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

描述（由申请人提供）：声音障碍的行为治疗（即声音治疗）需要日常的声音练习，在连接语音中实施改进的声音技术，以及其他被认为可以改善喉部健康的行为改变。因此，语音治疗需要患者的参与和行为改变的动机。对于其他需要积极参与的健康干预措施，如减肥和戒烟，行为改变的动机被划分为3个因素：(1)个人对行为改变目标的承诺，(2)对实现特定所需行为的能力的信心（即自我效能感），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。假设这些社会认知动机变量也可能在语音治疗中发挥作用是合理的。然而，这些变量与语音治疗成功的关系尚未得到研究，并且尚不清楚如何通过治疗增强患者的动机。因此，本应用的广泛目标是：1)量化语音治疗中患者动机与结果之间的关系；2)确定动机增强治疗策略是否能改善治疗动机和语音治疗结果。在40名诊断为声带小结或1期前结节周围水肿的语音治疗参与者（即在语音治疗前；时间1）和完成语音治疗（时间2）时，将获得声带功能和动机的测量。其中20名参与者将被随机分配到没有明确操纵患者动机的语音治疗中，而其余20名参与者将接受具有增强动机内容的语音治疗。为了捕捉社会认知动机因素，既定的测量将被用来评估目标承诺和技能归因，一个原始的，以前测试过的测量将被用来评估语音治疗的自我效能感。发声功能将通过捕捉发声功能亢进变化的既定措施进行评估，包括知觉评估、喉效率、声音相关生活质量和患者从治疗中感知的获益。本研究对于填补评估和增强语音治疗中以患者为中心的动机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.