Epstein, Ruth; (1998) The impact of botulinum toxin injections in adductor spasmodic dysphonia: A cross sectional and longitudinal study. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

This cross-sectional and longitudinal study focuses on (a) the impact of botulinum toxin injections on patients with adductor spasmodic dysphonia; (b) the psychosocial changes resulting from botulinum toxin injections over an eight month period, during which the patients underwent two injections; and (c) the influence of psychosocial factors on outcome. The study also examines a group of subjects with functional dysphonia, which was initially intended as a comparative group. The Voice Disability Questionnaire (VDQ) used in this study to assess disability associated with voice impairment consisted of five components: social isolation, negative communication, public avoidance, limited understanding and communication difficulty Disability, as measures by the VDQ, showed fluctuation in relation to intervention Five components were derived from the Voice Impairment Coping Questionnaire. These were physical avoidance, information seeking, social comparison/distraction, finding new meaning and religion/wishful thinking. The study confirms the role of coping as a mediator between disease process and outcome. Other variables examined over time were anxiety, self-esteem, depression, health locus of control, social support, expectations and satisfaction. Prediction of voice disability following first and second botulinum toxin injections suggested that improvement can be reliably predicted from coping, health locus of control, age and marital status, measured one week to three months earlier. Prediction of psychological well-being suggested that coping, voice disability and health locus of control can predict changes in depression, anxiety and self-esteem following intervention.

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