Effect of a Novel, Interactive Mobile APP on Voice Therapy Outcomes and Adherence

描述(由申请人提供)：患者对治疗的依从性差限制了行为发声治疗的有效性。虽然患者可以通过临床医生的反馈来产生目标语音技术，但他们在治疗过程中遇到了坚持失败的情况，其特征是无法独立复制目标技术，忘记练习，以及忘记整天使用该技术。患者克服这些挑战的自我效能感(即特定任务的自信)很差。问题：在我们过去的研究中，在移动MP4设备上提供语音治疗视频显著地提高了忠诚度和自我效能(即特定于任务的自信)，并改善了语音结果，但并不显著。因此，为了帮助患者自我评估语音技术并记住使用它，我们实验室开发了一个新的基于iOS的软件应用程序(APP)，它提供交互式语音质量反馈(抖动和倒谱峰值显著值)，提醒患者练习，通过治疗录音模拟个性化练习，并记录所有练习以直接跟踪依从性(无需自我报告)。目标：这个项目的目的是测试我们的移动应用程序在影响1)改善发声治疗结果和2)改善坚持和坚持的自我效能方面的效果。策略：60名在辛辛那提大学语音诊所和埃默里语音中心被诊断为发声功能亢进并被转介接受共鸣发声治疗的成年人将被随机分为两种情况：1)共鸣发声治疗辅以标准护理书面作业说明，或2)共鸣发声治疗辅之以移动语音治疗坚持应用程序。所有参与者都将在借来的iPod上记录他们的练习，但只有一半的人会收到这款应用。为了达到目标 结果测量(VHI评分、CAPE-V录音的声学和知觉分析)将在治疗前和治疗4个疗程后获得。对于目标2，将检查患者自我录音和通过APP使用获得的录音的频率和持续时间。自我效能感将通过声音疗法自我效能感量表每周进行跟踪。两个目标的分组差异将通过t检验来计算，自我效能感和坚持性对结果的影响将通过回归分析来检验。意义：该项目将产生直接转化为临床语音护理的临床工具和结果，是相关的 通过语音-语言病理干预，扩展依从性和运动学习的知识，并有潜力在不增加成本的情况下提高嗓音治疗效果。

DESCRIPTION (provided by applicant): Poor patient adherence to treatment limits the effectiveness of behavioral voice therapy. While patients can produce a target voice technique with clinician feedback, they experience adherence failure between therapy sessions characterized by an inability to replicate the target technique independently, forgetting to practice, and forgetting to use the technique all day. Patient self-efficacy (i.e. task-specific confidence) to overcome these challenges is poor. Problem: In our past research, provision of voice therapy videos on mobile MP4 devices significantly increased adherence and self-efficacy (i.e., task-specific confidence), and improved voice outcomes but not significantly so. Therefore, to assist patients in self-evaluating voice technique and remembering to use it, a novel iOS- based software application or "app" was developed in our laboratory that provides interactive voice quality feedback (jitter and cepstral peak prominence values), reminds patients to practice, models individualized practice via therapy recordings, and records all practice for direc tracking of adherence (without self-report). Objective: The aims of this project are to test the efficacy of our mobile app in affecting 1) improved voice therapy outcomes and 2) improved adherence and self-efficacy for adherence. Strategy: Sixty adults diagnosed with adducted hyperfunctional voice production and referred for resonant voice therapy at the University of Cincinnati Voice Clinic and Emory Voice Center will be randomized to one of two conditions: 1) resonant voice therapy supplemented by standard-of-care written homework instructions or 2) resonant voice therapy supplemented by the mobile voice therapy adherence app. All participants will record their practice on loaned iPods but only half will receive the app. For aim 1, outcome measures (VHI scores, acoustic and perceptual analysis of CAPE-V recordings) will be obtained prior to and following 4 sessions of treatment. For aim 2, adherence will be examined for frequency and duration of patient self-recordings and recordings obtained through app use. Self-efficacy will be tracked weekly through the Voice Therapy Self- Efficacy Scale. Group differences for both aims will be calculated via t-tests, and effects of self-efficacy and adherence on outcomes will be examined with regression analysis. Significance: This project will yield clinical tools and findings that translate directly to clinical voice care, are relevant across speech-language pathology interventions, expand knowledge of adherence and motor learning, and hold potential to increase voice therapy efficacy without increased cost.