Telepractice or In-Person? A Randomized Controlled Trial of Vocal Warm-Up and Vocal Hygiene for Teachers

This randomized controlled trial investigated the effectiveness of vocal hygiene education and structured vocal warm-up exercises in improving voice quality and reducing uncomfortable throat sensations (physical discomfort, pain, and fatigue) among teachers, comparing telepractice and in-person delivery methods.

Twenty female classroom teachers from public elementary schools (mean age = 41.3 ± 5.77 years) were randomly assigned to two groups: one received the intervention via telepractice, and the other through in-person delivery. The intervention consisted of vocal hygiene education and structured vocal warm-up exercises. Outcome measures included acoustic voice analysis, auditory-perceptual evaluation, and three validated self-report instruments targeting physical vocal discomfort, voice-related pain, and vocal fatigue. Data were analyzed using the Wilcoxon signed-rank test for within-group comparisons and the Mann-Whitney U test for between-group differences.

Both in-person and telepractice interventions led to measurable improvements in vocal function. In auditory-perceptual assessments, the in-person group showed significant reductions in severity scores for sustained vowels (MD = -8.5, P = 0.011) and connected speech (MD = -7.22, P = 0.041), while the telepractice group exhibited comparable but non-significant changes. Acoustic analyses revealed significant improvements in shimmer and HNR for both groups, with the in-person group showing greater gains in HNR for vowel /a/ (+6.04 dB, P = 0.005) and jitter reduction for vowel /i/ (-0.158%, P = 0.047). Self-reported vocal tract discomfort and pain scores decreased significantly post-treatment, with the telepractice group demonstrating a greater reduction in discomfort frequency (MD = -8.5, P = 0.005). Voice Fatigue Index scores improved across all subscales in both groups, with total scores decreasing from 29.5 to 19.6 (P = 0.005) in the in-person group and from 28.2 to 21.3 (P = 0.009) in the telepractice group. No significant between-group differences were observed, indicating comparable efficacy of both delivery modalities.

This study demonstrated that both telepractice and in-person delivery of vocal hygiene education and structured warm-up exercises are effective in enhancing vocal function among teachers. Significant improvements were observed across auditory-perceptual, acoustic, and self-reported outcomes, with no statistically significant differences between the two modalities. These results support the clinical viability of telepractice as an accessible and equally effective alternative to traditional in-person voice therapy, particularly for teachers as a large population of professional voice users.