title: Combining voice therapy and physical therapy: A novel approach to treating muscle tension dysphonia.
abstract: OBJECTIVE
  This study investigated the role of a specialized physical therapy program for muscle tension dysphonia patients as an adjunct to standard of care voice therapy.
  
  
  METHODS
  Retrospective Cohort Study Methods Adult MTD patients seen between 2007 and 2012 were identified from the clinical database. They were prescribed voice therapy and, if concomitant neck pain, adjunctive physical therapy. In a pragmatic observational cohort design, patients underwent one of four potential treatment approaches: voice therapy alone (VT), voice therapy and physical therapy (VT+PT), physical therapy alone (PT), or incomplete/no treatment. Voice handicap outcomes were compared between treatment approaches.
  
  
  RESULTS
  Of 153 patients meeting criteria (Median age 48 years, 68% female, and 30% had fibromyalgia, chronic pain, chronic fatigue, depression, and/or anxiety), there was a similar distribution of patients with moderate or severe pre-treatment VHI scores across treatment groups (VT 45.5%, VT+PT 43.8%, PT 50%, no treatment 59.1%; p=0.45). Patients treated with VT alone had significantly greater median improvement in VHI than those not treated: 10-point vs. 2-point (p=0.02). Interestingly, median VHI improvement in patients with baseline moderate-severe VHI scores was no different between VT (10), VT+PT (8) and PT alone (10; p=0.99).
  
  
  CONCLUSIONS
  Findings show voice therapy to be an effective approach to treating MTD. Importantly, other treatment modalities incorporating physical therapy had a similar, albeit not significant, improvement in VHI. This preliminary study suggests that physical therapy techniques may have a role in the treatment of a subset of MTD patients. Larger, comparative studies are needed to better characterize the role of physical therapy in this population.
  
  
  OBJECTIVE
  The reader will describe symptoms associated with muscle tension dysphonia and current treatment. The reader will describe the systematic adjunctive physical therapy approach and understand the rationale to consider incorporation of physical therapy into the current treatment regimen.
authors.affiliation: Vanderbilt Voice Center, 1215 21st Ave South, 7302 Medical Center East, South Tower, Nashville, TN 37212, United States. Electronic address: Jennifer.n.craig@vanderbilt.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Craig
authors.affiliation: Vanderbilt Dayani Center, Nashville, TN 37212, United States.
authors.forename: Carey
authors.initials: C
authors.lastname: Tomlinson
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN 37212, United States.
authors.forename: Kristin
authors.initials: K
authors.lastname: Stevens
authors.affiliation: Northwest Clinic for Voice and Swallowing, United States.
authors.forename: Kiran
authors.initials: K
authors.lastname: Kotagal
authors.affiliation: University Health-Shrevport, United States.
authors.forename: Judith
authors.initials: J
authors.lastname: Fornadley
authors.affiliation: Vanderbilt Department of Hearing and Speech Sciences, United States.
authors.forename: Barbara
authors.initials: B
authors.lastname: Jacobson
authors.affiliation: Vanderbilt Voice Center, 1215 21st Ave South, 7302 Medical Center East, South Tower, Nashville, TN 37212, United States.
authors.forename: C Gaelyn
authors.initials: CG
authors.lastname: Garrett
authors.affiliation: Vanderbilt Voice Center, 1215 21st Ave South, 7302 Medical Center East, South Tower, Nashville, TN 37212, United States; Center for Surgical Quality and Outcomes Research, United States.
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D055154:Dysphonia / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus / Q000502:physiology*; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014834:Voice Training