Efficacy of the Grit Scale Score in Predicting Voice Therapy Adherence and Outcomes

Voice therapy generally is considered first-line treatment for dysphonia and vocal fold paresis. It requires a commitment of time, effort and resources; currently, there is no good indicator to identify which patients are good candidates for voice therapy. The Grit scale, developed by psychologist Angela Duckworth, provides a method to quantify perseverance and commitment to long-term goals.

We hypothesized that the Grit scale score could correlate with patient adherence to voice therapy and outcomes, by which subjects with higher Grit scale scores demonstrate greater adherence and better outcomes.

Subjects were categorized into five groups, subjects who (1) were discharged from therapy after successful completion, (2) improved to normal, near-normal, or a level of voice function with which the patients were satisfied, and then stopped attending therapy (3) attended as at least the recommended number of sessions or greater than 8 sessions with some voice improvement (4) failed to improve to a voice function level satisfactory to the patient despite attending voice therapy, (5) failed to attend voice therapy as recommended. Subjects in groups 1-4 were considered adherent to voice therapy, whereas group 5 was considered not adherent. Category 1 was considered the most favorable outcome, whereas Category 5 was considered the least favorable outcome (1 > 2 > 3 > 4 > 5).

Eighty-nine subjects are included in the study. The average age of subjects was 44.9 years old, and there was a nearly equal split between male and female subjects. The mean Grit score (48) of the adherent group (categories 1-4) was not significantly different from that of the non-adherent group (47, P = 0.190). Spearman's rho between Grit scale score and the categories (1 > 2 > 3 > 4 > 5) was 0.0674, P = 0.530.

Neither the analysis by groups nor the Spearman correlation across all categories supported our hypothesis that higher Grit scale scores would be associated with better adherence and outcomes. The failure of the Grit scale score to predict adherence to voice therapy and outcomes emphasizes the need for further research to find a metric that will help predict and improve patient adherence with voice therapy and voice outcomes. Further research is needed to determine why it was unable to be predictive and to confirm or refute our findings.