Objective: This project sought to provide information on how voice-specialized speech-language pathologists determine appropriate dosing for voice therapy exercises (i.e., duration and frequency of home practice) across ten voice therapy programs.

Methods / Design: Surveys were administered via REDCap inquiring about recommended duration and frequency of home practice for ten voice exercise programs. Brown-Forsythe test of variances with Bonferonni corrections were used to compare variances in exercise dosing across programs. Surveys also included questions about clinician confidence when dosing voice therapy exercises and the extent to which clinicians believe the current literature provides clear guidance as to how to prescribe voice exercise dosages. Open-ended survey responses allowed clinicians to freely identify factors that influence their decisions about dosing.

Results: Forty-one speech pathologists completed the survey. Clinicians reported 74.85% mean self-confidence when prescribing voice exercise dosages but only 42.64% felt that the literature provides clear guidance in this area. Qualitative survey responses supported that clinicians feel confident about how to prescribe dosages, but that this confidence may not necessarily come from published literature; for example, “I like this rule…but to be completely honest I got it from a CF mentor and never looked into where it came from.” Preliminary thematic analysis of qualitative responses revealed that patient schedule, motivation, stimulability, voice severity, and vocal demands commonly inform clinician decisions about dosing. Brown-Forsythe test of variances with Bonferonni correction showed that clinicians show greater variance in mean frequency dosages for Conversation Training Therapy program than Semi-Occluded Vocal Tract Exercises (p=0.0304), Vocal Function Exercises (p=0.0114), Phonation Resistance Training Exercises (p=0.0040), and manual therapy (p=0.0059).

Conclusions: Clinicians report more confidence in themselves than in the literature when it comes to prescribing voice exercise dosages, suggesting that clinical expertise and patient values primarily inform current practice. CTT showed significantly greater variance in practice frequency dosages than SOVT, VFE, PhoRTE, and manual therapy programs, likely because CTT is designed to be practiced during conversational interactions rather than in a hierarchy of tasks. Future hypothesis-driven studies are needed to expand the evidence base and more clearly guide decision-making in the area of exercise dosing for voice therapy.