Comparison of Voice Stimulability Testing in Telehealth and In-Person Formats

Telehealth is a useful platform for behavioral voice evaluation and therapy and has been shown to be noninferior to in-person services. However, in the existing literature, therapy outcomes are only compared after a complete course of voice therapy. Voice stimulability testing is an important part of the behavioral voice evaluation and can guide treatment decisions, estimate prognosis for improvement, and facilitate the patient's readiness for change. It is unclear whether immediate changes that occur during stimulability testing differ between in-person and telehealth delivery models. This study examines whether stimulability ratings differ significantly between in-person and telehealth voice evaluations.

Charts from 86 patients who underwent a voice evaluation via telehealth and 86 patients who participated in an in-person evaluation were reviewed. Telehealth and in-person patients were matched based on voice diagnosis (structural, functional, and neurological) and which clinician they saw. Chart review included documentation of age, diagnosis, clinician, degree of overall stimulability (low, medium, and high), and degree of stimulability to specific tasks. Multinomial logistic regression was completed to determine whether there were differences in stimulability levels between practice modalities when controlling for age.

The overall logistic regression model was not statistically significant (P = 0.091). There were no statistically significant differences in overall stimulability level between patients undergoing in-person evaluation and those who participated in telehealth evaluations, even when controlling for age.

Voice stimulability testing can impact a clinician's therapeutic and prognostic decisions, so it is important that stimulability can be judged consistently across all treatment settings. The results from this study found that estimates of stimulability did not differ between telehealth and in-person modalities. These findings provide further support for the use of telehealth as a noninferior modality for voice therapy services.