Category: Cross-Cutting; Quality Improvement and Implementation Science
Objective : To improve the field's ability to study, teach, and supervise vocal rehabilitation treatments, lists of measureable/conceptually unique treatment targets and ingredients were derived according to the Rehabilitation Treatment Specification System (RTSS).
Design : Voice therapy taxonomy was restructured into two lists: RTSS-based ingredients and targets. Four rounds of modified Delphi surveys were completed. Rounds 1 and 3 solicited expert opinion on two RTSS constructs ([i] observability/measurability; [ii] conceptual uniqueness) for every individual target or ingredient, respectively. Rounds 2 and 4 solicited follow-up expert opinions regarding how low-consensus targets or ingredients could be revised or eliminated. Each round of feedback was monitored by two external readers.
Setting : Outpatient
Participants (or Animals, Specimens, Cadavers) : Ten voice-specialized speech-language pathologists (5 clinical researchers and 5 specialized clinicians) across 7 voice centers participated in the 4 rounds. Two external readers monitored the data analysis in terms of impartiality (they were rehabilitation specialists, but not voice therapists) and adherence to the RTSS guidelines.
Interventions : Not applicable
Main Outcome Measure(s) : Lists of ingredients and targets that reached supra-majority consensus (8 out of 10 expert agreement or more).
Results : Expert agreement on conceptual uniqueness was comparably lower than agreement on measurability. Subsequently, revisions regarding conceptual uniqueness resulted in supra-majority consensus for over 20 voice therapy treatment targets and over 30 voice therapy treatment ingredients. In addition to deriving consensus lists, underlying rationales were agreed upon for why each individual target or ingredient was considered conceptually unique.
Conclusions : Consensus lists of ingredients and targets have potential to improve voice therapy research and training for new clinicians. Methods developed to obtain these lists might be useful for other sub-disciplines of rehabilitation.
John Whyte
– Institute Scientist Emeritus, Moss Rehabilitation Research Institute, Elkins Park, PennsylvaniaJoseph Duffy
– Professor of Speech Pathology, Mayo Clinic - Rochester, Rochester, MinnesotaJulie Barkmeier-Kraemer
– Professor, University of Utah, Salt Lake City, UtahLisa Kelchner
– Professor, University of Cincinnati, Cincinnati, OhioNelson Roy
– Professor, University of Utah, Salt Lake City, UtahJoseph Stemple
– Professor, University of Kentucky, Lexington, KentuckySusan Thibeault
– Professor, University of Wisconsin - Madison, Madison, WisconsinPatricia Doyle
– Speech Language Pathologist, University of Connecticut Medical School, Farmington, ConnecticutShirley Gherson
– Speech Language Pathologist, New York University, New York, New YorkJason Muise
– Speech Language Pathologist, Massachusetts General Hospital, Boston, MassachusettsBrian Petty
– Speech Language Pathologist, Emory University, Atlanta, GeorgiaCarol Jorgensen Tolejano
– Speech Language Pathologist, University of Wisconsin - Madison, Madison, WisconsinJarrad Van Stan
– Assistant Professor, Speech Language Pathologist, Adjunct Professor, Harvard Medical School, Massachusetts General Hospital, MGH Institute of Health Professions, Boston, Massachusetts