Do We Need a Measure of Vocal Effort? Clinician's report of vocal effort in voice patients.
Miriam van Mersbergen, Bethany Helen Beckham, Eric J Hunter
PMID 38549948WHAT IT FOUND
Most voice clinicians treat vocal effort as a key symptom but lack a validated tool to measure it.
They rely on the Voice Handicap Index, which was not designed for this purpose. Developing a specific, reliable measure of vocal effort is a priority.
Key findings
01Seventy-eight percent of surveyed clinicians use the Voice Handicap Index (VHI) or VHI-10 to measure vocal effort, despite the VHI being a measure of perceived handicap rather than specific effort.
02Almost two-thirds of clinicians report that more than half of their voice patients complain of vocal effort, yet patients often struggle to describe this symptom, frequently using terms like 'strain', 'hard', or 'work'.
03Clinicians commonly include reducing vocal effort as a therapy goal, with resonant voice therapy and semi-occluded vocal tract exercises being the most frequently cited techniques for this purpose.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study is a descriptive survey with no inferential statistics, so it reports opinions and practices but cannot establish validity or reliability of the tools used. The sample was recruited from specific professional listservs (ASHA SIG 3 and University of Iowa voice listserv), which may introduce selection bias toward clinicians interested in voice disorders. Only 85 of the 118 respondents completed every question, which may affect the generalizability of findings for specific items. The survey relies on self-reported practice, which may not reflect actual clinical behavior or standardized assessment protocols.
Declared interests
The authors declared no conflicts of interest. The study was reviewed by the University of Memphis IRB and determined exempt.
The easy way to misread this
Do not interpret the widespread use of the Voice Handicap Index as evidence that it is an effective tool for measuring vocal effort. The paper states that the VHI is designed to measure perceived handicap, not effort, and that only three of its thirty items loosely relate to effort. Using the VHI to track effort may misrepresent patient progress.