The Reflux Symptom Score-12: Cross-cultural Adaptation and Validation for European Portuguese Speakers With Laryngopharyngeal Reflux.

OBJECTIVES: To translate and cross-culturally adapt the 12-item reflux symptom score (RSS-12) to European Portuguese (EP) and determine its clinimetric properties for symptomatic individuals with laryngopharyngeal reflux (LPR). STUDY DESIGN: Multinational cross-sectional cohort study. METHODS: The English RSS-12 was cross-culturally adapted according to the recommendations of the international guidelines. The validation study included the completion of the RSS-12, reflux symptom index, and voice handicap index by symptomatic and asymptomatic subjects with LPR. The RSS-12 was completed a second time by symptomatic subjects. Nine clinimetric properties were analyzed according to the international guidelines for validation of patient-reported outcome measures. RESULTS: The EP RSS-12 is equivalent to the English version (content, depth, and scoring). A total of 155 adults (84 with LPR symptoms) aged 21-78 years participated in the validation study. Statistical analyses revealed high internal consistency (Cronbach alpha >0.90), high test-retest reliability (intraclass correlation coefficient > 0.70, P < 0.001), low measurement error (Standard measure error of 5.21 for RSS and 1.59 for quality of life), good content validity (omission data <1% and item-total correlations > 0.652), good construct validity (61.9% of the total item variance with moderate item loadings), strong concurrent validity with reflux symptom index (rp = 0.772, P < 0.001) and moderate validity with voice handicap index (rp = 0.531, P < 0.001), and significantly known-groups validity (P < 0.001). The EP RSS-12 showed cross-cultural validity with French and Persian versions and high predictive validity with a cut-off value >8 for a sensitivity of 91.7% and a specificity of 91.5%. CONCLUSIONS: The EP RSS-12 retained the features of the English version and is a reliable and valid patient-reported outcome measure for EP individuals with LPR in the study.

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.

Expressões faciais emocionais em indivíduos laringectomizados totais / Emotional facial expressions in individuals with total laryngectomy

Objetivos: verificar se existem diferenças no grau de inteligibilidade de indivíduos laringectomizados totais, que utilizam diferentes formas de comunicação oral (fala murmurada, laringe eletrônica, voz esofágica e voz traqueoesofágica); verificar se existem diferenças na expressão facial (número e duração de movimentos faciais) de indivíduos laringectomizados totais, que utilizam diferentes formas de comunicação oral, durante tarefas de discurso espontâneo alegre e triste e, ainda, verificar se existem diferenças estatisticamente significantes na expressão facial (número e duração de movimentos faciais) de indivíduos com elevada e baixa inteligibilidade durante tarefas de discurso espontâneo alegre e triste. Métodos: tratou-se de um estudo exploratório, comparativo de base descritiva e de metodologia transversal, sendo que se constituiu um grupo de treze indivíduos laringectomizados totais. Os indivíduos foram filmados durante as duas tarefas de discurso espontâneo alegre e triste e avaliados quanto à inteligibilidade do discurso por pessoas sem patologia da comunicação, sendo que a análise da expressão facial foi realizada com recurso ao Sistema de Codificação de Ação Facial. A análise descritiva e inferencial foi efetuada com recurso ao SPSS19 por meio da aplicação dos testes Mann-Whitney e Kruskall-Wallis.Resultados: verificou-se que os diferentes tipos de comunicação apresentam diferentes graus de inteligibilidade no discurso e que descritivamente existem diferenças na expressão facial dos indivíduos laringectomizados totais durante o discurso espontâneo alegre e triste . Verifica-se ainda diferenças estatisticamente significantesna expressão facial nos grupos de baixa e elevada inteligibilidade, na duração média de cada unidade dos olhos no discurso espontâneo triste (p-valor=0,01).Conclusão: verificou-se que nos dois contextos emocionais, os laringectomizados, independentemente da sua forma comunicativa, são menos expressivos facialmente do que os normofalantes.

Purpose: to verify whether there are differences in the degree of intelligibility of individuals with total laryngectomy, using different forms of oral communication (speech whispered, electronic larynx, esophageal voice and tracheoesophagealspeech); verify whether there are differences in facial expression (number and duration of facial movements) in total laryngectomized individuals using different forms of oral communication during spontaneous happy and sad speeches and verify if there are differences in facial expression (number and duration of facial movements) of individuals with high and low intelligibility of spontaneous happy and sad speeches.Methods: treated an exploratory, descriptive and comparative basic methodology cross, and constituted a group of thirteen individuals with total laryngectomy. Subjects were videotaped during both spontaneous happy and sad speeches and evaluated for speech intelligibility for people without pathology of communication, and facial expression analysis was performed using the Facial Action Coding System. We used Statistical Package for the Social Sciences 19for descriptive and inferential analysis, and held the Mann-Whitney and Kruskall-Wallis statistical tests.Results: we found that different types of communication have varying degrees of intelligibility in speech and descriptively differences in facial expression of laryngectomized subjects during the two different type of speeches used in this study. We also verified statistically significant differences in facial expression in groups of low and high intelligibility, the average duration of each unit of sad eyes in spontaneous speech (p-value=0.01).Conclusion: it was found that the two emotional contexts, the laryngectomy, regardless of their communicative way, are less facially expressive than normofalantes.