Speech-Language Pathology Intervention Protocol for Individuals with Cervical Spinal Cord Injury - Content Validation

To validate the content of a speech-language pathology intervention protocol for respiratory and voice training in individuals with spinal cord injury, based on scientific evidence and expert consensus.

This methodological study comprised two phases: protocol development and content validation. The development phase followed the SEaRCH Expert Panel Process and the rehabilitation treatment specification system, supported by a systematic literature review to define therapeutic targets, ingredients, mechanisms of action, and dosages. The initial protocol was developed by three experienced voice specialists and structured according to identified respiratory and vocal deviations in individuals with cervical spinal cord injury. Content validation was conducted using the Delphi technique. Sixty-seven speech-language pathologists with expertise in voice and/or neurological disorders were invited, and 22 experts met the inclusion criteria and completed the first round. Agreement was assessed using the percentage of consensus, with a predefined threshold of ≥80%. Items that did not reach a consensus were revised and resubmitted for a second round. Content validation was conducted using the Delphi technique over two rounds. Sixty-seven speech-language pathologists with expertise in voice and/or neurological rehabilitation and at least 10 years of professional experience were invited; 22 experts completed the first round. Experts evaluated each protocol component through structured questions (eg, "Do you consider this intervention adequate for managing this deviation?"), with dichotomous responses (yes/no) and space for justification and suggestions. Items not reaching consensus in the first round were revised based on expert feedback and resubmitted for the second round.

In the first Delphi round, four of the six protocol components reached the consensus criterion (81.81-100%). Vocal instability and frequency modulation did not achieve adequate agreement (68.18% and 69.18%, respectively), mainly because of concerns regarding the exercise load and dosage. After adjustments based on expert feedback, both items reached a consensus in the second round (95.65% and 91.30%). The final protocol consisted of six therapeutic targets with clearly defined ingredients, execution guidelines, and standardized dosages.

The content validation process confirmed the adequacy and clarity of a structured speech-language pathology intervention protocol for individuals with spinal cord injuries.