Voice Research and Treatment: A UK Perspective In recent years, the United Kingdom (UK) has seen a considerable increase in clinical and research resources in voice disorders (Carding, 2000). This expansion is largely due to additional government funding for head and neck cancer services and the general expansion of voice clinic services (Carding, 2003). The voice pathologist’s ... World Beat
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World Beat  |   May 01, 2006
Voice Research and Treatment: A UK Perspective
Author Notes
  • Paul Carding, is professor of Voice Pathology at University Medical School and Freeman Hospital, Newcastle upon Tyne, United Kingdom. Contact him at paul.carding@ncl.ac.uk.
    Paul Carding, is professor of Voice Pathology at University Medical School and Freeman Hospital, Newcastle upon Tyne, United Kingdom. Contact him at paul.carding@ncl.ac.uk.×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Speech, Voice & Prosody / World Beat
World Beat   |   May 01, 2006
Voice Research and Treatment: A UK Perspective
The ASHA Leader, May 2006, Vol. 11, 6-7. doi:10.1044/leader.WB1.11072006.6
The ASHA Leader, May 2006, Vol. 11, 6-7. doi:10.1044/leader.WB1.11072006.6
In recent years, the United Kingdom (UK) has seen a considerable increase in clinical and research resources in voice disorders (Carding, 2000). This expansion is largely due to additional government funding for head and neck cancer services and the general expansion of voice clinic services (Carding, 2003).
The voice pathologist’s role and the services the clinician provides in UK otolaryngological practice are developing rapidly (e.g. Carding 2003a, b). It is acknowledged that highly specialized clinical practice and clinical research are necessary (and inevitable) partners. Specialist clinicians are expected to generate clinical questions and to seek the means to answer them (i.e., via good-quality research).
A large majority of UK voice research is done by practicing clinicians and, subsequently, most of the topics are of direct clinical value. We believe that this arrangement is crucial for the future of the specialty and indeed for the profession. The principles of evidence-based practice are firmly established in our national clinical guidelines (Taylor-Goh, 2004).
For all of these reasons, it is not surprising that one main area of UK research productivity relates to treatment efficacy/effectiveness and its corollary-treatment outcome measurement.
Professional Infrastructure
The infrastructure of post-graduate continuing education for speech/voice pathologists in the UK may well include courses in the “basic tools” of clinical research-that is, critical appraisal of published research, research design methodology, literature searching, systematic reviews, and publication skills.
These post-graduate courses are seen as a legitimate way of enhancing one’s clinical skills. Expert practice is about the judicious use of “best-evidence” to inform clinical decisions. In order to judge the quality of the published evidence, voice pathologists must be skilled in appropriately evaluating what they read. Where evidence doesn’t exist, clinical research projects are being generated.
The Royal College of Speech and Language Therapists is keen to ensure that these research skills, uniformly taught at the undergraduate level, remain central to clinicians as they mature. A growing number of specialist clinical posts in the UK now have a research component as a designated part of the job. There are now two part-time Voice/Dysphonia master’s programs that have a strong research component at London and Newcastle upon Tyne.
Voice Research in the UK
UK publications in speech and language treatment generally have grown by more than 50% in the past 15 years. The UK is the second most productive country of research output, generating 12% of the world’s publication output (Lewinson & Carding, 2003).
Voice research is one area of increasing strength. According to Robey’s five-phase model of clinical outcome research (Robey, 2004), voice research has confidently entered into phases 3 (large-scale efficacy studies) and 4 (effectiveness studies). Pring (2004) suggests that this may be because the field of voice disorders enjoys (relative to many other areas of speech and language pathology) clear(er) diagnostic categories, better agreement on treatment aims, and more defined treatment outcome measures.
The UK has provided some of the seminal treatment efficacy studies in non-organic voice disorders. These include one of the first major prospective group studies (Carding, Horsley, & Docherty, 1999) and the first randomized controlled trial (MacKenzie et al., 2001). Partly due to these studies, the treatment of non-organic dysphonia, the most common type of voice disorder, is considered efficacious. Other significant UK treatment effectiveness studies have followed (e.g. Rattenbury, et al., 2004; Gillivan-Murphy et al., 2005).
As a natural corollary to this clinical focus to our research activity, a number of UK publications have followed in the refinement and usage of voice outcome measures. These include publications about new patient-report instruments (Deary et al., 2003), patient self-ratings of voice quality (Lee et al., 2005), studies of the reliability and sensitivity to change of existing instrumental (acoustic) voice measurements (Carding et al., 2004) and the design of voice assessment material (Abberton, 2005).
And the Future?
With continued close liaison between clinical and research activity, voice pathologists look well placed to further contribute to the evidence base of voice disorders and its treatment.
The juxtaposition of clinical and research skills means that further studies of treatment effectiveness (rather than efficacy) are certainly possible and desirable. These ventures are likely to involve multiple-center, and multiple-clinician studies. These methodological designs will enable analysis of otherwise uncommon disorders and examine the effectiveness of voice therapy practice (i.e., treatment programs conducted by different clinicians) rather than the effectiveness of an individual voice therapist.
There are also indications that the psychological aspects of voice disorders require considerable research attention. Previous efficacy studies have suggested that psychological features do not improve following traditional voice therapy (e.g. MacKenzie et al., 2001). A question remains as to whether voice therapy should reasonably aim to change these aspects of the patient and, if so, how.
Finally, a group of UK voice pathologists are planning to address the issue of the long-term effect of voice treatment-an area long neglected in the world literature. Watch this space!
References
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May 2006
Volume 11, Issue 7