How Is Effort Defined in Communication Sciences and Disorders? A Systematic Review of Literature

This systematic literature review aims to develop a comprehensive understanding of effort as a multidimensional construct in individuals with impaired swallowing and/or spoken communication.

A comprehensive literature search was conducted across three databases: PubMed/MEDLINE, Embase, and CINAHL, covering publications from 1966 to 2024. The search included terms related to communication effort, speech effort, vocal effort, swallowing effort, and articulatory effort. A total of 1,226 publications were initially identified, with 131 meeting the inclusion criteria for full-text review. Methodological quality assessment was performed to evaluate the rigor and reliability of the studies included in the review. Given the diverse types of articles and the broad inclusion criteria, assessing the quality was challenging but necessary to ensure a comprehensive synthesis of the concept of effort. This assessment helps identify strengths and weaknesses in the current research, guiding future studies toward more standardized and robust methodologies.

As was expected, the review identified that effort in communication sciences and disorders is a multifactorial concept involving physical, cognitive, emotional, and physiological dimensions. Definitions and assessment methods varied across different types of effort, with vocal effort being the most frequently studied. The quality of the publications varied, with 8% rated as strong evidence, 34% as moderate, and 57% as weak.

This review identifies conceptual fragmentation and measurement inconsistency in how effort is defined and operationalized across domains in communication sciences and disorders. By thematically synthesizing the literature, the review reveals a need for more integrated theoretical models and standardized assessment frameworks to advance clinical practice and research in this area. While vocal effort was the most frequently studied type, the definitions and assessment methods varied widely. The quality of the reviewed publications was diverse, with only 8% rated as strong evidence.