Role of Social-Cognitive Motivational Factors in Achieving Voice Therapy Outcomes

描述(申请人提供)：发声障碍的行为治疗(即发声治疗)包括日常发声练习，在连接语音中实施改进的发声技术，以及其他被认为可以改善喉部健康的行为改变。因此，发声疗法需要患者的参与和行为改变的动力。对于其他需要积极参与的健康干预措施，如减肥和戒烟，行为改变的动机被分为三个因素：(1)个人对行为改变目标的承诺，(2)对实现特定、必要行为(即自我效能)的能力的信心，以及(3)对发展相关技能的能力的信念。研究发现，这些因素会影响期望行为的成功实现。我们有理由认为，这些社会认知动机变量也可能在发声治疗中发挥作用。然而，这些变量与发声治疗成功的关系还没有被研究过，也不清楚患者的动力如何在治疗上得到增强。因此，这项应用的广泛目标是：1)量化发声治疗中患者动机和结果之间的关系；2)确定增强动机的治疗策略是否改善了治疗动机和发声治疗结果。将对40名嗓音治疗参与者进行发声功能和动力的测量，这些患者在基线(即发声治疗之前；时间1)和完成发声治疗(时间2)时被诊断为声带小结或Pre-1小结周围水肿。其中20名参与者将被随机分配到发声治疗，而不会明确操纵患者的动机，而其余20名参与者将接受具有增强激励内容的发声治疗。为了捕捉社会认知动机因素，将使用既定的测量来评估目标承诺和技能归因，并将使用先前经过测试的原始测量来评估发声治疗的自我效能。发声功能将通过既定的测量方法进行评估，以捕捉发声功能亢进的变化，包括知觉评估、喉咙效率、与声音相关的生活质量以及患者从治疗中感受到的好处。这项拟议的研究对于填补关于评估和增强以患者为中心的声音治疗中激励因素的最有效方法的知识空白具有重要意义。这项工作很有可能产生与重要临床问题相关的有意义的发现。

DESCRIPTION (provided by applicant): Behavioral treatment of voice disorders (i.e. voice therapy) entails daily voice exercises, implementation of improved voice technique in connected speech, and other behavioral changes thought to improve laryngeal health. Thus, voice therapy requires patient participation and motivation for behavior change. For other health interventions that require active participation, such as weight loss and smoking cessation, motivation for behavior change has been partitioned into 3 factors: (1) an individual's commitment to the goals of the behavior change, (2) confidence in ability to achieve the specific, required behaviors (i.e. selfefficacy), and (3) belief in the ability to develop relevant skills. It has been found that these factors influence successful attainment of the desired behaviors. It is reasonable to assume that these social-cognitive motivational variables may play a role in voice therapy as well. However, the relationship of these variables to voice therapy success has not been studied, and it is unclear how a patient's motivation may be therapeutically enhanced. Therefore, the broad aims of this application are: 1) to quantify the relationship between patient motivation and outcome in voice therapy and 2) to determine if motivation-enhancing therapeutic strategies improve motivation for therapy and voice therapy outcomes. Measures of vocal function and motivation will be obtained in 40 voice therapy participants with a diagnosis of vocal nodules, or pre-1 peri-nodular edema at baseline (i.e. prior to voice therapy; Time 1) and completion of voice therapy (Time 2). Twenty of these participants will be randomly assigned to voice therapy without explicit manipulation of patient motivation, while the remaining 20 participants will receive voice therapy with enhanced motivational content. To capture social-cognitive motivational factors, established measures will be used to assess goal commitment and skill attribution, and an original, previously tested measure will be used to assess self-efficacy for voice therapy. Vocal function will be assessed through established measures that capture change in vocal hyperfunction, including perceptual assessment, laryngeal efficiency, voice-related quality of life, and patient-perceived benefit from therapy. The proposed research is significant in filling a gap in knowledge concerning the most effective methods for assessment and enhancement of patient-centered motivational factors in voice therapy. This work has a high likelihood of yielding meaningful findings related to an important clinical issue.