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语音治疗的有效性。虽然患者可以通过临床医生反馈产生目标语音技术，但他们在治疗会话之间经历了依从性失败，其特征在于无法独立地复制目标技术，忘记练习，并且整天忘记使用该技术。患者克服这些挑战的自我效能（即任务特定的信心）很差。问题：在我们过去的研究中，在移动的MP4设备上提供语音治疗视频显著增加了依从性和自我效能（即，任务特定的信心），并改善语音结果，但并不显着。因此，为了帮助患者自我评估语音技术并记住使用它，我们的实验室开发了一种新的基于iOS的软件应用程序或“应用程序”，其提供交互式语音质量反馈（抖动和倒谱峰值突出值），提醒患者练习，通过治疗记录对个性化练习进行建模，并记录所有练习以直接跟踪依从性（没有自我报告）。目的：该项目的目的是测试我们的移动的应用程序在影响1）改善语音治疗结果和2）改善依从性和依从性自我效能方面的有效性。策略：60名被诊断为内收性发声功能亢进并在辛辛那提大学语音诊所和埃默里语音中心接受共振语音治疗的成年人将被随机分配到以下两种情况之一：1）共振语音治疗，辅以标准护理书面作业指导，或2）共振语音治疗辅以移动的语音治疗依从性应用程序。所有参与者将在借来的iPod上记录他们的练习，但只有一半会接收应用程序。对于aim 1，将在4次治疗之前和之后获得结果测量（VHI评分、CAPE-V记录的声学和感知分析）。对于目标2，将检查患者自我记录和通过应用程序使用获得的记录的频率和持续时间的依从性。将通过语音治疗自我效能量表每周跟踪自我效能。两个目标的组间差异将通过t检验计算，自我效能和依从性对结果的影响将通过回归分析进行检查。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研究结果， 在言语语言病理学干预中，扩展了对依从性和运动学习的了解，并有可能在不增加成本的情况下提高语音治疗的疗效。

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.