A Systematic Review Of Group Therapy For Voice Disorders: Are We Optimizing The Group Modality?

Despite the significant societal and personal impacts of voice disorders, access and adherence to voice therapy remain challenges to address. Group voice therapy has been proposed to enhance access and motivation, yet its efficacy and effectiveness, especially compared to individual therapy, should be clarified. The objective of this review was to synthesize empirical data on group voice therapy for adults with dysphonia, examining (1) short- and long-term effects on objective and subjective voice measures, (2) adherence, and (3) patient perspectives, compared, when possible, to individual therapy.

A literature search was conducted in CINAHL, MEDLINE, LLBA, PsycInfo, and Web of Science. Studies involving adults with dysphonia receiving behavioral (non-surgical, non-pharmacological) group voice therapy were included. Methodological quality was appraised using the QualSyst tool. Results were reported in accordance with the PRISMA guidelines.

Sixteen articles reporting 15 independent studies met eligibility criteria. Groups typically included 3-15 participants and met weekly for 45-90 minutes over 3-8 weeks. Across designs, improvements were reported in acoustic, aerodynamic, auditory-perceptual, laryngeal, and patient-reported outcomes, although findings were mixed. Direct comparisons between group and individual therapy did not demonstrate a consistent advantage of either modality. Comparisons with no-intervention controls supported benefits of group therapy for selected outcomes. Six studies reported long-term outcomes up to 12 months, with several improvements maintained. Treatment attendance was generally high, and additional outcomes included reduced anxiety, improved work functioning, and a supportive group climate.

Group voice therapy can produce multidimensional improvements in individuals with dysphonia, particularly of a hyperfunctional etiology. However, the limited number of comparative studies and absence of equivalence or non-inferiority designs preclude definitive conclusions regarding its comparable effectiveness to individual therapy. Further standardized reporting of intervention details, as well as additional comparative RCTs are needed to refine best practices and clarify the active mechanisms of the group modality.