Pre- and Postoperative Voice Therapy for Benign Vocal Fold Lesions: Factors Influencing a Complex Intervention.

Objectives: (1) To describe factors influencing the content, timing, and intensity of pre- and postoperative voice therapy for patients undergoing phonosurgery for benign vocal fold lesions. (2) To understand experts' rationale for decisions made. (3) To critically analyze factors influencing intervention in relation to the wider literature in order to contribute to the development of a complex intervention.

Design: Qualitative interview study.

Setting: Multidisciplinary voice clinics in England.

Participants: Ten expert voice therapists with a mean of 22 years experience.

Main Outcome Measures: Participants were asked to describe factors influencing their current practice and views on optimum treatment for patients undergoing phonosurgery for benign vocal fold lesions. Data were analyzed using the Framework Method of thematic analysis.

Results: Factors influencing intervention related to four key themes. Pathophysiological, Patient, Therapist, and Service factors influenced the content, timing, and duration of the voice therapy provided. Consensus on core elements included delivering indirect and direct therapy preoperatively to manage underlying causative factors and address patient expectations. Postoperative intervention focused on indirect therapy to facilitate wound healing and direct therapy to improve vibratory characteristics of the vocal fold. Elements of therapy were highly individualized within participants according to the four themes above, but similarity between participants on broad parameters of intervention was high.

Conclusions: Expert voice therapists use direct and indirect methods pre- and postoperatively to treat patients with benign vocal fold lesions. Optimizing wound healing and mobilization of the epithelium postoperatively are concerns for expert voice therapists which distinguish postoperative patients from other dysphonic patients. This study provides an insight into the factors influencing clinician's intervention provision which can contribute to the development of an optimal pre- and postoperative voice therapy intervention. Further research to refine and test the effectiveness of an intervention is now required.