Developing and testing a smartphone application to enhance adherence to voice therapy

Research Objectives: The current research project's objective was to develop and test a delivery model that overcomes the barriers that influence voice therapy adherence.

Design: This was a two-part proof-of-concept study consisting of a randomized clinical trial and usability assessment.

Setting: The study was completed in a laboratory setting at the University of Kentucky.

Participants: Thirty-three participants over the age of 18 years were recruited for the study and were randomly assigned to the traditional or app group. Exclusion criteria included previous history of head and neck surgery or cancer, smoking, vocal fold lesion and neurogenic disorders. Of these, 25 participants completed the study(traditional group, n= 13; app group, n=12).

Interventions: A prototype of an mHealth-based smartphone application was developed using the framework of an evidence-based voice therapy program. A randomized clinical trial was then executed to beta-test the prototype in normophonic non-treatment-seeking individuals. Study participants were randomized to one of two groups, 1) Traditional voice therapy delivery (traditional group), 2) App-enhanced voice therapy delivery (app-group). Voice therapy intervention delivered was the Vocal Function Exercise program developed by Stemple (1995).

Main Outcome Measures: The primary outcome measure was adherence to the home-practice measure by calculating the number of missed home-practice tasks. Secondary outcome measures included percentage of maximum of phonation time goal achieved.
For the usability assessment, a three-step mixed-method approach consisting of surveys, "think aloud" protocol, and a focus group was employed.

Results: The primary outcome measure was compared using an independent sample t-test. The traditional group missed an average of 409 tasks ,and the app group missed an average of 202 tasks. This difference was statistically significant, p< 0.04.

Conclusions: Using an app-enhanced voice delivery method improved adherence to the home-practice of voice therapy. Data from usability testing showed favorable app features to complete home-practice. However, participants also had several suggestions for app improvement, which will be incorporated in the updated version.

Author(s) Disclosures: The first two authors receive a salary from University of Kentucky. The third author is professor emeritus at the University of Kentucky.