Voice treatment in Parkinson’s disease: patient perspectives

Figures & data

Table 1 Summary of treatment studies incorporating patient perspectives and/or self-report measures

Study	n	Study design	Voice treatment	Outcome measures	Self-report/patient perspective findings	Level of evidence
Whitehead^Citation33	4 pwPD, 4 spouses	Semi-structured Interview pwPD: Effect (physical) of communication changes & perception of effect Spouses: perspective of communication changes	N/A	N/A	pwPD expressed changes to “identity”: “communication”’; “psychological”; “social changes”; & “how I used to be”	N/A
Miller et al^Citation2	168 pwPD, 47 carers	Survey Questionnaire Views re communication & swallowing Changes & support they envisage needing	N/A	N/A	Generally positive experience re SLT Not everyone who wanted SLT received it Suggestions from pwPD re service issues	N/A
Searl et al^Citation65	15 pwPD	Feasibility study	8-week voice group “mimicking“ LSVT® Weekly 90 minute session, 8 consecutive weeks)	Questionnaire pwPD VHI Vocal intensity (dB) F0 MPT	Answered 7 questions (voice/speech change, strategies to increase intelligibility, change in amount of talking, focus & what not like about group) Total mean±scores pre-post treatment 50.40 ±22.49-35.80±20.79, P=0.004)	Level 3
Elefant et al^Citation66	10 pwPD	Feasibility, repeated study Group music therapy xl group	Voice & singing therapy 60 minutes weekly x20 consecutive weeks	VHI Speaking Singing Depression	Total mean scores pre-post treatment (22.4-24.34, P=0.96)	Level 3
Hal pern et al^Citation59	16 pwPD, 8 carers	RCT Immediate treatment (n=8) Delayed treatment (n=8)	LSVT® face-to-face with assistive technology (LSVT companion)	VHI LSVT VAS (carer) CETI-M (carer) SPL Perceptual rating of sentence pairs	Total mean±scores Immediate group: 45.6 ±20.9-36.6± 18.3-3 1,0± 13.3 (n/s) Delayed group: 43.1 ± l4.9-34.0± 13.1 -42.8±20.3 (n/s)	Level 3
Shih et al^Citation67	15 pwPD	Pilot open label	Group choral singing 12×90 minutes/weekly sessions	VHI VRQoL SPL (connected speech) Max cued volume & phonation time /a/ Average speaking F0 Pitch range S/Z ratio	Total mean±scores 43.7±22.2—47.0± 15.4—47.9 ±21.0 (P=0.84) Total score 69.2± 18.0-70.6± 19.4-68.1 ±24.0 (P=0.90)	Level 3
Simberg et al^Citation64	6 pwPD, 4 carers	Prospective 15 day in-patient rehabilitation course (10 & 5 days, separated by 3 month break) Individual (10×30 minutes) & Group (9×60 minutes) Spouses of 4 pwPD attended last 2 days of part 1 of course	Proprioceptive awareness, Vocal loudness intonation (LSVT approach)	VAPP pwPD Auditory perceptual Voice Quality (GRBASI) Acoustic (F0 in speech) SPL (reading & speech)	Total mean ± scores 83±35-63±57-65±62 (p=0.294)	Level 3
Spurgeon et al^Citation56	9 pwPD	Retrospective Semi-structured Interviews (telephone)	NHS 6-8 sessions ×60 minutes (not described) LSvt® 16 sessions ×60 minutes	Qualitative thematic analysis findings	Four key themes emerged Emotional impact of therapy Physical effects Practical concerns Expectations	N/A
Wight and Miller^Citation60	33 pwPD, 23 carers	Retrospective Clinical audit	LSVT®	VHI Carer VAS ratings SPL (prolonged vowels, reading, monolog)	Total median (IQ R) scores pre-post: 54 (69-33) - 29 (43-12) P<0.001 12 months: 30 (42-25) P=0.01 24 months: 34 (45-22) P=0.173	Level 4
Dias et al^Citation63	20 pwPD	Prospective	Telerehabilitation LSVT-X	Structured questionnaire (4 questions: satisfaction with online approach & quality of audio/video recording Voice quality rating	Online approach relative to face-to-face: 100% satisfied Satisfaction with online treatment: 80% very satisfied; 20% satisfied	Level 3
Stegemoller et al^Citation68	27 pwPD	Prospective pilot	Group Therapeutic Singing High dosage (twice weekly) Low dosage (once weekly) X8 weeks	V-RQoL Voice (intensity, duration, range) Respiratory (MIP & MEP) Health QoL	Total mean±scores pre-post High dosage: 22.2±2.9-1 7.2±2.3 Low dosage: 18.4±2.3-1 8.1 ±2.2 Pre-post testing: P=0.008 Interaction effect: P=0.017	Level 3
Yorkston et al^Citation55	24 pwPD (community dwelling)	Interview (face-to-face semi-structured) Qualitative Impact of communication dis-order Some had/had not treatment	N/A	N/A	Two major themes: Speaking (physical & cognitive effort in a social context) Treatment Positive experiences Dissatisfaction (speech drills, exercises, lack of focus on social aspects of communication)	N/A
Stegemöller et al^Citation78	20 pwPD	Interview Qualitative content analysis	Group therapeutic singing x8 weeks (1-2 sessions weekly) Vocal exercises followed by group singing	N/A	PwPD enjoyed singing in a group format, regarded group as fun, social, and engaging, appreciated fellowship with other pwPD, felt more like a social or support group Reported improvements in breathing, and loud speaking	N/A
Moya-Galé et al^Citation61	15 pwPD	Prospective	LSVT®	VHI Conversational intelligibility score	VHI total mean±scores pre-post-1 month 37.54±27.67-29.54±24.37-29.98±22.27 (not significant)	Level 3
Ramig et al^Citation62	81 pwPD 25 HC	Prospective un-blinded RCT LSVT LOUD LSVT ARTIC (articulation) UNTXPD (untreated PD)	LSVT®	CETI-M SPL (reading, spontaneous speech)	Median (IQR) scores Change baseline-1 month: 13 (0,21) P=0005 Change baseline-7 months: 8 (2,15) P=0.0011	Level 2
Sackley et a I^Citation74	89 pwPD	Pilot 3-arm RCT Feasibility study	LSVT® SLT (NHS) Control (No intervention)	VHI V-RQoL Additional voice,speech, QoL measures	VHI total mean±scores pre-3 months Mean difference (95% Cl) LSVT: 42.2±20.2-33±22.4 NHS: 42±25.5-36±2l .2 Control: 42±21,0-46±25.1 LSVT vs Control: -12.5 (-26.2 to 1.2) NHS vs Control: -9.8 (-23.2 to 3.7) V-RQoL total mean±scores pre-3 months Mean difference (95% Cl) LSVT: 20±8.9-18±7.8 NHS: 20±8.3-19±5.6 Control: 21 ±7.1 -22±8.0 LSVT vs Control: -3.5 (-8.1 to 1.1) NHS vs Control: -3.2 (-7.1 to 0.7)	Level 2

Abbreviations: Fo, fundamental frequency; PD, Parkinson’s disease; pwPD, people with PD; RCT, randomized controlled trial; VHI, Voice Handicap Index; V-RQoL, Voice Related Quality-of-Life Measure; QoL, quality-of-life; NHS, National health Service; N/A, not applicable; HC, healthy controls; CETI-M, CETI-M,Modified Communication Effectiveness Index; MPT, maximum phonation time; MIP, maximum inspiratory pressure; MEP, maximum expiratory pressure; SPL, sound pressure level; S/Z, S/Z ratio; VAPP, voice activity and participation profile; VAS, visual analog scale; SLT, speech and language therapy.

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