small consecutive cohort study were used to design and refine a brief cognitive behavioural therapy (CBT) training intervention for a SLT. This was then implemented in an external pilot patient randomised trial where one SLT delivered standard voice therapy or voice therapy plus CBT to 74 patients. The primary outcomes were of the acceptability of the intervention to patients and the SLT, and the feasibility of changing the SLT’s clinical practice through a brief training. This was measured through monitoring treatment flow and through structured analysis of the content of intervention for treatment fidelity and inter-treatment contamination. Results: As measured by treatment flow, the intervention was as acceptable as standard voice therapy to patients. Analysis of treatment content showed that the SLT was able to conduct a complex CBT formulation and deliver novel treatment strategies for fatigue, sleep, anxiety and depression in the majority of patients. On pre-post measures of voice and quality of life, patients in both treatment arms improved. Conclusion: These interventions were acceptable to patients. Emotional and psychosocial issues presented routinely in the study patient group and CBT techniques were used, deliberately and inadvertently, in both treatment arms. This CBT “contamination” of the voice therapy only arm reflects the chief limitation of the study: one therapist delivered both treatments. Trial registration: Registered with the ISRCTN under the title: Training a Speech and Language Therapist in Cognitive Behavioural Therapy to treat Functional Dysphonia - A Randomised Controlled Trial. Trial Identifier: ISRCTN20582523 Registered 19/05/2010; retrospectively registered. http://www.isrctn.com/ISRCTN20582523

Keywordsmedically unexplained symptoms; cognitive behavioural therapy; speech and language therapy; functional dysphonia; pilot randomised controlled trial
Year2018
JournalPilot and Feasibility Studies
Journal citation4 (1), pp. 1 - 12
PublisherSpringer Nature
ISSN2055-5784
Digital Object Identifier (DOI)https://doi.org/10.1186/s40814-018-0240-5
Scopus EID2-s2.0-85046812497
Open accessOpen access
Page range1 - 12
Research GroupSchool of Allied Health
Publisher's version
License
Place of publicationUnited Kingdom
Permalink -

https://acuresearchbank.acu.edu.au/item/89777/a-psychosocial-intervention-for-the-management-of-functional-dysphonia-complex-intervention-development-and-pilot-randomised-trial

Download files

  • 1
    total views
  • 2
    total downloads
  • 1
    views this month
  • 2
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Communication changes with laryngectomy and impact on quality of life: A review
Sharpe, Gabriella, Costa, Vera Camoes, Doubé, Wendy, Sita, Jodi, McCarthy, Christopher and Carding, Paul. (2019) Communication changes with laryngectomy and impact on quality of life: A review. Quality of Life Research. 28, pp. 863 - 877. https://doi.org/10.1007/s11136-018-2033-y
Voice outcome measures for adult patients with Unilateral Vocal Fold Paralysis: A Systematic Review
Walton, Chloe, Carding, Paul, Conway, Erin, Flanagan, Kieran and Blackshaw, Helen. (2019) Voice outcome measures for adult patients with Unilateral Vocal Fold Paralysis: A Systematic Review. The Laryngoscope. 129, pp. 187 - 197. https://doi.org/10.1002/lary.27434
Behavioural interventions to treat drooling in children with neurodisability: A systematic review
McInerney, Michelle, Reddihough, Dinah, Carding, Paul, Swanton, Ruth, Walton, Chloe and Imms, Christine. (2018) Behavioural interventions to treat drooling in children with neurodisability: A systematic review. Developmental Medicine and Child Neurology. 61(1), pp. 39 - 48. https://doi.org/10.1111/dmcn.14048
Perspectives on voice treatment for unilateral vocal fold paralysis
Walton, Chloe, Carding, Paul and Flanagan, Kieran. (2018) Perspectives on voice treatment for unilateral vocal fold paralysis. Current Opinion in Otolaryngology and Head and Neck Surgery. 26(3), pp. 157 - 161. https://doi.org/10.1097/MOO.0000000000000450
Unilateral vocal fold paralysis: A systematic review of speech-language pathology management
Chloe, Walton, Conway, Erin, Blackshaw, Helen and Carding, Paul. (2017) Unilateral vocal fold paralysis: A systematic review of speech-language pathology management. Journal of Voice. 31(4), pp. 7 - 22. https://doi.org/10.1016/j.jvoice.2016.11.002
Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders
Carding, Paul, Bos-Clark, M., Fu, S., Gillivan-Murphy, Patricia, Jones, S. M. and Walton, Chloe. (2017) Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders. Clinical Otolaryngology. 42(2), pp. 201 - 217. https://doi.org/10.1111/coa.12765
Vocal tract characteristics in Parkinson's disease
Gillivan-Murphy, Patricia, Carding, Paul Nicholas and Miller, Nick. (2016) Vocal tract characteristics in Parkinson's disease. Current Opinion in Otolaryngology and Head and Neck Surgery. https://doi.org/10.1097/MOO.0000000000000252
Swallowing performance and tube feeding status in patients treated with parotid-sparing intensity-modulated radiotherapy for head and neck cancer
Carding, Paul Nicholas, Roe, Justin W., Drinnan, Michael J., Harrington, Kevin J. and Nutting, Christopher M.. (2016) Swallowing performance and tube feeding status in patients treated with parotid-sparing intensity-modulated radiotherapy for head and neck cancer. Head and Neck. 38, pp. 1 - 9. https://doi.org/10.1002/hed.24255
Swallowing outcome measures in head and neck cancer - How do they compare?
Carding, Paul Nicholas, Pederson, A., Wilson, Janet, McColl, Elaine and Patterson, Jo M.. (2016) Swallowing outcome measures in head and neck cancer - How do they compare? Oral Oncology. 52, pp. 104 - 108. https://doi.org/10.1016/j.oraloncology.2015.10.015
TOPPITS: Trial Of Proton Pump Inhibitors in Throat Symptoms. Study protocol for a randomised controlled trial
Watson, Gillian, O'Hara, James, Carding, Paul Nicholas, Lecouturier, Jan, Stocken, Deborah, Fouweather, Tony and Wilson, Janet. (2016) TOPPITS: Trial Of Proton Pump Inhibitors in Throat Symptoms. Study protocol for a randomised controlled trial. Trials. https://doi.org/10.1186/s13063-016-1267-7
Contemporary management of voice and swallowing disorders in patients with advanced lung cancer
Carding, Paul, Brady, Grainne C., Bhosle, Jaishree and Roe, J. W.. (2015) Contemporary management of voice and swallowing disorders in patients with advanced lung cancer. Current Opinion in Otolaryngology and Head and Neck Surgery. 23(3), pp. 191 - 196. https://doi.org/10.1097/MOO.0000000000000155
Head and neck cancer patients perceptions of swallowing following chemoradiotherapy
Patterson, Joanne M., McColl, Elaine, Wilson, Janet, Carding, Paul Nicholas and Rapley, Tim. (2015) Head and neck cancer patients perceptions of swallowing following chemoradiotherapy. Supportive Care in Cancer. 23(12), pp. 3531 - 3538. https://doi.org/10.1007/s00520-015-2715-8
Injection laryngoplasty in the outpatient clinic under local anaesthetic: A case series of sixty-eight patients
Powell, Jason, Carding, Paul Nicholas, Birdi, R. and Wilson, Janet. (2014) Injection laryngoplasty in the outpatient clinic under local anaesthetic: A case series of sixty-eight patients. Clinical Otolaryngology. 39(4), pp. 224 - 227. https://doi.org/10.1111/coa.12274
Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?
Roe, Justin W. G., Drinnan, Michael J., Carding, Paul N., Harrington, Kevin J. and Nutting, Christopher M.. (2014) Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia? Oral Oncology. 50(12), pp. 1182 - 1187. https://doi.org/10.1016/j.oraloncology.2014.09.009
Swallowing in the first year after chemoradiotherapy for head and neck cancer : Clinician-and patient-reported outcomes
Patterson, J, McColl, E, Carding, Paul, Hildreth, A, Kelly, Charles and Wilson, Janet. (2014) Swallowing in the first year after chemoradiotherapy for head and neck cancer : Clinician-and patient-reported outcomes. Head and Neck: journal for the sciences and specialities of the head and neck. 36(3), pp. 352 - 358. https://doi.org/10.1002/hed.23306
Head and neck cancer and dysphagia : Caring for carers
Patterson, J, Rapley, T, Carding, Paul, Wilson, Janet and McColl, E. (2013) Head and neck cancer and dysphagia : Caring for carers. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. https://doi.org/10.1002/pon.3226
Current issues in voice assessment and intervention in the United Kingdom
Carding, Paul. (2013) Current issues in voice assessment and intervention in the United Kingdom. In In E. M-L. Yiu (Ed.). International perspectives on voice disorders pp. 83 - 89 Multilingual Matters.
Swallowing in the first year after chemoradiotherapy for head and neck cancer : Clinician-and patient-reported outcomes
Patterson, J, McColl, E, Carding, Paul, Hildreth, A, Kelly, Charles and Wilson, Janet. (2013) Swallowing in the first year after chemoradiotherapy for head and neck cancer : Clinician-and patient-reported outcomes. Head and Neck: journal for the sciences and specialities of the head and neck. https://doi.org/10.1002/hed.23306
Head and neck cancer and dysphagia : Caring for carers
Patterson, J, Rapley, T, Carding, Paul, Wilson, Janet and McColl, E. (2013) Head and neck cancer and dysphagia : Caring for carers. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. https://doi.org/10.1002/pon.3226
Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer : A prospective study
Paleri, V, Carding, Paul, Chatterjee, S, Kelly, Charles, Wilson, Janet, Welch, Andrew and Drinnan, M. (2012) Voice outcomes after concurrent chemoradiotherapy for advanced nonlaryngeal head and neck cancer : A prospective study. Head and Neck: journal for the sciences and specialities of the head and neck. 34(12), pp. 1747 - 1752. https://doi.org/10.1002/hed.22003
A new voice rating tool for clinical practice
Gould, James, Waugh, J, Carding, Paul and Drinnan, M. (2012) A new voice rating tool for clinical practice. Journal of Voice. 26(4), pp. 163 - 170. https://doi.org/10.1016/j.jvoice.2011.07.011
Assessment and management of dysphagia in patients with head and neck cancer who receive radiotherapy in the United Kingdom : A web-based survey
Roe, J, Carding, Paul, Rhys-Evans, P, Newbold, K, Harrington, K and Nutting, C. (2012) Assessment and management of dysphagia in patients with head and neck cancer who receive radiotherapy in the United Kingdom : A web-based survey. Oral Oncology. 48(4), pp. 343 - 348. https://doi.org/10.1016/j.oraloncology.2011.11.003
What other journals tell us. Laryngeal transplantation: Working party final report, June 2011
Narula, Tony, Bradley, Patrick, Carding, Paul Nicholas, Hakim, Nadey, Rumsey, Nichola, Sokol, Daniel and Edwards, Simon. (2012) What other journals tell us. Laryngeal transplantation: Working party final report, June 2011. Clinical Otolaryngology. 37(1), pp. 53 - 55. https://doi.org/10.1111/j.1749-4486.2012.02439.x
Dysphagia after nonsurgical head and neck cancer treatment :Patients' perspectives
Wilson, Janet, Carding, Paul and Patterson, J. (2011) Dysphagia after nonsurgical head and neck cancer treatment :Patients' perspectives. Otolaryngology. 145(5), pp. 767 - 771. https://doi.org/10.1177/0194599811414506
Effectiveness of voice therapy in functional dysphonia :Where are we now?
Bos-Clark, M and Carding, Paul. (2011) Effectiveness of voice therapy in functional dysphonia :Where are we now? Current Opinion in Otolaryngology and Head and Neck Surgery. 19(3), pp. 160 - 164. https://doi.org/10.1097/MOO.0b013e3283448f85
Relationship between fatigue, perfectionism, and functional dysphonia
O'Hara, J, Miller, T, Carding, Paul, Wilson, Janet and Deary, V. (2011) Relationship between fatigue, perfectionism, and functional dysphonia. Otolaryngology. 144(6), pp. 921 - 926. https://doi.org/10.1177/0194599811401236
The clinical application of the 100 mL water swallow test in head and neck cancer
Patterson, J, Hildreth, A, McColl, E, Carding, Paul, Hamilton, D and Wilson, Janet. (2011) The clinical application of the 100 mL water swallow test in head and neck cancer. Oral Oncology. 47(3), pp. 180 - 184. https://doi.org/10.1016/j.oraloncology.2010.11.020
Reliable jitter and shimmer measurements in voice clinics :The relevance of vowel, gender, vocal intensity, and fundamental frequency effects in a typical clinical task
Brockmann, M, Drinnan, M, Storck, C and Carding, Paul. (2011) Reliable jitter and shimmer measurements in voice clinics :The relevance of vowel, gender, vocal intensity, and fundamental frequency effects in a typical clinical task. Journal of Voice. 25(1), pp. 44 - 53. https://doi.org/10.1016/j.jvoice.2009.07.002
From dysphonia to dysphoria : Mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire
Deary, Ian, Wilson, Janet, Carding, Paul, MacKenzie, K and Watson, Roger. (2010) From dysphonia to dysphoria : Mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire. Journal of Psychosomatic Research. 68(1), pp. 67 - 71. https://doi.org/10.1016/j.jpsychores.2009.06.008
Swallowing outcomes following intensity Modulated Radiation Therapy (IMRT) for head & neck cancer : A systematic review
Roe, J, Carding, Paul, Dwivedi, R, Kazi, R, Rhys-Evans, P, Harrington, K and Nutting, C. (2010) Swallowing outcomes following intensity Modulated Radiation Therapy (IMRT) for head & neck cancer : A systematic review. Oral Oncology. 46(10), pp. 727 - 733. https://doi.org/10.1016/j.oraloncology.2010.07.012
From dysphonia to dysphoria : Mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire
Deary, Ian, Wilson, Janet, Carding, Paul, MacKenzie, K and Watson, Roger. (2010) From dysphonia to dysphoria : Mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire. Journal of Psychosomatic Research. 68(1), pp. 67 - 71. https://doi.org/10.1016/j.jpsychores.2009.06.008
Swallowing outcomes following intensity Modulated Radiation Therapy (IMRT) for head & neck cancer : A systematic review
Roe, J, Carding, Paul, Dwivedi, R, Kazi, R, Rhys-Evans, P, Harrington, K and Nutting, C. (2010) Swallowing outcomes following intensity Modulated Radiation Therapy (IMRT) for head & neck cancer : A systematic review. Oral Oncology. 46(10), pp. 727 - 733. https://doi.org/10.1016/j.oraloncology.2010.07.012
Swallowing performance in patients with head and neck cancer: A simple clinical test
Patterson, Joanne M., McColl, Elaine, Carding, Paul Nicholas, Kelly, Charles G. and Wilson, Janet A.. (2009) Swallowing performance in patients with head and neck cancer: A simple clinical test. Oral Oncology. 45(10), pp. 904 - 907. https://doi.org/10.1016/j.oraloncology.2009.03.012
The voice handicap index with post-laryngectomy male voices research report
Evans, Eryl, Carding, Paul Nicholas and Drinnan, Michael. (2009) The voice handicap index with post-laryngectomy male voices research report. International Journal of Language and Communication Disorders. 44(5), pp. 575 - 586. https://doi.org/10.1080/13682820902928729
Comparing health locus of control in patients with" "spasmodic dysphonia, functional dysphonia and nonlaryngeal dystonia
Haselden, Karen, Powell, Theresa, Drinnan, Mike and Carding, Paul Nicholas. (2009) Comparing health locus of control in patients with" "spasmodic dysphonia, functional dysphonia and nonlaryngeal dystonia. Journal of Voice. 23(6), pp. 699 - 706. https://doi.org/10.1016/j.jvoice.2008.03.011
Measuring voice outcomes: State of the science review
Carding, Paul Nicholas, Wilson, Janet A., MacKenzie, K. and Deary, Ian J.. (2009) Measuring voice outcomes: State of the science review. Journal of Laryngology and Otology. 123(8), pp. 823 - 829. https://doi.org/10.1017/S0022215109005398
Can we perceptually rate alaryngeal voice? Developing the Sunderland Tracheoesophageal Voice Perceptual Scale
Hurren, A., Hildreth, A. J. and Carding, Paul Nicholas. (2009) Can we perceptually rate alaryngeal voice? Developing the Sunderland Tracheoesophageal Voice Perceptual Scale. Clinical Otolaryngology. 34(6), pp. 533 - 538. https://doi.org/10.1111/j.1749-4486.2009.02034.x
Speech and voice outcomes in oropharyngeal cancer and evaluation of the University of Washington Quality of Life speech domain
Thomas, Lois H., Jones, Tony M., Tandon, S., Carding, Paul Nicholas, Lowe, Derek G. and Rogers, Sarah. (2009) Speech and voice outcomes in oropharyngeal cancer and evaluation of the University of Washington Quality of Life speech domain. Clinical Otolaryngology. 34(1), pp. 34 - 42. https://doi.org/10.1111/j.1749-4486.2008.01830.x
The nature and severity of voice disorders in lung cancer patients
Lee, Clare F., Carding, Paul Nicholas and Fletcher, Mike. (2008) The nature and severity of voice disorders in lung cancer patients. Logopedics Phoniatrics Vocology. 33(2), pp. 93 - 103. https://doi.org/10.1080/14015430701745997
Short-term voice quality results following percutaneous medialisation of the paralysed vocal cord under local anaesthesia using calcium hydroxyapatite gel: How we do it
Karagama, Y., Hurren, A., Carding, Paul Nicholas and Lindsey, L.. (2008) Short-term voice quality results following percutaneous medialisation of the paralysed vocal cord under local anaesthesia using calcium hydroxyapatite gel: How we do it. Clinical Otolaryngology. 33(4), pp. 362 - 366. https://doi.org/10.1111/j.1749-4486.2008.01690.x
Optimising outcome assessment of voice interventions, ii: Sensitivity to change of self-reported and observer-rated measures
Steen, I. N., MacKenzie, K., Carding, Paul Nicholas, Webb, A., Deary, Ian J. and Wilson, Janet A.. (2008) Optimising outcome assessment of voice interventions, ii: Sensitivity to change of self-reported and observer-rated measures. Journal of Laryngology and Otology. 122(1), pp. 46 - 51. https://doi.org/10.1017/S0022215107007839
Voice change following thyroid and parathyroid surgery
Meek, Pauline, Carding, Paul Nicholas, Howard, D. H. and Lennard, T. W.J.. (2008) Voice change following thyroid and parathyroid surgery. Journal of Voice. 22(6), pp. 765 - 772. https://doi.org/10.1016/j.jvoice.2007.02.002
Voice loudness and gender effects on jitter and shimmer in healthy adults
Brockmann, Meike, Storck, Claudio, Carding, Paul Nicholas and Drinnan, Michael J.. (2008) Voice loudness and gender effects on jitter and shimmer in healthy adults. Journal of Speech, Language, and Hearing Research. 51(5), pp. 1152 - 1160. https://doi.org/10.1044/1092-4388(2008/06-0208)