Pre- and post-operative voice therapy (PaPOV): Development of an intervention for patients with benign vocal fold lesions.

The underlying systematic review included only 35 studies, and the authors note that most of these had poor reporting of intervention details, materials, and dosing, which created large areas of silence in the triangulation. 34 of 61 proposed components failed to reach consensus, leaving substantial gaps in what the intervention should include. The PPI group consisted of 5 patients, and the survey included clinicians with varying levels of BVFL-specific experience. The intervention is explicitly not ready for clinical implementation; the authors state it needs further refinement and a feasibility trial before it can be tested. Many areas of silence were attributed to poor reporting in the existing literature rather than to the absence of practice, so the gaps may overstate what is actually unknown.

Funded by an NIHR (National Institute for Health and Care Research) Programme Grant. No commercial conflicts of interest are declared in the text provided.

Do not read the 27 consensus components as a ready-to-use clinical protocol. The authors explicitly state the intervention is not suitable for implementation into clinical practice and that the protocol needs further refinement before a feasibility trial is conducted. This is a development paper identifying what should go into a future intervention, not a validated treatment to adopt on Monday.