Vocal Fatigue Index: Validation and Cut-off Values of the Brazilian Version

Vocal Fatigue Index (VFI): Cross-Cultural Adaptation, Validation, and Cut-off Values of the Arabic Version

OBJECTIVE

This study aims to validate, cross-culturally, and linguistically adapt the Vocal Fatigue Index (VFI) into Arabic.

STUDY DESIGN

Cross-sectional study.

METHODS

The VFI was translated into Arabic, reverse translated, and content validated. To assess its psychometric properties, 398 patients with voice disorders (199 males, 199 females, mean age=46.2 ± 15.0years) and 121 vocally healthy controls (57 males, 64 females, mean age=42.1 ± 6.9years) completed the VFI-Arabic. We calculated internal consistency and test-retest reliability using Cronbach's alpha and intraclass correlation (ICC) coefficients. Independent sample t tests determined mean factor score differences between groups, while receiver operator characteristic curves analyzed sensitivity, specificity, and cut-off scores for the three factors.

RESULTS

The overall Cronbach's alpha was 0.95, across all factors combined, it was 0.68; and for factors 1, 2, and 3, it was 0.95, 0.91, and 0.91, respectively. Test-retest reliability for the subscales was excellent (ICC: 0.97, 0.91, 0.82 for factors 1, 2, and 3). Mean subscale scores were significantly higher in the voice-disordered group than in controls. The area under the curve for factors 1, 2, and 3 was 0.824, 0.759, and 0.646, respectively. Best cut-off scores were ≥14.5 (69.8% sensitivity, 83.1% specificity) for factor 1, ≥3.5 (66.3% sensitivity, 74.4% specificity) for factor 2, and ≥5.5 (60.1% sensitivity, 64.5% specificity) for factor 3.

CONCLUSION

The VFI-Arabic is a valid and reliable tool for identifying and quantifying vocal fatigue symptoms in Arabic speakers.

Prospective Teacher's Voice Questionnaire (PTVQ): Development of a Questionnaire to Assess Training-Related Voice Symptoms Among Prospective Teachers

AIM

To develop and validate a self-administered population-specific survey, available in Spanish, Portuguese, and English, which investigates the prevalence of voice symptoms and perceptions of risk factors associated with training among prospective teachers.

METHODS

The present study had three stages: the first stage included a literature review and content validation by experts that supported the survey development. From this phase, we defined five aspects of the Prospective Teacher's Voice Questionnaire (PTVQ): (1) target population, (2) research objectives, (3) questions to be included, (4) scales for the answers, and (5) relevance, comprehensiveness, clarityclarity, and understandability of the questions. This process was performed in parallel for the three languages (Spanish, Portuguese, and English). The second stage included pilot testing. This involved administering the first draft of the survey to a group of 120 students to evaluate the feasibility and effectiveness of the survey instrument, identify any potential problems with the survey, and refine the instrument based on feedback from the pilot participants. The third stage includes the restructuring of the questionnaire's voice quality section to eliminate redundant questions. Through Principal Component Analysis, multicollinear variables were condensed, facilitating the removal of redundant items, and ensuring that the final questionnaire comprised only the most relevant and discriminative questions.

RESULTS AND DISCUSSION

The final version of the survey, available in Spanish, Portuguese, and English, consists of four sections with a total of 57 questions. The development of the PTVQ represents a significant step toward better understanding and addressing voice disorders among prospective teachers. Future research could further refine the questionnaire and explore its predictive validity in identifying individuals at risk of voice disorders early in their teaching careers. Additionally, interventions based on the findings from the PTVQ could be developed to support the voice health and well-being of prospective teachers, ultimately improving teaching quality and job satisfaction in educational settings.

Impact of Cultural-Linguistic Differences on Vocal Fatigue Perception: A Systematic Review and Meta-Analysis

PURPOSE

The perception of a clinical condition or disorder can vary across patients from different cultural-linguistic backgrounds. There is insufficient evidence to inspect this potential impact on the perception of vocal fatigue (VF) as a common condition perceived by patients with voice disorders. In order to more comprehensively explore this phenomenon, a systematic review was carried out to investigate the differences in perceived VF in a variety of cultural-linguistic contexts, based on a standard self-assessment instrument-the Vocal Fatigue Index (VFI), as translated in different languages.

METHOD

A thorough search was done in MEDLINE, CENTRAL, Web of Science, and Google Scholar by March 2024. Cross-sectional studies investigating the accuracy of the VFI to detect perceived VF in all available languages were considered. The VFI has three distinct parts or factors assessing: (a) tiredness of voice, (b) physical discomfort associated with voicing, and (c) improvement of symptoms with rest. The cutoff points and sensitivity and specificity of each factor were submitted to meta-analysis, and the summary receiver operating characteristic curves were used to determine pooled sensitivity and specificity of each factor of the VFI.

RESULTS

Eight papers that examined the diagnostic accuracy of the VFI in English, Malayalam, Turkish, German, Mandarin Chinese, Polish, Cantonese, and Finnish languages were identified as being eligible for this meta-analysis. The pooled sensitivity and specificity along with their confidence intervals (CIs) were as follows: 0.91 CI [0.80, 0.96] and 0.88 CI [0.78, 0.94] for Factor 1, 0.83 CI [0.69, 0.91] and 0.84 CI [0.76, 0.89] for Factor 2, and 0.75 CI [0.67, 0.82] and 0.77 CI [0.59, 0.89] for Factor 3.

CONCLUSIONS

The present research demonstrates medium to high but heterogeneous accuracy of the VFI for detecting perceived VF across cultural-linguistic contexts. Given the promising results, future studies should focus on (a) further investigating the underlying factors for the observed heterogeneity in diagnostic accuracy and (b) adapting and validating the VFI in more languages toward establishing its validity as a cross-linguistic diagnostic tool for the perception of VF.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26397106.

Validity and Reliability of the German Vocal Fatigue Index in Adults With Voice Disorders

PURPOSE

Vocal fatigue-related symptoms, frequent in patients with voice disorders, are reliably quantifiable with the Vocal Fatigue Index (VFI) in several languages. The main aim of this work was to investigate the content and construct validity of the German Vocal Fatigue Index (VFI-D) by comparison with the German Voice Handicap Index 9 international (VHI9i) and the Vocal Tract Discomfort Scale (VTD). Moreover, the scale and retest reliability were investigated.

METHOD

In a prospective cohort study at two tertiary care hospitals, 93 adults with all types of voice complaints filled out the VFI-D, the VHI-9i, and the VTD. Eighty-one adults (Mage = 53.5 years, SD = 15.7) completed them one time, and additional 12 patients (Mage = 53.8 years, SD = 15.6) did a test-retest, completed them twice at an interval of 1 week. The validity was assessed by Spearman's rho and Mokken scaling and the reliability by a factor analysis and a two-tailed t test.

RESULTS

Mokken scaling has proven the VFI-D as one-dimensional questionnaire (one cluster, r = .95). All VFI-D items could be assigned to one of three factors according to principal component and principal axis factor analysis. Although Factor 1 related best to the VHI9i (∅ rs = .76) and Factor 2 to the VTD (∅ rs = .74), Factor 3 correlated moderately with the VHI9i (rs = .34) and weakly with the VTD (rs = .25). Results from the first and second VFI-D completion agreed strongly (t = -1.78, p = .10).

CONCLUSIONS

In this study, the content and construct validity of the VFI-D were confirmed. Also, both scale reliability with identical factors as those in the original study and retest reliability were verified. The VHI9i and VTD were highly indicative of VFI-D Factors 1 and 2, respectively. No correlation between Factor 3 and the other questionnaires was determined. Future research should evaluate which characteristics are specific to vocal fatigue versus general voice disorder-related symptoms.

Vocal risk mapping in classical singers: an analysis of the self-perception of voice quality, vocal fatigue, and singing voice handicap

PURPOSE

To map the vocal risk in professional classical singers, analyzing their self-assessment of voice and self-perception of singing voice handicap and vocal fatigue.

METHODS

The study sample comprised of 52 professional classical choir singers, aged 31 to 72 years. They answered an online questionnaire in Google Forms, addressing their characterization, self-assessment of voice, the Voice Handicap Index-10 (VHI-10), Classical Singing Handicap Index (CSHI), and Vocal Fatigue Index (VFI).

RESULTS

The mean self-assessment of voice was between "Good" and "Very good" (1.2). The mean total VHI-10 score was 1.35, which is below the cutoff. The mean total CSHI score was 10.04. The mean total VFI score was 10.83, near the cutoff value. Classical singers who use their voice to give examples to students in their classes had higher scores in VHI-10 (p = 0.013), VFI voice restriction (p = 0.011), and VFI total score (p = 0.015). Besides, classical singers who already visited a Speech-Language Pathologist for voice problems had higher scores in VFI voice restriction (p = 0.040) and VFI recovery with voice rest (p = 0.019), in addition to correlations between instrument scores.

CONCLUSION

Professional classical singers did not have voice handicaps. However, their self-perception of vocal fatigue was more present when the singing voice was used, such as giving examples with their own voice in class. Having had voice problems and visited a Speech-Language Pathologist in the past led to a greater perception of vocal recovery with rest.

Measuring Vocal Fatigability in Teachers: The Vocal Fatigability Scale for Teachers (VFS-T)

OBJECTIVES

This study focuses on the distinction between vocal fatigability and vocal fatigue (VF), highlighting the importance of vocal fatigability when assessing teachers' quality of life. Vocal fatigability is more critical for quality of life than performance or perceived VF because it considers the accumulation and chronicity of fatigue over isolated tasks. The objectives are to develop and validate the Vocal Fatigability Scale for Teachers (VFS-T), to assess teachers' levels of vocal fatigability, and to analyze variations based on personal and occupational traits. The VFS-T construct encompasses items related to vocal sensations and performance, their connection to accumulated demanding vocal activity, descriptions of recovery strategies, necessary rest periods, and the impact of VF on daily activities.

STUDY DESIGN

A single cross-sectional study with an ex post facto design was conducted.

METHODS

The sample consisted of 184 active teachers with various vocal conditions. They completed the VFS-T questionnaire, provided personal and occupational data, and completed the VHI-10 questionnaire. The data collected were analyzed for item refinement, internal structure, reliability, validity, diagnostic capacity, cutoff values, and group differences.

RESULTS

The item refinement and internal structure analysis revealed a scale comprising 17 items grouped into two factors. The VFS-T shows good reliability and validity, with cutoffs at <15 for no fatigability, 15-27 for moderate fatigability, and >28 for high fatigability. Most teachers fall into the moderate fatigability range, with 72% experiencing vocal fatigability.

CONCLUSIONS

The VFS-T is a reliable tool for detecting vocal fatigability in teachers. This scale focuses on the construct of vocal fatigability, which is related to chronicity of VF and limitations in daily activities in teachers.

Cross-Cultural Adaptation, Validation, and Diagnostic Accuracy of the Voice Fatigue Handicap Questionnaire-Persian Version

OBJECTIVE

The current study aimed to determine the psychometric characteristics of a translated version of the Voice Fatigue Handicap Questionnaire in Persian by examining the validity, reliability, and diagnostic accuracy using data collected from people with and without dysphonia.

STUDY DESIGN

Cross-sectional study.

METHOD

The original questionnaire was translated from Italian to Persian using the International Quality of Life Assessment criteria. The translated version was completed by 122 people with dysphonia and 49 people without dysphonia. The validity, reliability, and diagnostic accuracy of the Voice Fatigue Handicap Questionnaire Persian-version were evaluated. A panel of five voice-specializing Speech and Language Pathologists and 20 native Persian speakers (with dysphonia) in a pilot study confirmed the translated version for content and face validity, respectively. The internal consistency was evaluated by Cronbach's alpha and McDonald omega coefficients. The intraclass correlation coefficient was used to examine the test-retest reliability. For discriminant validity, the mean total and subscale scores of respondents with and without dysphonia were compared through independent t tests. Finally, sensitivity, specificity, and ideal cut-off value were determined using the receiver-operating characteristic curve.

RESULTS

Cronbach's alpha coefficient was 0.965 for the total score (functional: α = 0.883, emotional: α = 0.944, physical: α = 0.917). Also, the McDonald omega coefficient was 0.966 for the total score (functional: ω = 0.889, emotional: ω = 0.933, physical: ω = 0.920). The intraclass correlation coefficient for measuring the test-retest reliability was 0.971 for the total score (functional: ICC=0.937, emotional: ICC=0.954, physical ICC=0.976). The results of the independent samples t tests indicated that the dysphonia group obtained significantly higher mean scores (total and subscale scores) than the group without dysphonia. The cutoff value of 13.5 was determined based on the optimal balance of sensitivity (0.992) and specificity (0.918).

CONCLUSION

The Voice Fatigue Handicap Questionnaire-Persian version is a valid and reliable questionnaire to identify individuals at high risk of vocal fatigue and subsequent dysphonia.

Effect of Face Mask on Voice Production During COVID-19 Pandemic: A Systematic Review

OBJECTIVE

The Coronavirus Disease 2019 (COVID-19) is an ongoing global pandemic and wearing face mask is recommended across the globe to break the transmission chain of infection. The masks available in the market are of different types and materials and tend to alter the voice characteristics of the speaker. This can therefore impair optimal communication and the present study is a systematic review exploring the effect of various masks on voice production parameters.

STUDY DESIGN

Systematic review.

MATERIALS AND METHODS

The titles and abstracts screening was carried out for the inclusion of articles using eight electronic databases spanning the period from 1st January 2020 to 30th April 2021. 10 articles (8 published & 2 in pre-print) that met the inclusion criteria were considered for this systematic review and the pooled age range was 18 -69 years.

RESULTS

Three primary studies from the USA, 2 each from Australia & Italy, one each from Brazil, China, and Germany were found to have investigated the influence of wearing N95, KN95, surgical and fabric masks on voice related measures. The users significantly reported vocal fatigue, discomfort, and also perceived voice problems. Attenuation of speech sound amplitude was highest for the transparent mask followed by cloth mask, N95, KN95, and surgical mask.

CONCLUSION

The World Health Organization (WHO) has been repeatedly endorsing the need to use a face mask in the current COVID-19 pandemic. However, for an unintruded voice production, the surgical mask is recommended for everyone, including healthcare professionals when they are not in close contact with patients, and not involved in aerosol-generating procedures. For teachers, doing direct teaching (offline classes), 'surgical mask' can reduce the vocal load of teachers, smoothen the teacher-student interaction and thereby facilitate better learning by the students. Additionally, it would be useful to protect oneself from the risk of developing voice problems by following standard vocal healthcare tips.

Vocal Sensory Symptoms, Vocal Fatigue and Vocal Habits in University Professors

PURPOSE

To identify vocal sensory symptoms, vocal fatigue, and vocal habits, compare and correlate them in university professors who have passed or failed a screening related to vocal symptoms.

STUDY DESIGN

Cross-sectional, quantitative, non-randomized study.

METHODS

The professors responded to four vocal self-assessment Patient-Reported Outcome Measures (PROM): the Brazilian validated version of the Voice Symptom Scale (VoiSS), the Brazilian version (not validated) of the Vocal Tract Discomfort Scale, the Brazilian validated version of the Vocal Fatigue Index and the validated version of the Vocal Health and Hygiene Questionnaire ("Questionário de Saúde e Higiene Vocal - QSHV," in Portuguese). After the PROM's application, the professors were divided into two groups from the VoiSS cutoff point. G1 was formed by professors who passed in the VoiSS screening, that is, those who achieved a total score below 16 points, and G2, formed by professors who failed, that is, those who achieved 16 points or more. The Mann-Whitney U test was used to compare the values of PROM between G1 and G2 groups, and the Spearman correlation test was used to correlate the PROM with one another.

RESULTS

One hundred and two professors filled in the PROM, 23 from G1 and 79 from G2. Results showed that the total scores of all PROM used exceeded their cutoff scores in the overall sample. It was also observed that professors who failed the screening through VoiSS presented higher scores of vocal sensory symptoms and vocal fatigue, however no differences regarding knowledge on vocal health and hygiene were noticed. In G1, the protocols showed significant correlations ranging from moderate to very strong with one another, but the QSHV showed no correlation with any of the instruments. In G2, the protocols presented weak to strong correlation ratios, and the QSHV reported correlation with all protocols, except for Vocal Fatigue Index.

CONCLUSION

University professors presented scores higher than the cut-off point suggested by the literature for vocal sensory symptoms, vocal fatigue and knowledge on vocal health and hygiene. Professors who failed the screening performed through VoiSS achieved higher scores of vocal discomfort and fatigue, but also presented a high score for knowledge on vocal hygiene. There was a moderate to very strong statistical correlation among the vocal symptoms, discomforts, vocal fatigue and vocal habits in professors who failed the screening through VoiSS, however among those professors who passed the screening, knowledge on vocal health and hygiene showed no correlation with the PROM analyzed.

Self-perception of the Immediate Impact on the Voice of Gospel Singers after a one-hour Presentation

PURPOSE

To investigate the immediate impact on the voice of gospel singers with and without vocal complaints after a one-hour individual presentation.

METHODS

Application of an online questionnaire that addressed the following aspects: 1 - Sociodemographic data; 2 - Self-assessment of the ability to sing using the Evaluation of the Ability to Sing Easily (EASE-BR) protocol; 3 - Self-assessment of vocal fatigue symptoms using the Vocal Fatigue Index (VFI) protocol; and 4 - Self-assessment of voice handicap using the Voice Handicap Index 10 (VHI-10) protocol. Participants were divided into two groups: Group with Vocal Complaint (WVC) and Group with no Vocal Complaint (WnVC) based on the total score of the IDV-10. Data underwent descriptive and inferential statistical analysis with a significance level of 5%.

RESULTS

The study included 43 gospel singers with a median age of 34 years: 32 were in the WnVC group and 11 were in the WVC group. The WVC group reported hoarseness and experienced more difficulty while singing in the EASE, resulting in higher scores in both the VHI-10 and VFI protocols. A positive correlation was observed between singing difficulty and vocal handicap due to fatigue in amateur gospel singers, with this correlation being stronger within the WnVC group.

CONCLUSION

After one hour of performance, singers with vocal complaints exhibited higher rates of vocal fatigue, vocal disadvantage, and greater difficulty in singing. Singers without complaints may have their ability to sing impaired by vocal fatigue. Variations in singing ability and vocal handicaps in amateur gospel singers may be directly related to vocal fatigue.

Cross-cultural adaptation and validation of vocal fatigue index (VFI) to Chinese language

Objectives: This study aimed to translate the Vocal Fatigue Index (VFI) into Simplified Chinese and test its reliability and validity in mainland China. Methods: The original English version of the VFI was translated and adapted to a Simplified Chinese version (VFI -SC). Fifty-four participants with voice disorders and 21 healthy controls completed the VFI-SC. Sixteen participants with voice disorders completed it again two weeks later. Reliability, validity, and receiver operating characteristic (ROC) of the VFI-SC were analyzed. Results: The Cronbach's alpha values for the VFI factor scores were found to be 0.930 for tiredness and avoidance of voice use (factor 1), 0.878 for physical discomfort with voice use (factor 2), and 0.915 for improvement of symptoms with voice rest (factor 3). The test-retest reliability was 0.967 for all three factors. There was a significant difference between the total scores of the patient group and the control group (p < 0.01). Factor 1 and factor 2 were positively correlated with the Voice Handicap Index (VHI-30). The ROC curves showed acceptable intrinsic accuracies for factor 1 (AUC = 0.883), factor 2 (AUC = 0.901), and factor 3 (AUC = 0.800), with cutoff scores of 22, 7, and 9, respectively. Conclusions: This study provides preliminary evidence that the VFI-SC has good reliability and validity. It can be used to screen for clinical symptoms of voice fatigue in mainland China.

Adaptation and Validation of the Voice Symptom Scale into Kannada (VoiSS-K)

BACKGROUND

The Voice Symptom Scale (VoiSS) is a self-assessment tool that assesses vocal symptoms and measures the effect of dysphonia. Adapting VoiSS into Kannada can be beneficial in evaluating dysphonia-related symptoms, especially in the Kannada-speaking population.

OBJECTIVES

To adapt the VoiSS into Kannada and to assess the reliability, validity, and cut-off values of the VoiSS Kannada version (VoiSS-K).

STUDY DESIGN

The study used a prospective nonrandomized standard group comparison.

METHODS

Initially, the VoiSS was translated into Kannada. The VoiSS-K was administered to 76 participants (34 females and 42 males) with a mean age of 46.4 ± 14.5 years having voice disorders. The VoiSS-K was also administered to 76 respondents having clinically normal voice who were age and gender-matched to the participants with voice disorders.

RESULTS

Cronbach's alpha was utilized to evaluate the internal consistency, and the intraclass correlation coefficient to evaluate the test-retest reliability. The findings indicated that the VoiSS-K had excellent test-retest reliability and internal consistency. The study group participants had significantly higher VoiSS-K scores than the control group participants. Thus, the outcomes indicated that the VoiSS-K had good discriminative validity. Receiver operating characteristic curve analysis was conducted, and the cut-off score of VoiSS-K was 40.50.

CONCLUSION

As the VoiSS-K is a rigorous, robust, and detailed self-assessment questionnaire, it can be used as a clinically sensitive tool to evaluate voice symptoms in Kannada-speaking individuals.

Vocal Fatigue, Dysphonia Risk, and Associated Factors in Male Brazilian Evangelical Pastors

OBJECTIVES

To identify the presence of vocal fatigue and dysphonia risk in evangelical pastors and to verify associations of vocal fatigue with dysphonia risk and other factors.

STUDY DESIGN

Cross-sectional observational study.

METHODS

Ninety-two evangelical pastors, professionally active, answered an on-line questionnaire divided in three steps. The first step consisted of data for the characterization of the sample. In the second stage, participants answered the vocal fatigue index questionnaire (VFI). Finally, they answered to the Brazilian Dysphonia Screening tool. A descriptive analysis of the data was performed along with Spearman's Correlation test between VFI factors and the three possible decision rules for the Brazilian Dysphonia Screening tool. A linear regression model was designed to verify predictive variables associated with the outcome "vocal fatigue".

RESULTS

Ninety male individuals were included. The average sample was off the threshold scores of tiredness and voice impairment, physical discomfort, improvement of voice symptoms with rest, and the total score of VFI. The dysphonia risk was low and was weakly negatively correlated with the improvement of voice symptoms with rest. The linear regression indicated that the presence of a current vocal complaint increases about four points in the VFI.

CONCLUSION

Evangelical pastors present symptomatology of vocal fatigue and low risk for dysphonia. However, the greater the improvement of voice symptoms with rest, the lower the risk for dysphonia. Furthermore, the presence of a current vocal complaint is associated with increased symptoms of vocal fatigue.

Comprehensive Index of Vocal Fatigue (CIVF): Development and Clinical Validation

OBJECTIVES

In this study, we sought to investigate whether auditory-perceptual and acoustic measures change after a passage-reading task and to develop a multidimensional index of performance fatigue in voice disorders. The clinical usefulness and cut-off scores of the newly developed index were also explored.

METHODS

A total of 150 patients (age = 35.65 ± 11.44 years) with voice disorders and 100 healthy controls (age = 35.04 ± 11.26 years) were enrolled in the study. Overall severity (OS) and acoustic measures of sentence samples were obtained before and after a passage-reading task and compared between the two positions. Acoustic features included cepstral peak prominence (CPP), σCPP, L/H spectral ratio (SR), and σSR. Using the changes (Δ) in those acoustic measures and the scores of the Vocal Fatigue Index (VFI), a predictive model of the ΔOS was established. The clinical cut-off point of the index was also identified.

RESULTS

For the patient group, OS was higher, but CPP and σCPP were lower for the rear position (after reading the passage) compared to the front position (before reading the passage). A significant portion (adjusted R² = 77.7%) of the ΔOS was predicted by ΔCPP, tiredness score of the VFI, ΔσCPP, ΔσSR, and ΔSR. The area under the curve of the newly developed index was .864 (sensitivity, 78.67%; specificity, 78.00%), and the index's criterion was >2.6489.

CONCLUSIONS

The newly developed Comprehensive Index of Vocal Fatigue (CIVF) can quantify vocal fatigue in voice disorders, reflecting both acoustic and auditory perceptual changes after a passage-reading task. Further studies should explore the responsiveness of the CIVF and the impact of related factors on the CIVF in various voice disorders.

Vocal Fatigue Index in Finnish-Speaking Population

BACKGROUND AND OBJECTIVE

Vocal fatigue is an important complaint that may indicate a voice disorder or a risk thereof. There is a need for a reliable tool to detect and quantify vocal fatigue and distinguish dysphonic and vocally healthy speakers. The Vocal Fatigue Index (VFI) questionnaire has been found valid and reliable among speakers of different languages. This study aims to validate it for speakers of Finnish.

STUDY DESIGN

Experimental comparative study.

METHODS

The VFI questionnaire was translated from English to Finnish according to the WHO recommendations. Next, it was subjected to the validation procedure. In total, 160 Finnish speakers volunteered to participate in the study. Hundred-and-eight were voice patients (83 males, 25 females) and 52 were vocally healthy controls (37 females, 15 males). As a comparison, the Voice Handicap Index (VHI) questionnaire was completed and voice samples were recorded to enable Acoustic Voice Quality Index (AVQI03.01_FIN) analysis.

RESULTS

Results from the first and second completions of the VFI(F) questionnaire correlated strongly (Spearman's rho 0.901, P = 0.01). Answers to the individual questions the VFI(F) also correlated strongly, showing high internal consistency. Factor 1 (Tiredness of voice and avoidance of voice use) of the VFI correlated strongly with the VHI, and the two other factors (Physical discomfort associated with voicing and Improvement of symptoms) correlated moderately with the VHI. Factor one of the VFI(F) correlated moderately with AVQI03.01_FIN and its sub-parameters, CPPS, HNR, and shimmer. The VFI(F) showed good construct validity, differentiating voice patients and controls at cut-off 13.5, with sensitivity of 0.963 and specificity of 0.885. Discriminatory power was strong for all factors: F1 A_ROC = 0.985, F2 A_ROC = 0.864, and F3 A_ROC = 0.821.

CONCLUSION

The VFI(F) correlates with the VHI and with AVQI01.01_FIN and it is a valid and reliable tool for detecting vocal fatigue in Finnish speakers.

Relation between Orotracheal Intubation, Inflammatory Markers, Breathing and Voice in Post-COVID-19

INTRODUCTION

COVID-19, an infectious disease with a wide spectrum of clinical manifestations and intensities in the human body, it can cause respiratory and vocal disorders, with fatigue.

OBJECTIVE

To verify the relation between biological Inflammatory markers D-dimers and C-Reactive Protein, Forced Vital Capacity, Maximum Phonation Time, vocal performance and fatigue, length of hospitalization period and gender of people affected by COVID-19 who were hospitalized, but did not use orotracheal intubation and compare with a group of post-COVID-19 patients with orotracheal intubation.

METHODS

Data on D-dimers and C-Reactive Protein, spirometry, Maximum Phonation Time, performance and vocal fatigue were collected. The study included 42 adult people affected by COVID-19 who were hospitalized, 22 (52.4%) female and 20 (47.6%) male; 23 (54.8%) critical cases composing the group with orotracheal intubation (average age 48.9 years old) and 19 (45.24%) severe cases in the group without orotracheal intubation (average age 49.9 years old).

RESULTS

hospital length of stay was significantly longer for the group with orotracheal intubation; D-dimers were significantly altered in all groups; correlations between maximum phonation times were positive and significant; correlations between maximum phonation times, vocal performance and fatigue were both negative and significant.

CONCLUSION

Patients with orotracheal intubation had longer hospital internment and increased D-dimers and were amazed that, whenever maximum phonation times decreased performance and vocal fatigue increased.

What are the Symptoms that Characterize the Clinical Condition of Vocal Fatigue? A Scoping Review and Meta-Analysis

INTRODUCTION

Vocal fatigue is a clinical manifestation associated with a perception of negative vocal adjustment. It is related to the increase in the sensation of excessive effort when speaking and the lack of conditioning of the muscles and structures that involve vocal production. Because it has a complex and multifactorial diagnosis, there is still no consensus on the symptoms most commonly found in this clinical condition.

OBJECTIVE

To review and analyze the symptoms that characterize the clinical condition of vocal fatigue.

METHODS

This study consists of a scoping review carried out in the Cochrane Library, Embase, Lilacs, and Medline databases. Observational studies or clinical trials from the last 10 years. Studies with participants younger than 18 years of age were excluded; as well as research that did not describe symptoms of vocal fatigue or that presented vocal fatigue as a symptom; studies with patients with neurological, psychiatric, syndromic conditions, or head and neck cancer. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies NHLBI-NIH scale was used to assess the methodological quality of selected observational studies and the PEDro scale for the analysis of experimental studies. The steps were performed by three blinded evaluators. Subsequently, meta-analyses of global means were executed for each factor under study; a comparison of the difference in the mean score for each factor between exposed and unexposed; a comparison of the difference in the average score, among non-professional voice users, for each factor between exposed and unexposed.

RESULTS

In the searches performed, 956 articles were found and 29 articles were selected according to the eligibility criteria. Of these, 93.11% of the studies were observational and 6.89% were clinical trials. Regarding the gender and age group of the study samples, women aged between 30 and 45 years were predominant. As for the occupational use of voice, 68.97% of the samples were composed of professional voice users and 31.03% of non-professional voice users, with most professional voice users being teachers and non-professional voice users, individuals with dysphonia or vocal complaint. To assess vocal fatigue symptoms, 28 studies used the Vocal Fatigue Index (VFI) protocol, and only one study used another assessment protocol, Self-Administered Voice Rating. All studies were classified as regular, according to the scale used. As for the meta-analyses performed, the mean scores of the VFI factors were higher among professional voice users when compared to non-professional voice users and higher in dysphonic individuals compared to non-dysphonic individuals.

CONCLUSION

The vocal fatigue symptoms found in this review were common in the populations of professional voice users and non-professional voice users and dysphonic and non-dysphonic individuals. These symptoms were related to vocal recovery after rest, physical discomfort, and restricted vocal use.

Vocal Self-Perception of Home Office Workers During the COVID-19 Pandemic

OBJECTIVE

To investigate the self-perception of vocal fatigue symptoms and musculoskeletal pain in home office workers before and during the coronavirus disease (COVID-19) pandemic.

MATERIALS AND METHODS

A total of 424 individuals participated in this cross-sectional, observational, and descriptive study; they were stratified into the experimental group (EG), consisting of 235 individuals working from home office during the COVID-19 pandemic; and the control group (CG), with 189 individuals who continued to work in person during this period. All participants answered the vocal fatigue index and the musculoskeletal pain investigation questionnaires. The data were analyzed in a descriptive and inferential manner.

RESULTS

Participants in the EG reported more vocal fatigue symptoms and musculoskeletal pain than those in the CG before the pandemic. However, during the pandemic, the EG presented a higher frequency of pain in the posterior of the neck, shoulder, upper back, and temporal and masseter muscles, while the CG presented a higher frequency of pain in the larynx. With regard to vocal fatigue, during the pandemic, EG had an increase in scores to factors such as tiredness and voice impairment, avoidance of voice use, and total scores. No such differences were noted in the CG.

CONCLUSION

Workers who migrated to home offices during the COVID-19 pandemic are at risk of developing vocal disorders.

Effect of Wearing a Face Mask on Vocal Self-Perception during a Pandemic

OBJECTIVE

To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic.

MATERIALS AND METHODS

This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic; and the Essential Activities Group, with individuals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed.

RESULTS

Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feedback, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing.

CONCLUSION

Use of face masks increases the perception of vocal symptoms and discomfort, especially in individuals who wore it for professional and essential activities.

Validation of the Self-assessment of Communication Competence (SACCom) in Brazilian Portuguese Through Item Response Theory

OBJECTIVE

To evaluate the validity of the Self-assessment of Communication Competence - SACCom by analyzing the communication competency of adult individuals using the item response theory (IRT).

METHODS

Overall, 778 individuals who responded to SACCom participated in this study. The initial version consisted of 20 polytomous items regarding communication skills. Polytomous answer keys to each item were ordered as follows: 1 - no, 2 - more or less, and 3 - yes. The IRT and the gradual response model, a 2-parameter logistic model for polytomous items, were used for validation.

RESULTS

Due to problems in the preliminary analysis using the item characteristic curve (ICC), answer keys to SACCom items were reorganized in an ordinal dichotomous way. Response 1 was coded as 0 - no, while responses 2 and 3 were coded as 1 - yes. Item 9 of the ICC was problematic and did not add information to the instrument; hence, this item was excluded. SACCom, in its dichotomous format with 19 items, was unidimensional according to the eigenvalues graph and tetrachoric correlation analysis. The Cronbach's alpha coefficient showed an internal consistency value of 0.711. All item-total correlations were greater than 0.284. Item discrimination parameters ranged from a = 0.563 to a = 1.505, and the difficulty of the items ranged between b = -2.725 and b = 0.612. The likelihood ratio test showed that the model without restrictions best fit the data. ICC gleaned more information for individuals with lower communication skills.

CONCLUSION

The 19-item, dichotomous SACCom is valid for the analysis of communication skills according to the IRT.

Vocal fatigue perceived in remote working by teachers of different school grades during COVID-19 pandemic

Objective

Teachers have an increased prevalence of voice disorders. The present study aimed to investigate the impact of remote teaching on perceived voice fatigue among Italian teachers of all grades during the lockdown due to the COVID-19 pandemic.

Method

s The participants were 195 female teachers (M_age=48.77; SD_age=9.61) in primary, secondary, and high schools. They completed the Vocal Fatigue Index (VFI) through an online survey. The tool includes 19 items grouped into three dimensions: tiredness of voice and avoidance of voice use (TA); physical discomfort (PD); and improvement of symptoms with rest (IS). The participants reported their perceived voice fatigue during remote teaching. They were also asked to provide data about voice fatigue as perceived in previous classroom teaching. The data were analyzed through two sets of independent one-way ANOVAs, with voice fatigue subscales as criterion variables and school grade as a between-subjects factor.

Results

The teachers involved in the study reported higher voice fatigue scores than vocally healthy adults from the general population. Primary school teachers showed higher voice fatigue during remote teaching than both secondary and high school teachers, specifically for the TA and PD dimensions, whereas no difference emerged for IS. The VFI scores of primary school teachers were similar to those of dysphonic individuals.

Conclusion

The results of the study confirm that primary school teachers are more vulnerable to developing voice disorders and suggest the need for specific vocal health interventions in case of prolonged remote work.

The Reliability and Validity of the Mandarin Chinese Version of the Vocal Fatigue Index: Preliminary Validation

PURPOSE

This study attempted to develop and to preliminarily validate the Mandarin Chinese version of the Vocal Fatigue Index (VFI) as a standardized self-assessment questionnaire tool for potential clinical applications.

METHOD

The experimental procedure involved (a) cross-cultural adaptation of the VFI into the Mandarin Chinese version (CVFI), (b) evaluation by an expert panel, (c) back translation, (d) pilot testing, and (e) validation of the questionnaire by three participant groups: 50 with voice disorders, 50 occupational voice users (at-risk group), and 50 with normal voice (control group). Internal consistency, test-retest reliability, content validity, and convergent validity of the CVFI were examined, and discriminatory ability (diagnostic accuracy) for distinguishing between the groups was evaluated.

RESULTS

Results showed high internal consistency (Cronbach's alpha ≥ .8817 for the total CVFI scores for all groups), high test-retest reliability (intraclass correlation coefficients ≥ .9072, p < .001 for the total CVFI scores for all groups), high content validity (total content validity index = 0.9368), and high convergent validity (Pearson r ≥ .8155, p < .001 between the total CVFI scores and Factors 1 and 2 scores). Significant differences between the three groups were found in all scores. Receiver operating characteristic analysis revealed a high diagnostic accuracy for distinguishing between the disorders group and the normal group (area under the curve ≥ 0.927, p < .001 for the total CVFI scores and Factors 1 and 2 scores), with cutoff scores of ≥ 36 (total CVFI score), ≥ 23.5 (Factor 1 score), ≥ 7.5 (Factor 2 score), and ≤ 6.5 (Factor 3 score).

CONCLUSIONS

These findings suggested that the CVFI could be a reliable and valid self-assessment tool for the clinical evaluation of vocal fatigue in Mandarin Chinese-speaking populations. A full-scale validation study of the CVFI is recommended to verify these results.

Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment

During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment

ABSTRACT During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part “a” of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Maturidade em Gestão do Conhecimento: aplicação prática de um método

Resumo Esta pesquisa analisa o nível de maturidade em Gestão do Conhecimento de uma empresa de assessoria empresarial e serviços contábeis. Essa avaliação foi feita a partir da aplicação de um instrumento prototípico, que é parte de um modelo - em desenvolvimento - de avaliação de maturação e do potencial para a prática da Gestão do Conhecimento em organizações. Esse modelo estabelece cinco níveis de maturidade em Gestão do Conhecimento, sendo: (1) Incógnito (desconhecido); (2) Manifesto (conhecido); (3) Incipiente (inicial, embrionário); (4) Gerenciando (andamento); e (5) Holístico (totalidade). Para a análise da maturidade em Gestão do Conhecimento, foi aplicado um questionário à população de funcionários da empresa, sendo obtida a amostra de 90,9%. A abordagem quantitativa foi aplicada para análise dos dados. Por resultados, a empresa se enquadra no nível três de cinco de maturidade em Gestão do Conhecimento, sendo esse considerado um estágio incipiente (inicial, embrionário), pois busca gerenciar o conhecimento e suas áreas críticas de sucesso. Conclui-se que o método de maturidade apresentado reflete a realidade da empresa analisada. Espera-se que ele possa contribuir com outras organizações que queiram avaliar seu nível de maturidade em Gestão do Conhecimento.

Fatigue, effort and vocal discomfort in teachers after teaching activity

PURPOSE

Investigate vocal fatigue and its relationship with the sensation of phonatory effort and discomfort in the vocal tract of teachers after a week of activity.

METHODS

Cross-sectional, quantitative study, involving 40 teachers with complaints of vocal fatigue. Procedures performed at the beginning and end of the week, before the classes start were Vocal Fatigue Index, Borg Scale, Vocal Tract Discomfort Scale, and voice recording for perceptual analysis.

RESULTS

There were no changes in phonatory effort and in frequency and intensity of discomfort in vocal tract. In relation to the VFI, in the domains of fatigue and vocal limitation and physical discomfort associated with the voice, teachers started and ended the week with values compatible with dysphonia. In the vocal restriction domain, they started the week with values compatible with vocal healthy individuals and at the end of the week they had scores compatible with dysphonia. In recovery with vocal rest, the pre and post values were below the cut-off score, meaning less vocal recovery. The greater the sensation of vocal fatigue, the greater the perception of phonatory effort; more frequent is the sensation of tightness, dryness, sore, sensitive and irritated throat and more intense the sensations of discomfort in the vocal tract: tightness, dryness, itching, sensitive and irritated throat.

CONCLUSION

Teachers perceive an increase in vocal fatigue, without changes in phonatory effort and vocal tract discomfort after one week of class. The greater the perception of vocal fatigue, the greater the sensation of effort and phonatory discomfort.

Cross-Cultural Adaptation and Validation of the Hong Kong-Chinese Version of Vocal Fatigue Index (VFI(HK))

PURPOSE

This study aimed to cross-culturally adapt and validate the Hong Kong-Chinese version of the Vocal fatigue index (VFI(HK)).

METHOD

The original English version of the Vocal fatigue index (VFI) was translated and adapted to the VFI(HK). A total of 206 subjects (87 in the Fatigue group and 119 in the Control group) completed the VFI(HK) and validity, reliability and receiver operating characteristic (ROC) were analysed.

RESULT

The VFI(HK) exhibited satisfactory psychometric properties. It showed good content validity (scale-level content validity indices ≥ 0.842) and excellent internal consistency (Part 1: α = 0.945, Part 2: α = 0.914, Part 3: α = 0.951). Parts 1 and 2 of the questionnaire showed good construct validity (Part 1: t(204) = 5.743, P < 0.001; Part 2: t(204) = 5.049, P < 0.001). Test-retest reliability ranged from acceptable (Part 3: Ρ = 0.702) to good (Part 1: Ρ = 0.885, Part 2: Ρ = 0.827). ROC curves showed acceptable and close-to-acceptable intrinsic accuracies for Parts 1 (Aera under curve (AUC) = 0.712) and 2 (AUC = 0.694) respectively. Cutoff scores of 25 and 10 are suggested for Parts 1 and 2 respectively.

CONCLUSION

The VFI(HK) is a valid and sensitive assessment tool. It may be adopted to identify individuals with vocal fatigue in the Hong Kong-Chinese population.