Adaptation and validation of Spanish version of the pediatric Voice Handicap Index (P-VHI)

Adaptation and Validation of the Mandarin Chinese Version of the Pediatric Voice Handicap Index-10 (pVHI-10)

OBJECTIVES

The purpose of this study was to adapt and validate the Mandarin Chinese version of the pediatric Voice Handicap Index-10 (pVHI-10).

METHODS

A cross-sectional study was conducted from January 2018 to December 2019. A total of 422 parents completed the questionnaire, including 283 parents of children with voice disorders (dysphonic group) and 139 parents of children without voice disorders (control group). Internal consistency, test-retest reliability, clinical effectiveness, and cut-off value were evaluated.

RESULTS

In the dysphonic group, the internal consistency of the Mandarin Chinese version of pVHI-10 was excellent (Cronbach's α = 0.95). The test-retest reliability was excellent for the total score of the Mandarin Chinese version of pVHI-10 (interclass correlation coefficient = 0.916). The total scores as well as scores on individual items were significantly higher in the dyphonic group compared to those in the control group (P <0.001). In addition, the optimum cut-off value for the Mandarin Chinese version of pVHI-10 was 6.5 (87% sensitivity and 86.3% specificity, respectively).

CONCLUSION

The Mandarin Chinese version of the pVHI-10 is a valid tool that evaluates the quality of life of children with voice disorders from the parents' perspective.

Pediatric Voice Handicap Index (pVHI): Validation in European Portuguese Children

OBJECTIVES

To determine reliability and validity of the European Portuguese pVHI version (pVHI-EP).

STUDY DESIGN

Cross-sectional design.

METHODS

The pVHI-EP and the talkative and global voice assessment scales were administered to the caregivers of children aged from 3 to 16 years old with and without dysphonia. Reliability (internal consistency and test-retest) was analyzed. The validity analyses performed were: (1) content validity by analyzing the percentage of missing data; (2) construct validity with intraclass correlation coefficients among pVHI-EP domains and overall score; (3) concurrent validity was conducted between pVHI-EP, the caregivers' judgment of the child's voice severity on a visual analog scale and the Speech-Language Pathologist perceptual voice assessment; (4) known-groups validity between children with and without dysphonia, and (5) predictive validity by calculating receiver operating characteristics, sensitivity and specificity and determining cut-off points.

RESULTS

A total of 283 children (61.5% boys, mean age 8.3 years) participated in the study. The pVHI-EP showed an excellent internal consistency for the pVHI-EP total data. Strong to moderate test-retest reliability confirms pVHI-EP reproducibility. Excellent to good intraclass correlation coefficients between the pVHI-EP overall and the domains confirms its construct validity. Weak to moderate concurrent validity with visual analog scale and Speech-Language Pathologist perceptual voice assessment was confirmed. The pVHI-EP significantly distinguished two groups of different voice conditions. A cut-off point of 10.5 with 95.9% sensitivity and 92.5% specificity was determined for the overall score of the pVHI-EP.

CONCLUSIONS

The pVHI-EP is a reliable and valid caregiver voice outcome tool for EP children with dysphonia.

Adaptation and Validation of the Lithuanian Version of the Pediatric Voice Handicap Index

OBJECTIVES

The aim of this study was to develop the Lithuanian version of the Pediatric Voice Handicap Index (pVHI) and to assess its psychometric characteristics.

METHODS

The Lithuanian version of the pVHI was prepared according to the standard requirements for the questionnaire translation and adaptation procedure. It also included forward and backward translations of the original questionnaire, as well as a committee review and psychometric testing of the final version of the pVHI. A total of 126 children between 4 and 13 years of age were included in the study. Two study groups were formed: a group consisting of children with dysphonia (n = 70) and a control group of children without any alterations in their voice (n = 56). The questionnaire was always completed by their parents. The results were statistically analysed to assess the reliability, validity, sensitivity and specificity of the Lithuanian version of the pVHI.

RESULTS

High internal consistency of the Lithuanian version of the pVHI was determined (Cronbach's α = 0.938). The test-retest analysis also showed a high correlation between the two tests (r = 0.949) for both the dysphonic and control groups. The mean overall pVHI score was significantly higher (P < 0.001) in the dysphonic group than in the control group: 26.16 ± 11.84 and 2.43 ± 2.61, respectively. Similar results were obtained for all domains of pVHI. The most sensitive and specific limiting value for discrimination between the clinical and control groups was the sum of 8 points.

CONCLUSIONS

The Lithuanian version of the pVHI is a reliable and valid instrument for the evaluation of the Voice Handicap Index in the pediatric population and can be easily applied in daily clinical practice.

Development, Validation, and Reliability of the Teacher-Reported Pediatric Voice Handicap Index

PURPOSE

The purpose of this study was to develop a novel teacher-reported pediatric voice outcome measure and to investigate its psychometric properties.

METHOD

In the first stage, a new instrument, the Teacher-Reported Pediatric Voice Handicap Index (TRPVHI), was developed. After item generation, a panel of experts evaluated the items to assess the content validity. Subsequently, the final version of the preliminary instrument was applied to teachers of 306 children (57 dysphonic and 249 vocally healthy) between the ages of 4 and 11 years. Eventually, the construct validity, criterion-related validity, test-retest reliability, and internal consistency of the developed instrument were examined.

RESULTS

The items with a content validity ratio less than .8 were modified or removed, and accordingly, the preliminary version of the index was finalized. After the application of the preliminary version, item reduction was made based on the factor analysis. The index is composed of 27 questions and three subscales: Functional, Physical, and Emotional. A significant difference was observed between the dysphonic and vocally healthy children for the TRPVHI scores (p < .001). A positive moderate correlation was determined between the Pediatric Voice Handicap Index and TRPVHI scores. Correlation coefficients between the test and retest scores of the TRPVHI were in the range of .92-.98. Cronbach's alpha values computed to assess the internal consistency were in the range of .94-.98.

CONCLUSIONS

The TRPVHI is the only valid and reliable teacher-reported outcome measure of the effects of voice disorders on children. It is anticipated that the deployment of the TRPVHI in conjunction with other subjective tools, both in the initial evaluation and the follow-up of the treatment results, will allow a better understanding of the physical, functional, and emotional effects of voice disorders on children. Furthermore, it can potentially lead further research to enable the use of the TRPVHI for screening purposes.

Readability analysis of Spanish language patient-reported outcome measures in pediatric otolaryngology

BACKGROUND

Pediatric otolaryngology encompasses interactions with a young patient, parent and/or guardian, and the provider. As healthcare transitions toward patient-centered care, clinicians are using direct tools of measurement such as patient-reported outcome measures (PROM) as a modality of communication between the patient and healthcare provider. Therefore, literacy levels of both the patient and their parent or guardian must be considered. Moreover, PROMs administered in pediatric audiology and otolaryngology in Spanish were found to be above the recommended reading level. Assessing the readability of Spanish translated PROMs is vital in providing safe, accurate, and quality care. The goal of this study is to analyze the readability of PROMs in pediatric otolaryngology and assess their compliance with readability recommendations.

METHODS

Pediatric otolaryngology PROMs were identified from Powell's systematic review on pediatric otolaryngology PROMs. Spanish pediatric otolaryngology PROMs were selected from a literature search through PubMed (pubmed.ncbi.nlm.nih.gov) and Google scholar databases (scholar.google.com). After completion of the literature search, seven PROMs were identified. Only four PROMs Spanish validations included the translation of the PROM in their publication. The authors of the remaining PROMs were contacted via email. Ultimately, eight pediatric otolaryngology PROMs were included in this study. The PROMs included were assessed by a Latin Spanish translator for grammar, syntax, and comprehension ease.

RESULTS

Four out of eight PROMs (50%) included in our study had readabilities above the recommended sixth-grade level. The following PROMs were noted with readabilities above the recommended level: tonsil & adenoid health status instrument (TAHSI), the nasal quality of life survey (SN-5), Spanish pediatric voice handicap index (P-VHI), and velopharyngeal insufficiency effects on life outcome (VELO).

CONCLUSIONS

Currently, some Spanish translated pediatric PROMs are written at a reading level above the recommended range for patients and their families.

Speech pathology telepractice intervention during the COVID-19 pandemic for Spanish-speaking children with cleft palate: A systematic review

BACKGROUND

Due to the lockdown and quarantines caused by the COVID-19 pandemic, the need to study and use telepractice for providing speech pathology interventions for children with cleft palate has arisen.

OBJECTIVE

To carry out a systematic review of the use of telepractice during the COVID-19 pandemic for providing speech pathology interventions for Spanish-speaking children with cleft palate.

METHODS

In July and August 2020, the authors searched the electronic databases Medline, LILACS, SciELO, and the Cochrane Library using the following keywords in English (MeSH): Cleft palate combined with Early intervention, Speech therapy, Rehabilitation of speech and language disorders, Speech production measurement, Speech articulation tests and Telemedicine. Original articles were selected and analyzed, complemented by an analysis of flowcharts and recommendations by the GES Clinical Guide of Cleft Lip and Palate of Chile's Government and the authors' expert opinions.

RESULTS

A total of 2680 articles were retrieved, of which 23 were critically analyzed and used to adapt the early stimulation, evaluation, and treatment of children with CP to speech therapy telepractice at the Gantz Foundation, a Hospital in Santiago de Chile.

LIMITATIONS

Only three researchers carried out a quick review, which limited the depth of individual analysis of the studies included. Also, the suggestions and material presented should be evaluated in future investigations.

CONCLUSION

This systematic review provides useful guidelines for providing speech pathology interventions through telepractice for children with cleft palate. Audiovisual materials seem to be extremely useful for families receiving the interventions. The use of interactive videos for Spanish-speaking children and educational videos for parents is manifest.

Polish version of the pediatric Voice Handicap Index (pVHI)

INTRODUCTION

The modern standard of voice diagnostics in both the adult and pediatric populations is based on perceptual, acoustic and videolaryngoscopic assessment, as well as self-assessment of voice quality. Currently, only two tools for assessing the voice in the pediatric population were translated into Polish: pVHI and its abbreviated version - cVHI (Children Voice Handicap Index). Thanks to the use of pVHI, the therapist and the patient, as well as his family and relatives, become aware of what functional zones are disturbed as a result of voice problems.

AIM

The aim of the study was to analyze various methods of assessing children's voice, including the pVHI voice disability questionnaire in children with various voice disorders. In addition, the authors wanted to develop a classification of the degree of disability of children's voice expressed by the sum of points obtained in pVHI.

MATERIAL AND METHOD

The study included a group of 89 children aged 5-12. Each child underwent a standard otolaryngological and phoniatric examination procedure with hearing assessment and fiberoscopic laryngeal evaluation. The voice of the dysphonic children was assessed with a spectrogram and the GRBAS scale. The children's guardians completed the Pediatric Voice Handicap Index (pVHI).

RESULTS

Polish children without voice disorders obtained an average of 1.9 points as a total result of the pVHI questionnaire. The results of the questionnaire obtained from children with voice disorders were on average 24.7 (SD 13.9). Total and individual domain scores were significantly higher in children with dysphonia than in asymptomatic children. Children with voice disorders were rated an average of 1.95 (SD 0.6) degree of hoarseness in Yanagihara's scale, and obtained an average overall score of 4.8 on the GRBAS scale (SD 2). A common upward trend in all types of evaluation is evident, along with an increase in the handicap expressed in pVHI score. Statistical analysis showed significant dependence between the overall pVHI score and other voice rating indicators. The result correlated to a moderate degree with the sum of points obtained from GRBAS and the severity of hoarseness assessed subjectively (G) and objectively according to Yanagihara's scale. In addition, weak correlations of the functional part of the questionnaire with the presence of learning problems, and the emotional part with the presence of problems with socialization were noticed. Analyzing the results of the questionnaire depending on the GRBAS results and the Yanagihara scale, a better fit of the exponential trend line than the linear one was observed. The point of inflection of the exponential curve, and thus a significant deterioration in voice assessment indicators, was observed in children who obtained over 32 points, which is 33% of the maximum value that can be obtained from the questionnaire.

CONCLUSIONS

A new voice assessment tool for the pediatric population has been developed that complements the diagnostic facilities of the otolaryngologist, phoniatrician and speech therapist. Adaptation of the Polish version of the Voice Handicap Index (pVHI) allows the introduction of a new diagnostic indicator into medical and speech therapy practice. The pVHI questionnaire result differentiates children with voice and speech disorders from healthy children. The analysis of children's voice using various methods allows the clinician to further characterize the disturbance of voice quality. It is possible to assess the scale of the severity and type of problem, as well as the spheres of life it concerns most. There is a correlation between the severity of voice disorders and the severity of voice disability expressed in the pVHI question.

Adaptation and validation of the Persian version of pediatric Voice Handicap Index (pVHI)

BACKGROUND AND OBJECTIVES

This study aimed to assess the reliability and validity of the Persian version of the Pediatric Voice Handicap Index (pVHI).

MATERIALS AND METHODS

The questionnaire was translated into Persian and then administrated to the parents of 45 dysphonic children and parents of 135 normal children. The content validity of the questionnaire was confirmed by eight speech-language pathologists. Internal consistency and test-retest reliability were measured via Cronbach's alpha and intra-class correlation coefficient, respectively. Independent-samples t-test was used to evaluate the discriminative and clinical validity of Persian pVHI.

RESULTS

Cronbach's coefficient values were excellent for the total score (α = 0.94) and physical subcomponent (α = 0.91). Moreover, these corresponding values were satisfactory for functional (α = 0.82) and emotional (α = 0.79) subcomponents. Test-retest reliability for the total score was high in both dysphonic and control groups (intra-class correlation coefficient> 0.92). There were significant differences between the control and dysphonic groups in terms of the total score and all subcomponents scores of Persian pVHI. However, no significant difference was observed in the mean total score of the Persian pVHI between the control and dysphonic group regarding gender (P < 0.001).

DISCUSSION

Persian version of pVHI is a valid and reliable tool to evaluate the severity of voice disorder and its negative effects on the daily life of Persian children with voice disorder from the Parents' viewpoint.

Dysphonia in children. Descriptive analysis of the factors involved, clinical parameters and impact on quality of life

INTRODUCTION

The prevalence of dysphonia in children is estimated at around 6%. Dysphonia in this age group is usually due to misuse of the voice that leads to the development of vocal fold injuries. This condition can negatively affect the child's self-esteem. The aim of the study is to describe the epidemiology of voice disorders in children in our area, perform an examination of the voice, as well as identify the impact of this pathology on quality of life.

MATERIAL AND METHOD

We present a descriptive study with 87 patients aged between 5 and 14 years old, diagnosed with dysphonia. Data collection was carried out in our centre between January 2016 and April 2019. We analysed epidemiological and clinical factors. The impact on quality of life was studied using the Pediatric Voice Handicap Index questionnaire.

RESULTS

87 patients, 57 men (65.5%) and 30 women (34.5%) were included. Mean age 8.5 years (SD: 2.08; range 4-13). The most frequent phonatory disturbance was global muscle tension (88.5%). In the laryngoscopic examination, the most frequent finding was the presence of vocal nodules (45.9%). The average score on the Pediatric Voice Handicap Index was 24.3 points in total; 4.9 on the functional scale; 17.6 on the physical scale and 1.8 on the emotional scale.

CONCLUSION

A correct anamnesis that includes the family environment and practice of team sport is essential. The physical examination should include a laryngoscopic examination. There is an impact on the quality of life of patients with dysphonia perceived by them and their families; the physical component is perceived to be most affected. We consider a multidisciplinary approach to this condition necessary.

Association Between the Development of Pediatric Voice Disorders and Singing in Children's Choir

Importance

Pediatric vocal fold pathology is important because having a healthy voice free from disorders is crucial in a child's emotional and educational development.

Objective

To determine whether there is an association between singing in a children's choir and the development of voice disorders.

Design, Setting, and Participants

Prospective cohort study of children (aged 8 to 14 years) singers selected from local children's choirs and nonsingers selected from local schools evaluated at Clarós Otorhinolaryngology Clinic in Barcelona, Spain, from October 2016 through April 2018.

Exposures

Singing for a mean time of 7.5 hours per week for 2.5 years.

Main Outcomes and Measures

The primary outcome of the study was the prevalence of voice disorders measured using videostroboscopy. The obtained values were analyzed statistically and used to compare the characteristics of the children and the frequency of voice disorders between the groups.

Results

Of 1495 enrolled children (745 male [49.8%]; median age, 9.3 years [range, 8-14 years]), 752 were singers and 743 were nonsingers. No differences in baseline characteristics were observed between the groups. Voice disorders were more frequent in the nonsinging group than in the singing group (32.4% vs 15.6%; difference, 16.8%; 95% CI, 12.3%-21.4%). Of 12 voice disorders considered in this study, all 12 were more frequent in the nonsinging group. Functional voice disorders were more frequent in the nonsinging group than in the singing group (20.2% vs 9.4%; difference, 10.8%; 95% CI, 7.2%-14.3%), as were organic voice disorders (12.2% vs 6.1%; difference, 6.1%; 95% CI, 2.6%-9.6%).

Conclusions and Relevance

Voice disorders were less common among children in the cohort who sing in choirs, possibly because of voice training and the commonly observed habit of attending regular ear, nose, and throat examination. Voice disorders may be prevented in nonsinging children if the same solicitude for voice is observed.

Index of pediatric voice handicap: Translation, transculturalization and validation to Argentinian Spanish

OBJECTIVE

Voice disorders are very common in the pediatric population, with 6% and 23% of all children presenting with some form of dysphonia [1,2]. For many years, these patients have been underdiagnosed. There has been increasing awareness and interest in the study of voice alterations in children, and, most importantly, their impact in their quality of life. To do this, an instrument capable of measuring the quality of life in pediatric patients with vocal pathology is required, which can be used extensively in the scientific community. The objective of our study is to carry out the translation, transculturalization and validation of pVHI (Pediatric Voice Handicap Index) to Argentinian Spanish-speakers.

MATERIAL AND METHODS

A study was carried out in the Hospital de Pediatria Dr. JP Garrahan in the city of Buenos Aires, Argentina. It included patients between 3 and 18 years old. The pVHI was translated and transculturalized for said population and for its validation, a survey was carried out in two groups of patients: one group being children with a background of both reconstructive larynx surgery, and dysphonia (n = 35) and the other group being control patients, without any voice pathology (n = 35). The survey was conducted among either parents or caregivers of the children in question.

RESULTS

A significant difference was found between both groups, for both overall pVHI score and survey subgroups score (p < 0.001) with an optimal internal confidence and a good Alpha Cronbach for each of the subgroups (functional 0,92; organic 0,87 and emotional 0,88). Test-retest for reliability revealed "p-values" without any significant difference (p > 0.05) for each of all subgroups (functional 0,68; organic 0,32 and emotional 0,72).

CONCLUSION

The validation and transculturalization of the rate of pediatric vocal impairment to Argentinian Spanish population presented an adequate validity and reliability. The rate of pediatric vocal impairment was identified through this simple and practical survey, offering additional information on the child's own vocal perception by part of the caregiver. We recommend this survey being included as a valuable tool in the evaluation of pediatric dysphonia in Spanish-speaking families.

Reliability and validity of The Danish pediatric voice handicap index

BACKGROUND

The pediatric voice handicap index (pVHI) questionnaire was developed in 2006 to provide parental information regarding the impact of a voice disorder on their child's life.

OBJECTIVES

The aim of this study was to make a Danish version of the original American pVHI and to validate the Danish pVHI by evaluating its internal consistency and reliability.

MATERIALS AND METHODS

The original version of the pVHI was translated into Danish. Nineteen parents of dysphonic children, diagnosed in a tertiary otolaryngology hospital department, and 43 parents of children without known voice disorder (control group) completed the questionnaire. The internal consistency, content validity including comparisons of the scores in the two groups and the test-retest reliability were assessed through statistical analysis.

RESULTS

The total pVHI scores significantly differed between the group of parents with dysphonic children and the group of parents with children without known voice disorder (p < 0.001). The internal consistency showed an excellent consistency (Chronbach's α > 0.9) of the three subdomains score and the total pVHI score. The test-re-test reliability of the total pVHI score was "strong" with a Pearson's correlation coefficient of 0.97.

CONCLUSIONS AND SIGNIFICANCE

The Danish pVHI is a valid and reliable instrument to assess the parents' perception of the impact of a voice disorder on a child's physical, social and emotional well-being.

Glottal function index questionnaire for screening of pediatric dysphonia

OBJECTIVE

to assess the diagnostic value of Lithuanian version of Glottal Function Index (GFI-LT) questionnaire in pediatric dysphonia screening.

METHODS

The GFI-LT was completed by 82 children (7-16 years old): 41 patients with voice disorders (patients group) and 41 healthy subjects (control group). Auditory-perceptual evaluation of voice was performed using the Grade Roughness Breathiness (GRB) protocol. Acoustic voice analysis was accomplished for F0, SDF0, jitter, shimmer and NNE using Dr. Speech, Tiger Elemetrics software. To evaluate the diagnostic accuracy differentiating normal and dysphonic voice, the receiver operating characteristic statistics were used.

RESULTS

Perceptually dysphonia was revealed in all children of the patients group. Grade I (65.9%) was the most prevalent (p > 0.05). No dysphonia was detected in the control group. Acoustic voice analysis revealed statistically significantly (p < 0.001) deteriorated all acoustic voice parameters in patients' group comparing to control group. Statistically significant (p < 0.05) strong or moderate correlations were found between the GFI-LT, auditory-perceptual rating and all acoustic voice parameters of the patients group. The strongest correlations were observed between GFI-LT and G (r = 0.70), R (r = 0.69), jitter (r = 0.56) and SDF0 (r = 0.56). No statistically significant correlations between GFI-LT and children' age or gender were found (p > 0.05). The GFI-LT cut-off score of ≥3.0 was associated with excellent test accuracy (AUC = 0.961) distinguishing children with voice disorders from healthy controls, resulting in a balance between sensitivity and specificity (95.1% vs 85.4%).

CONCLUSION

GFI-LT is considered to be a valid and reliable tool for self-assessment and screening of voice disorders in children.

Evaluation of Psychometric Properties of Voice Activity and Participation Profile (VAPP): A Spanish Version

OBJECTIVES

This study aimed to analyze the psychometric properties of the Spanish version of the Voice Activity and Participation Profile (SVAPP) questionnaire.

STUDY DESIGN

A randomized, cross-sectional sampling strategy with controls was used.

METHODS

Two samples with a total of 169 participants were analyzed, specifically 61 men (mean age 37.02) and 108 women (mean age 37.78). Of these participants, 112 were patients and 57 were controls. The instrument was submitted to reliability (internal consistency and corrected item-total correlations) and reproducibility analyses. Validation assessment was based on the construct validity, convergent validity, discriminant validity, and concurrent validity.

RESULTS

The global internal consistency was excellent (Cronbach's α = 0.976), corrected item-total correlations were satisfactory and ranged 0.63-0.89, and factor loadings were above 0.50. The different subscales showed good internal consistency (alpha coefficients ranged 0.830-0.956) and test-retest values were consistently associated. The exploratory factor analysis evidenced a strongly defined five factors internal structure, with factors loadings ranging 0.51-0.86. Convergent validity demonstrated that all subscales and scores were very strongly correlated (Pearson r above 0.735) and significantly associated. The discriminant validity analysis showed that SVAPP had good specificity to distinguish dysphonic from healthy voice subjects. Concurrent validity with Voice Handicap Index Spanish version (SVHI) showed very strong correlations between total scores, and between SVHI total score and SVAPP Daily and Social Communication subscales; correlations between both tests subscales were strong; only between SVAPP Work and SVHI Physical sections correlations were moderate.

CONCLUSIONS

The findings of the present study demonstrated evidence for the SVAPP questionnaire reliability and validity, and provided insightful implications of voice disorders on Spanish patients' quality of life. However, further investigations are required.

Reliability and validity of the Chinese pediatric voice handicap index

OBJECTIVES

To evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI).

MATERIAL AND METHODS

The original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient.

RESULTS

The internal consistency of total score and three subscales scores of Chinese pVHI were 0.788-0.944. The test-retest reliability was 0.631-0.887(P < .001). The pVHI scores of control group significantly were lower than the pathological group (P = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694-0.807, P = .000). The pVHI scores positively correlated with GRB assessment (P < .01).

CONCLUSIONS

The Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia.

Health-related quality of life in children with dysphonia and validation of the French Pediatric Voice Handicap Index

OBJECTIVE

voice disorders are common in the pediatric population and can negatively affect children's quality of life. The pediatric voice handicap Index (pVHI) is a valid instrument to assess parental perception of their children voice but it is not translated into French language. The aim of the present study was to adapt a French version of the pVHI and to evaluate its psychometric properties including construct validity, reliability, and some aspects of external validity.

PATIENTS AND METHOD

we performed a cross sectional study including 32 dysphonic children and 60 children with no history of voice problems between 3 and 12 years of age. The original pVHI was translated into French language according to forward-backward rules and then administered to parents or caregivers. Construct validity and internal consistency were explored using confirmatory factor analysis and Cronbach's alpha. The questionnaire was filled twice to assess test-retest reliability using the intra-class correlation coefficient. The external validity was explored by comparing the French pVHI total and subscales scores between dysphonic and asymptomatic children. Correlations between the French pVHI and both the perceptual GRBAS scale and the health-related quality of life (HRQOL) survey "Vécu et Santé Perçu de l'Adolescent et de l'Enfant" (VSP-Ap) were also performed.

RESULTS

the structure of the French pVHI showed a good fit with excellent reliability (α = 0.929) and high test-retest reliability. Significant differences were found between the group of dysphonic children and the control group (p < 0.001). The French pVHI scores were positively correlated to all parameters of the GRBAS scale (p < 0.05). Significant negative correlations were found between the Functional domain of the pVHI and various domains of the VSP-Ap as Leisure Activities, Schooling and Sentimental Relationship (p < 0.05).

CONCLUSION

the French pVHI is considered to be a valid and reliable instrument to assess voice-related quality of life in children with voice disorder. We recommend its use in the multidimensional protocols for assessing voice disorder in the pediatric population.

Reliability and validity of the Dutch pediatric Voice Handicap Index

INTRODUCTION

The pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score.

METHODS

All items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point.

RESULTS

We obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%.

CONCLUSIONS

The Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia.

Development and validation of a short version of the Spanish pediatric voice handicap index (P-VHI-10)

OBJECTIVES

A child's voice is used both as a tool for communication and as a form of emotional expression. Thus, voice disorders suffered by children have negative effects on their quality of life, which can be assessed using the "Pediatric Voice Handicap Index" (P-VHI). This questionnaire is completed by the parents of dysphonic patients and it has been validated in different languages: Italian, Korean, Arabic, and Spanish. More recently, the "Children Voice Handicap Index-10" test (C-VHI-10) was developed and validated, an Italian version reduced into 10 items that is answered by children themselves. The objective of this study was to develop and validate a short Spanish version of the P-VHI (P-VHI-10) and to assess whether it is comparable to the Italian C-VHI-10.

MATERIALS AND METHODS

We conducted a cross-sectional study on 27 patients between 6-15 years of age. We developed an abbreviated version of the P-VHI that consisted of 10 statements to be answered by parents of children with dysphonia (P-VHI-10). These statements were based on the 10 items with the highest score in the validated Spanish version of the P-VHI. In addition, the validated Italian version of C-VHI-10 was translated into Spanish and this translation was reviewed and modified by three specialists, resulting in an adapted version to be answered by parents (C*-VHI-10). The parents and children included in the study of this index were the same patients as those included in the study to validate the Spanish P-VHI.

RESULTS

There were no significant differences in the results obtained with the extended version of the P-VHI (17.4) and with the P-VHI-10 (18.7: Pearson coefficient = 0.602, p < 0.36). A paired student's t-test identified significant differences (p < 0.0001) when comparing the P-VHI-10 and C*-VHI-10, both of which were answered by parents, with average scores of 18.7 and 9.48, respectively. Both these reduced versions have good internal consistency, with a satisfactory Cronbach's alpha coefficient (α = 0.75 to P-VHI-10 and α = 0.73 in C*-VHI-10). No statistically significant differences were found when the average total score between the C-VHI-10 and C*-VHI-10 were compared, with a Pearson's correlation coefficient of 0.559 (p < 0.9).

CONCLUSION

The short version of the P-VHI10 questionnaire is a clinically valid tool that has good internal consistency.