Abstract
Physiotherapy has the potential to benefit a wide range of people with voice and throat problems, in conjunction with existing Ear, Nose and Throat (ENT) and Speech Language Therapist (SLT) services. Yet as a niche area of physiotherapy practice, little is known about what this service might offer clients alongside other health professionals in a New Zealand setting and beyond. The purpose of this thesis was to explore the role of voice and throat physiotherapy as a clinical service, in order to more clearly define the place for physiotherapy in voice and throat care.
Design:
This thesis involved a narrative review followed by four original studies, underpinned by a pragmatic theoretic approach. A narrative review of the literature explored the role of physiotherapy in voice and throat care and helped develop the research questions explored in subsequent studies (Chapter 2). A retrospective case notes review explored the clinical characteristics of those presenting to voice physiotherapy with voice and throat problems (Chapter 3). This was followed by a qualitative study which explored the role and impact of voice physiotherapy in voice and throat care through semi structured interviews with those who had accessed the service (Chapter 4). The interviews were thematically analysed using an interpretive description approach. A second retrospective case notes review examined an ENT clinicians’ notes to explore the characteristics of individuals presenting for ENT care, and to evaluate the potential for this cohort to benefit from physiotherapy input (Chapter 5). A prospective observational case series of six individuals with Globus Pharyngeus was conducted to explore the clinical characteristics and outcomes of the cases, and to describe outcomes of those with Globus Pharyngeus over the course of physiotherapy management (Chapter 6). Lastly, an integrated discussion summarises and discusses key findings from this body of work.
Results:
The first retrospective case notes review showed that the typical participant accessing voice and throat physiotherapy was 35 years, 71% female, 81% singers, and 38% with problems more than three months since onset. A high prevalence of muscle related problems and wider issues were identified, consistent with the physiotherapy skill set.
The qualitative study derived four main themes from patient interviews indicating that the impact of physiotherapy went beyond physical and functional benefits, improving people’s understanding and facilitating individuals’ specific management. Participants described physiotherapy as complementary to existing services, providing additional value to people with a range of vocal issues.
The second retrospective case notes review of people presenting to ENT care indicated a current referral rate to physiotherapy of 9%, and a high prevalence of musculoskeletal findings on examination (41%). The current referral rate to physiotherapy likely reflects a minimum, reflecting limited availability of physiotherapy care for voice and throat issues. This suggests that between 9-41% of people presenting to ENT might benefit from physiotherapy input.
The prospective case series of six individuals with Globus Pharyngeus found laryngeal muscle tension across the cases, as well as concurrent symptoms linked to laryngeal muscular tension including chronic cough, voice and swallowing problems. The cases varied in complexity, and the approach described appeared to both manage that complexity and offer specific benefits described by participants. The findings and outcomes are encouraging for this challenging condition and will support future research.
Conclusion:
This thesis addresses a novel question; what is the role of physiotherapy in voice and throat care? The results from the mix of qualitative and quantitative studies indicate that there is a clear role for physiotherapy in the treatment of voice and throat problems, especially those with laryngeal muscle tension. The approach to voice and throat care that considers muscular tension at the larynx and wider contributing factors beyond the larynx that is offered by physiotherapists complements and adds to existing medical, speech language and other voice services, providing clients with more control and more avenues of treatment. Moving forward, physiotherapists wanting to contribute to voice and throat care will require training and support, and other professionals will need a greater awareness of what physiotherapy can offer. The findings in this thesis clearly indicate that physiotherapy has a valuable role to play that can positively impact a broad range of people with voice and throat problems.