title: Adherence to Voice Therapy Recommendations Is Associated With Preserved Employment Fitness Among Teachers With Work-Related Dysphonia.
abstract: OBJECTIVE
  Referral to voice therapy and recommendations for voice rest and microphone use are common interventions in occupational medicine aimed at preserving the working capability of teachers with occupation-related voice problems. Research on the impact of such interventions in terms of employment is lacking. This study examined changes in fitness (ie, ability) to work of dysphonic teachers referred to an occupational clinic and evaluated employment outcomes following voice therapy, voice rest, and microphone use.
  
  
  METHODS
  A historical prospective study was carried out.
  
  
  METHODS
  Of 365 classroom teachers who were first referred to a regional occupational medicine clinic due to dysphonia between January 2007 and December 2012, 156 were sampled and 153 were followed-up for an average of 5 years (range 2-8). Data were collected from medical records and from interviews conducted in 2014 aimed at assessing employment status. Logistic regression models were used to assess associations between interventions and employment outcomes. Survival analyses were performed to evaluate the association between participating in voice therapy and length of retained employment fitness.
  
  
  RESULTS
  Thirty-four (22.2%) teachers suffered declines in working capabilities due to dysphonia. Voice therapy was demonstrated as being a protective factor against such declines (odds ratio = 0.05 [0.01-0.27]). Adherence to recommendation of voice therapy was <50%. Most of the decline in working fitness among nonadherent teachers occurred within 20 months after referral. Unlike voice therapy, voice rest and microphone use were not associated with retention of working capabilities.
  
  
  CONCLUSIONS
  Voice therapy, especially when instituted early, is a strong predictor for retaining fitness for employment among dysphonic teachers.
authors.affiliation: Department of Occupational Medicine, Jerusalem District, Clalit Health Services, Jerusalem, Israel; Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: lilah.rinsky@mail.huji.ac.il.
authors.forename: Lilah
authors.initials: L
authors.lastname: Rinsky-Halivni
authors.affiliation: Department of Occupational Medicine, Jerusalem District, Clalit Health Services, Jerusalem, Israel.
authors.forename: Miriam
authors.initials: M
authors.lastname: Klebanov
authors.affiliation: School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Lerman
authors.affiliation: Braun School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ora
authors.initials: O
authors.lastname: Paltiel
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D018450:Disease Progression; D055154:Dysphonia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009784:Occupational Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016272:Occupational Health; D016017:Odds Ratio; D010349:Patient Compliance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D020127:Recovery of Function; D012307:Risk Factors; D000070777:School Teachers / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D014833:Voice Quality; D014834:Voice Training; D014938:Work Capacity Evaluation; D055815:Young Adult
keywords: Fitness to work; Occupational dysphonia; Teachers; Voice disorders; Voice therapy