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RTSS-Voice: Application to everyday clinical care (Wolfberg et al., 2023)

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posted on 2023-12-15, 23:17 authored by Jeremy Wolfberg, John Whyte, Patricia Doyle, Shirley Gherson, Jason Muise, Brian Petty, Carol Jorgensen Tolejano, Robert E. Hillman, Tara Stadelman-Cohen, Jarrad H. Van Stan

Purpose: Rehabilitation intervention descriptions often do not explicitly identify active ingredients or how those ingredients lead to changes in patient functioning. The Rehabilitation Treatment Specification System (RTSS) provides guidance to identify the critical aspects of any rehabilitation therapy and supported the development of standardly named ingredients and targets in voice therapy (Rehabilitation Treatment Specification System for Voice Therapy [RTSS-Voice]). This study sought to test the content validity of the RTSS-Voice and determine if the RTSS-Voice can be used to identify commonalities and differences in treatment (criterion validity) across clinicians in everyday clinical practice.

Method: Five speech-language pathologists from different institutions videotaped one therapy session for 59 patients diagnosed with a voice or upper airway disorder. Specifications were created for each video, and iterative rounds of revisions were completed with the treating clinician and two RTSS experts until consensus was reached on each specification.

Results: All 59 sessions were specified without the addition of any targets or ingredients. There were two frequent targets: (a) increased volition and (b) decreased strained voice quality. There were three frequent ingredients: (a) information regarding the patient’s capability and motivation to perform a therapeutic behavior, (b) knowledge of results feedback, and (c) opportunities to practice voicing with improved resonance and mean airflow. Across sessions treating vocal hyperfunction, there was large variability across clinicians regarding the types and number of treatment components introduced, types of feedback provided, and vocal practice within spontaneous speech and negative practice.

Conclusions: The RTSS and the RTSS-Voice demonstrated strong content validity, as they comprehensively characterized 59 therapy sessions. They also demonstrated strong criterion validity, as commonalities and differences were identified in everyday voice therapy for vocal hyperfunction across multiple clinicians. Future work to translate RTSS principles and RTSS-Voice terms into clinical documentation can help to understand how clinician and patient variability impacts outcomes and bridge the research–practice gap.

Supplemental Material S1. Vocal hyperfunction specifications.

Supplemental Material S2. All other diagnoses specifications.

Wolfberg, J., Whyte, J., Doyle, P., Gherson, S., Muise, J., Petty, B., Jorgensen Tolejano, C., Hillman, R. E., Stadelman-Cohen, T., & Van Stan, J. H. (2023). Rehabilitation treatment specification system for voice therapy: Application to everyday clinical care. American Journal of Speech-Language Pathology, 33(2), 814–830.


This work was supported by National Institute on Deafness and Other Communication Disorders and Office of Behavioral and Social Sciences Research Grants R21 DC016124 and R01 DC020247 (principal investigator: Jarrad Van Stan).