Tele-rehabilitation in voice disorders during the pandemic: a consensus paper from the French Society of Phoniatrics and Laryngology.

OBJECTIVES: To establish a consensus protocol for telerehabilitation in speech therapy for voice disorders. METHODS: The study was conducted according to a modified Delphi method. Twenty speech therapist or laryngologist experts of the French Society of Phoniatrics and Laryngology assessed 24 statements of voice telerehabilitation with a 10-point visual analog scale ranging from 1 (totally disagree) to 10 (totally agree). The statements were accepted if more than 80% of the experts rated the item with a score of ≥ 8/10. The statements with ≥ 8/10 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. RESULTS: The French Society of Phoniatrics and Laryngology experts validated 10, 6, and 2 statements after the first, second and third voting round, respectively. Seven statements did not reach agreement threshold and were rejected. The validated statements included recommendations for setting (N = 4), medical/speech history (N = 2), subjective voice evaluations (N = 3), objective voice quality measurements (N = 3), and voice rehabilitation (N = 5). The experts agreed for a follow-up consisting of combined telerehabilitation and in-office rehabilitation. The final protocol may be applied in context of pandemic but could be assessed out of pandemic period for patients located in rural regions. CONCLUSIONS: This Delphi study established the first telerehabilitation protocol of the French Society of Phoniatrics and Laryngology for patients with voice disorders. Future controlled studies are needed to assess its feasibility, reliability, and the patient perception about telerehabilitation versus in-office rehabilitation.

Inter-rater Reliability of the Reflux Sign Assessment-10 (RSA-10).

OBJECTIVE: To evaluate the inter-rater reliability and internal consistency of the Reflux Sign Assessment-10 (RSA-10) among otolaryngologists and speech therapists with various experiences. METHODS: Six experts (2 otolaryngologists, 2 speech-therapists, and 2 speech-therapist students) rated 300 clinical images of oral, laryngeal, and pharyngeal signs from patients with laryngopharyngeal reflux disease diagnosis at the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring. Inter-rater reliability and internal consistency were evaluated with Intraclass Correlation (ICC) and Cronbach-α. The severity of scores was compared between judges. The intra-rater (test-retest) reliability was evaluated with the Spearman correlation coefficient. RESULTS: The pictures of 40 patients were included. There were 18 females and 22 males. The mean age was 52.6 ± 13.9 years. The Cronbach-α was 0.854, which indicates a high internal consistency between judges. The overall ICC was 0.787 (95% CI: 0.715-0.845; P = 0.001). The ICC varied among judges with the highest value for students (ICC = 0.960) and SLP seniors versus students (ICC = 0.805). The severity of RSA-10 rating scores was influenced by the number of reflux patients seen (rs =-0.941; P = 0.001) and the number of fiberscope examinations performed (rs =-0.812; P = 0.049). The RSA-10 was more severely scored by speech therapists with the least experience compared to otolaryngologists with the most experience in fiberscope/reflux patient assessment. CONCLUSION: The RSA-10 demonstrated adequate global ICC and internal consistency among otolaryngologists and speech therapists with various degrees of experience. The assessment of RSA was influenced by the fibroscopy experience, and the number of reflux patients seen.