title: Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population.
abstract: OBJECTIVE
  To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI).
  
  
  METHODS
  Prospective, survey study.
  
  
  METHODS
  Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database with voice, concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study. The VHI was sent to patients 6 months post clinic visit to determine change in voice handicap from baseline. General health was screened using the 12-item Short Form Health Survey, using physical component summary and mental component summary scores. Predictor variables included treatment (medical and/or behavioral); dysphonia sub-diagnosis; grade, roughness, breathiness, asthenia, and strain rating; age; sex; socioeconomic factors; smoking history; and comorbidity score.
  
  
  RESULTS
  Two hundred thirty-seven patients met study criteria and were followed longitudinally. Eighty-two patients returned 6-month surveys. The VHI was significantly correlated with mental component summary scores. Patients with a higher grade in baseline grade, roughness, breathiness, asthenia, and strain score were more likely to receive voice intervention (P = 0.04). Six-month improvement in VHI score was associated with both higher initial VHI score and higher educational level in both univariate (P < 0.01, P = 0.04) and multivariate analyses (P < 0.01, P = 0.02). Voice treatment (medical and/or behavioral) was not a significant factor for improvement in VHI score.
  
  
  CONCLUSIONS
  Our results suggest that it is important to consider baseline self-perceived voice impact measures and educational level in setting expectations for voice treatment. Future studies examining the relationship between treatment patterns and voice-related patient outcomes are warranted.
authors.affiliation: Department of Surgery and Communication Sciences and Disorders, 5107 Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, 1111 Highland Ave., Madison, Wisconsin 53705-2275.
authors.forename: Jaime
authors.initials: J
authors.lastname: Moore
authors.affiliation: Department of Surgery and School of Medicine and Public Health, 7375 Clinical Science Center, K6/148, University of Wisconsin-Madison, 600 Highland Ave., Madison, Wisconsin 53792.
authors.forename: Caprice
authors.initials: C
authors.lastname: Greenberg
authors.affiliation: Department of Surgery, 5107 Wisconsin Institutes for Medical Research, University of Wisconsin-Madison, 1111 Highland Ave., Madison, Wisconsin 53705-2275.. Electronic address: thibeault@surgery.wisc.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Thibeault
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007600:Judgment; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012649:Self Concept; D013061:Speech Acoustics; D013067:Speech Perception; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014832:Voice Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D014833:Voice Quality
keywords: Long-term outcomes; Patient-centered outcomes; Voice; Voice Handicap Index; Voice disorders