Patient factors related to voice therapy attendance and outcomes

Limited information is available concerning factors that may be associated with attendance and outcomes among patients referred for voice therapy. The purpose of this study was to determine whether patient-related factors could be identified which distinguished patients who attended voice therapy and had positive voice change from those who did not. This retrospective study included medical record information for 100 patients seen at a major urban, academic medical center. The attendance/outcomes of voice therapy resulted in patient division into five groups, those who (1) were successfully discharged from therapy, (2) attended a few sessions, had voices that improved to normal or were near normal and then stopped attending therapy, (3) attended many sessions with some voice gain, (4) failed to improve despite attending voice therapy, or (5) failed to attend voice therapy as recommended. Outcomes for groups 1-3 (53% of patients) were considered successful (positive voice change), whereas outcomes for groups 4 and 5 (47% of patients) were considered unsuccessful. A high percentage of patients (44%) essentially did not attend therapy. Patients having successful outcomes were more likely to be female, younger, employed, with fewer laryngeal diagnoses and medical problems, a less severe voice disorder and lower Voice Handicap Index (VHI) scores at the start of therapy. Patients with more complex laryngeal diagnoses, more perceived vocal severity, occupational issues, more health issues, and higher VHI scores at the time of the initial voice evaluation may be at greater risk for failing to attend voice therapy sessions.