title: Vocal hygiene education, voice production therapy, and the role of patient adherence: a treatment effectiveness study in women with phonotrauma.
abstract: OBJECTIVE
  To assess the effectiveness of vocal hygiene education (VHE) and voice production therapy (VP) in altering patient perception of vocal handicap in adult women with benign, bilateral phonotraumatic vocal fold lesions and the role of adherence in that perception.
  
  
  METHODS
  Sixty-two women were randomly assigned to 6 weeks of VP (n = 31) or VHE (n = 31), followed by 4 weeks of self-study. The primary outcome measure was the Voice Handicap Index (VHI) score, assessed at baseline, post-therapy, and post-self-study. Patient adherence was assessed as a cofactor.
  
  
  RESULTS
  Both groups achieved a decrease in VHI scores from baseline to completion of the study, although the improvement was significantly greater for the VP group. The treatment effect size was large for the VP group and small for the VHE group. More participants adhered to VP than to VHE. Only adherent participants achieved significant improvement. Only adherent participants in the VP group improved with self-study. More than two thirds of the VP group achieved final VHI scores within normal limits, compared with approximately one third of those in the VHE group.
  
  
  CONCLUSIONS
  VP therapy may be more effective than VHE in addressing patient perception of vocal handicap in adult women with phonotrauma, and self-study may be an important component of therapy. However, adherence is a critical mediator of outcome.
authors: New York University, New York, NY, USA. alisonbehrman@verizon.net
authors: Alison
authors: A
authors: Behrman
authors: John
authors: J
authors: Rutledge
authors: Amanda
authors: A
authors: Hembree
authors: Sarah
authors: S
authors: Sheridan
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010349:Patient Compliance; D010353:Patient Education as Topic; D016896:Treatment Outcome; D014827:Vocal Cords / Q000502:physiology; D014831:Voice; D014832:Voice Disorders / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D014833:Voice Quality; D014834:Voice Training