内收肌痉挛发声障碍(ADSD)研究的障碍,绑架者SD(ABSD),语音震颤(VT),肌张力障碍(MTD)缺乏选择这些疾病患者的标准。
为了确定不使用标准指南对ABSD患者进行分类的专家之间的协议,ADSD,VT,和MTD,并制定专家共识属性对患者进行分类研究。
从2011年到2016年,一项多中心观察性研究检查了在对ADSD患者进行分类时,盲目专家之间的一致性。ABSD,VT或MTD(首次研究)。随后,一项4期德尔菲法研究使用专家小组和46名社区专家的重复审查阶段,就用于对4种疾病患者进行分类的属性达成共识(第二项研究).该研究使用了178名临床诊断为ADSD的患者的便利样本,ABSD,VTMTD,声带麻痹/麻痹,心因性嗓音障碍,或继发于帕金森病的低张力。参与者年龄在18岁或以上,没有喉部结构性疾病或ADSD手术,并按照标准协议进行了语音和鼻喉镜检查视频记录。
遵循标准协议的语音和鼻喉镜检查视频记录。
4个地点的专家将178名患者分为11类。四位国际专家在观看语音和鼻喉镜检查录像后,使用相同的类别独立地对75名患者进行了分类,而没有指南。在观看语音/喉部任务的视频剪辑后,来自4个站点的每个成员还对来自其他站点的50名患者进行了分类。评分者κ小于0.40表明评分者对之间和招募地点之间的分类协议较差。因此,一个由13名专家组成的Delphi小组确定了语音和喉部运动属性,并对其进行了分类,ABSD,VT,和MTD,由46名社区专家审查。根据中位数属性排名,为每种疾病创建最终属性列表.
在没有指南的情况下对患者进行分类时,评分者的分类分布不同(似然比,χ2=107.66),评分者之间的协议很差,与网站类别的一致性很差。对于11个类别,最高的是34%,没有κ值大于0.26。在外部评估者对中,κ最高为0.23,一致性最高为38.5%。使用6个类别,最高的百分比一致性为73.3%,最高的κ为0.40。Delphi方法产生了18个属性,用于从言语和鼻喉镜检查中对疾病进行分类。
没有指南的专家在对患者进行分类研究时意见不一致,导致基于Delphi的Spasmodic发音障碍属性清单的开发,用于对ADSD患者进行分类,ABSD,VT,和MTD用于研究。
A roadblock for research on adductor spasmodic dysphonia (ADSD), abductor SD (ABSD), voice tremor (VT), and muscular tension dysphonia (MTD) is the lack of criteria for selecting patients with these disorders.
To determine the agreement among experts not using standard
guidelines to classify patients with ABSD, ADSD, VT, and MTD, and develop expert
consensus attributes for classifying patients for research.
From 2011 to 2016, a multicenter observational study examined agreement among blinded experts when classifying patients with ADSD, ABSD, VT or MTD (first study). Subsequently, a 4-stage Delphi method study used reiterative stages of review by an expert panel and 46 community experts to develop
consensus on attributes to be used for classifying patients with the 4 disorders (second study). The study used a convenience sample of 178 patients clinically diagnosed with ADSD, ABSD, VT MTD, vocal fold paresis/paralysis, psychogenic voice disorders, or hypophonia secondary to Parkinson disease. Participants were aged 18 years or older, without laryngeal structural disease or surgery for ADSD and underwent speech and nasolaryngoscopy video recordings following a standard protocol.
Speech and nasolaryngoscopy video recordings following a standard protocol.
Specialists at 4 sites classified 178 patients into 11 categories. Four international experts independently classified 75 patients using the same categories without guidelines after viewing speech and nasolaryngoscopy video recordings. Each member from the 4 sites also classified 50 patients from other sites after viewing video clips of voice/laryngeal tasks. Interrater κ less than 0.40 indicated poor classification agreement among rater pairs and across recruiting sites. Consequently, a Delphi panel of 13 experts identified and ranked speech and laryngeal movement attributes for classifying ADSD, ABSD, VT, and MTD, which were reviewed by 46 community specialists. Based on the median attribute rankings, a final attribute list was created for each disorder.
When classifying patients without
guidelines, raters differed in their classification distributions (likelihood ratio, χ2 = 107.66), had poor interrater agreement, and poor agreement with site categories. For 11 categories, the highest agreement was 34%, with no κ values greater than 0.26. In external rater pairs, the highest κ was 0.23 and the highest agreement was 38.5%. Using 6 categories, the highest percent agreement was 73.3% and the highest κ was 0.40. The Delphi method yielded 18 attributes for classifying disorders from speech and nasolaryngoscopic examinations.
Specialists without
guidelines had poor agreement when classifying patients for research, leading to a Delphi-based development of the Spasmodic Dysphonia Attributes Inventory for classifying patients with ADSD, ABSD, VT, and MTD for research.