Pre- and Postoperative Voice Therapy for Benign Vocal Fold Lesions: An International Electronic Delphi Consensus Study

Anna White; Paul Carding; Vicky Booth; Pip Logan; Julian McGlashan; Rehab Awad

doi:10.1016/j.jvoice.2022.12.008

Pre- and Postoperative Voice Therapy for Benign Vocal Fold Lesions: An International Electronic Delphi Consensus Study

J Voice. 2023 Jan 7:S0892-1997(22)00397-6. doi: 10.1016/j.jvoice.2022.12.008. Online ahead of print.

Authors

Anna White¹, Paul Carding², Vicky Booth³, Pip Logan⁴, Julian McGlashan⁵, Rehab Awad⁶

Affiliations

¹ Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK. Electronic address: anna.white3@nottingham.ac.uk.
² Oxford Institute of Midwifery, Nursing and Allied Health Research, Oxford, UK.
³ Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK.
⁴ Centre for Rehabilitation & Ageing Research, Academic Unit of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
⁵ Nottingham University Hospitals NHS Trust, Nottingham, UK.
⁶ University Hospital Lewisham NHS Trust, London, UK; Kasr Al-Aini Hospital, Cairo University, Cairo, Egypt.

PMID: 36624018
DOI: 10.1016/j.jvoice.2022.12.008

Abstract

Introduction: Voice therapy management of benign vocal fold lesions (BVFLs) is variable and there are currently no clinical guidelines. Poor descriptions of voice therapy interventions lead to unwarranted variation in treatment. Triangulation of the current evidence identifies a number of potential best practice elements, but also a number of outstanding questions to be explored. The aim of this study was to refine and gain global consensus on "best practice" for a pre- and postoperative voice therapy intervention for adults with BVFLs.

Methods: An international sample of expert voice therapists (n = 42) were recruited to take part in this three-round electronic modified Delphi study. Participants were presented with statements concerning a pre- and postoperative voice therapy intervention. Statements were developed from previous research and based on the TIDieR checklist (eg, why, when, what, how?) Participants rated the extent to which they agreed or disagreed with a statement and gave comments to support their response. Consensus was defined as >75% of participants agreeing or strongly agreeing with a given statement. If consensus was not reached, participant comments were used to generate new statements and were rated in the next round. Stability of consensus between rounds was assessed.

Results: The 42 international experts achieved consensus on 33 statements relating to components of a best practice pre- and postoperative voice therapy intervention for patients with BVFLs. Consensus on statements ranged from 81% to 100%. These statements were explicitly mapped to the TIDieR checklist to ensure that all aspects of the intervention were considered and the questions of "why, what, how, when and individual tailoring" were addressed.

Conclusions: This study has significantly enhanced our understanding of what should be in a best practice pre- and postoperative voice therapy intervention. It is important to now test these findings for acceptability and feasibility, prior to considering effectiveness research.

Keywords: Benign vocal fold lesions; Consensus; Delphi; Phonosurgery; Pre- and postoperative; Voice therapy.