University of Oulu

Pirilä, S., Saarentaus, P., Ansamaa, T., Niemitalo-Haapola, E., Yliherva, A., & Rantala, L. (2022). A randomized controlled trial with female teachers: Are there differences between and within the outcomes in voice therapy groups with and without carryover strategies? Journal of Voice.

A randomized controlled trial with female teachers : are there differences between and within the outcomes in voice therapy groups with and without carryover strategies?

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Author: Pirilä, Sirpa1; Saarentaus, Paula1; Ansamaa, Terhi2;
Organizations: 1Faculty of Social Sciences, University of Tampere, Tampere, Finland
2Department of Otorhinolaryngology, Oulu University Hospital, Oulu, Finland
3Faculty of Humanities/Logopedics, Child Language Research, University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2023-01-09


Purpose: We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy).

Method: A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f₀, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]).

Results: No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f₀ increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f₀ decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls’ eight-week non-therapy period (P = 0.003).

Conclusions: The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group’s voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.

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Series: Journal of voice
ISSN: 0892-1997
ISSN-E: 1873-4588
ISSN-L: 0892-1997
Volume: In press
DOI: 10.1016/j.jvoice.2022.06.029
Type of Publication: A1 Journal article – refereed
Field of Science: 616 Other humanities
3121 General medicine, internal medicine and other clinical medicine
Copyright information: © 2022 The Authors. Published by Elsevier Inc. on behalf of The Voice Foundation. This is an open access article under the CC BY license (