Stages of Readiness in Patients With Dysphonia: A Proposal Based on Factor Analysis Using the URICA-V Scale

Abstract

In terms of treatment results, the readiness stage presents the best conditions for adherence to a therapeutic proposal, and it allows for an estimated disease prognosis and assistance with treatment monitoring. Patients with dysphonia who are treated using vocal rehabilitation (basically a behavioral program), regardless of disease etiology, can optimize their treatment by understanding the stages of behavioral change. To evaluate the accuracy of the components constituting the stages of readiness to change on the University of Rhode Island Change Assessment-Voice (URICA-V) scale using confirmatory factor analysis and internal consistency indices. This documentary study evaluated the records of 488 patients with dysphonia collected from a voice laboratory database. Most of the patients were Brazilian women with higher education who were single, nonprofessional voice users. The results of the URICA-V self-assessment questionnaire were analyzed to determine the patients' stage of readiness to change when vocal rehabilitation was proposed as a treatment. A descriptive and inferential statistical analysis was conducted using confirmatory factor analysis to determine the correlation between the questionnaire items and the stages of readiness. Of the eight items in the precontemplation stage, only four presented significant factor loading within that stage. Three items in the action stage did not present significant factor loading during that stage. The items in the contemplation and maintenance stages presented significant factor loadings within their respective stages. The results of a confirmatory factor analysis allowed us to propose an adjustment to the URICA-V scale. The objective of the adjusted scale is to improve the instrument's ability to make evaluations prethrepy and posttherapy and to more reliably assess readiness in patients undergoing voice therapy.