Exploring Factors Impacting Engagement in Speech Pathology Intervention for Inducible Laryngeal Obstruction

Janine Mahoney; Anne Vertigan; Mark Hew; Jennifer Oates

doi:10.1016/j.jvoice.2024.03.008

Exploring Factors Impacting Engagement in Speech Pathology Intervention for Inducible Laryngeal Obstruction

J Voice. 2024 Apr 1:S0892-1997(24)00079-1. doi: 10.1016/j.jvoice.2024.03.008. Online ahead of print.

Authors

Janine Mahoney¹, Anne Vertigan², Mark Hew³, Jennifer Oates⁴

Affiliations

¹ Speech Pathology, La Trobe University, Melbourne, Victoria, Australia; Speech Pathology Department, The Alfred, Melbourne, Victoria, Australia. Electronic address: J.Mahoney@alfred.org.au.
² Speech Pathology, John Hunter Hospital, Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia; Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
³ Allergy, Asthma and Clinical Immunology Service, The Alfred, Melbourne, Victoria, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Speech Pathology, La Trobe University, Melbourne, Victoria, Australia.

PMID: 38565469
DOI: 10.1016/j.jvoice.2024.03.008

Abstract

Aim: Speech pathology is the first-line treatment for inducible laryngeal obstruction (ILO) and involves behavioral techniques to address symptoms and modify maladaptive laryngeal postures. Benefit from speech pathology is reliant on patients engaging in treatment sessions, regular home practice, and generalizing techniques to everyday activities. There is limited research exploring engagement in speech pathology treatment for ILO, particularly from the patient perspective. This study aimed to explore the experiences of living with ILO and how this experience may impact the way patients engage in speech pathology treatment.

Study design: Qualitative study.

Methods: Semistructured interviews were completed with seven participants exploring their experiences living with ILO, their diagnostic process and their experiences with speech pathology treatment. Data were analyzed using reflexive thematic analysis to determine shared meanings across participants and themes were developed.

Findings: Three major themes were identified - Life with ILO, Challenges of Speech Pathology Treatment, and What Matters to Me. Patients' reports of living with ILO and interacting with speech pathology suggested that these experiences impacted their readiness to start treatment and persist through the challenges of the treatment. Engagement appeared to be positively associated with significant ILO symptom burden and life impact, confidence in the diagnostic process, recommendation for speech pathology treatment, a tailored intervention by a patient-perceived expert in the field and working in a partnership with the speech pathologist to develop a sense of agency. Patients indicated their engagement was negatively influenced by competing time demands, social embarrassment when using symptom relief techniques and laryngeal exercises, and a low ILO symptom burden and life impact.

Conclusion: The reasons behind engagement in speech pathology treatment for ILO appear to be a complex interaction between previous experiences of living with ILO including the diagnostic process and the experience of speech pathology treatment. A patient-centered approach to therapy may help to maximize engagement by exploring readiness and expectations for treatment. The greater understanding of the patient experience provided through this study may allow speech pathologists to devise meaningful ways to maximize engagement in treatment for people with ILO.

Keywords: Adherence; Engagement; Inducible laryngeal obstruction; Paradoxical vocal fold movement; Speech pathology.