嗓音障碍团体治疗的系统综述：我们是否在优化团体治疗模式？

文献信息

中文摘要

目的： 尽管嗓音障碍对社会和个人有显著影响，但嗓音治疗的获取和依从性仍是需要解决的挑战。团体嗓音治疗已被提出用于提高获取性和动机，但其疗效和效果，尤其是与个体治疗相比，仍需明确。本综述的目的是综合关于成人发声障碍团体嗓音治疗的实证数据，考察（1）对客观和主观嗓音测量的短期和长期效果，（2）依从性，以及（3）患者观点，并在可能时与个体治疗进行比较。
方法： 在CINAHL、MEDLINE、LLBA、PsycInfo和Web of Science中进行了文献检索。纳入涉及接受行为（非手术、非药物）团体嗓音治疗的成人发声障碍研究。使用QualSyst工具评估方法学质量。结果按照PRISMA指南报告。
结果： 16篇文章报告了15项独立研究符合纳入标准。团体通常包括3-15名参与者，每周会面45-90分钟，持续3-8周。在不同设计中，报告了声学、空气动力学、听觉感知、喉部和患者报告结局的改善，尽管结果不一。团体治疗与个体治疗之间的直接比较未显示任一模式的持续优势。与无干预对照的比较支持团体治疗在选定结局方面的益处。六项研究报告了长达12个月的长期结局，若干改善得以维持。治疗出席率通常较高，其他结局包括焦虑减轻、工作功能改善和支持性团体氛围。
结论： 团体嗓音治疗可在发声障碍个体中产生多维改善，尤其是功能亢进性病因者。然而，比较研究数量有限且缺乏等效性或非劣效性设计，无法就其与个体治疗的可比有效性得出明确结论。需要进一步标准化报告干预细节以及更多比较性随机对照试验，以完善最佳实践并阐明团体模式的主动机制。

英文摘要

OBJECTIVES: Despite the significant societal and personal impacts of voice disorders, access and adherence to voice therapy remain challenges to address. Group voice therapy has been proposed to enhance access and motivation, yet its efficacy and effectiveness, especially compared to individual therapy, should be clarified. The objective of this review was to synthesize empirical data on group voice therapy for adults with dysphonia, examining (1) short- and long-term effects on objective and subjective voice measures, (2) adherence, and (3) patient perspectives, compared, when possible, to individual therapy.
METHOD: A literature search was conducted in CINAHL, MEDLINE, LLBA, PsycInfo, and Web of Science. Studies involving adults with dysphonia receiving behavioral (non-surgical, non-pharmacological) group voice therapy were included. Methodological quality was appraised using the QualSyst tool. Results were reported in accordance with the PRISMA guidelines.
RESULTS: Sixteen articles reporting 15 independent studies met eligibility criteria. Groups typically included 3-15 participants and met weekly for 45-90 minutes over 3-8 weeks. Across designs, improvements were reported in acoustic, aerodynamic, auditory-perceptual, laryngeal, and patient-reported outcomes, although findings were mixed. Direct comparisons between group and individual therapy did not demonstrate a consistent advantage of either modality. Comparisons with no-intervention controls supported benefits of group therapy for selected outcomes. Six studies reported long-term outcomes up to 12 months, with several improvements maintained. Treatment attendance was generally high, and additional outcomes included reduced anxiety, improved work functioning, and a supportive group climate.
CONCLUSIONS: Group voice therapy can produce multidimensional improvements in individuals with dysphonia, particularly of a hyperfunctional etiology. However, the limited number of comparative studies and absence of equivalence or non-inferiority designs preclude definitive conclusions regarding its comparable effectiveness to individual therapy. Further standardized reporting of intervention details, as well as additional comparative RCTs are needed to refine best practices and clarify the active mechanisms of the group modality.