The role of quality‐of‐life instruments in predicting voice therapy dropout

OBJECTIVES/HYPOTHESIS: Voice therapy (VT) is essential to the successful management of voice disorders. Despite this, two-thirds of patients drop out of therapy before completion. In this study we examine whether responses to specific question items or domains from the Voice Handicap Index (VHI) are associated with VT compliance. STUDY DESIGN: Single-institution retrospective cohort study. METHODS: All patients presented to a tertiary care center between January 2011 and June 2016 with dysphonia. Patients were excluded if seen by speech language pathology (SLP) for preoperative assessment only, there was no order for therapy, or there was no documentation of therapy performed at outside facilities. Data collected included VHI responses, demographics, diagnosis, social history, and clinical exam. Patients were divided into three groups for analysis: 1) did not attend therapy, 2) partially completed therapy, or 3) completed therapy. RESULTS: Of 489 patients referred for VT, 36.2% did not attend, 36.0% partially completed VT, and 27.8% completed VT. Patients who did not attend had significantly lower scores in VHI, VHI-10, and each of the VHI domains. There was a significant difference in age between VT groups, with those electing to not attend representing older age. Patients who attended VT were more likely to use their voice for work (P = .015). There were statistically significant differences among the groups for six VHI question items. CONCLUSIONS: Understanding patient motivations, whether a patient uses their voice for work, and specific responses to the VHI questionnaire may allow clinicians to better understand patient engagement in voice therapy. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:2832-2837, 2018.