Pre- and Post-operative Voice Therapy for Benign Vocal Fold Lesions: A feasibility Trial of the PAPOV Intervention

INTRODUCTION: Clinical management of benign vocal fold lesions is variable. Phonosurgery combined with pre- and post-operative voice therapy (PAPOV) may improve voice and quality-of-life outcomes, but the content of the voice therapy had previously not been defined or evaluated. We created the PAPOV intervention for adults with benign vocal fold lesions undergoing phonosurgery. It comprises seven essential and four additional intervention components. This study tested the feasibility of delivering PAPOV in the UK NHS. METHODS: A nonrandomized, multicenter feasibility trial was conducted in two UK NHS hospital sites. Measures of feasibility included recruitment, retention, and intervention fidelity. Multidimensional clinical and health economic outcomes were gathered to assess data completion rates and give preliminary indications of voice changes over time using standardized assessments. RESULTS: All feasibility objectives were met. In total, 41 patients were recruited to the trial with an attrition rate of 15% (n = 6). Intervention fidelity was high with 93% of participants receiving the seven essential components of the PAPOV intervention. Data collection for all clinical and health economic outcomes remained over 80% completion at each time point. There was evidence of statistically significant changes in all patient-reported [Voice Handicap Index (VHI), Vocal Tract Discomfort Scale (VTDS), and Reflux Symptom Index (RSI)], clinician-reported (CAPE-V), and acoustic (AVQI and ABI voice outcomes before and after treatment). There was no evidence of change in maximum phonation time (MPT) and pitch range. CONCLUSION: The PAPOV intervention appears feasible for delivery by voice specialist speech and language therapists. Patients tolerated and competed the intervention and preliminary indications suggest potential benefit for voice and quality of life. Further research including randomized controlled trials is required to establish clinical and cost-effectiveness research for this intervention.