Cross-cultural adaptation, validation, and cutoff point of the Italian version of the voice activity and participation profile: Profilo di Attività e Partecipazione Vocale.

OBJECTIVES/HYPOTHESIS: The purpose of the study was to investigate the validity of the Profilo di Attività e Partecipazione Vocale (PAPV) and to identify the cutoff point of the total score that discriminates dysphonic from vocally healthy individuals. STUDY DESIGN: Cross-sectional, nonrandomized, prospective study with controls. METHODS: The PAPV was administered to 239 individuals, 108 with vocal complaint, 131 without vocal complaint, 141 female, 98 male, mean age of 45.8 years. The instrument was submitted to validity, reliability, reproducibility, and responsiveness. RESULTS: Construct-related validity was evaluated by comparing the scores of the groups with and without voice problem (Job: P < 0.001, self-perceived severity: P < 0.001, daily communication: P < 0.001, social communication: P < 0.001, emotion: P < 0.001, total: P < 0.001). The evaluation of criterion-related validity showed moderate-strong correlation coefficients between the PAPV, Voice Handicap Index, and vocal self-assessment. High alpha coefficients showed good internal consistency (job: 0.910, daily communication: 0.981, social communication: 0.981, emotion: 0.948, total: 0.989). High intraclass correlation coefficient showed good reproducibility (Job: 0.967, self-perceived severity: 0.979, daily communication: 0.990, social communication: 0.950, emotion: 0.976, total: 0.993). Changes after treatment were statistically significant for all PAPV scores (self-assessment P < 0.001, job P < 0.001, daily communication P < 0.001, social communication P = 0.005, emotion P < 0.001, total P < 0.001). The cutoff point with the highest sensitivity (84%) and specificity (100%) was 37.45 points. CONCLUSIONS: The PAPV has undergone important steps required for cultural adaptation and validation process of outcome measures and it may be considered an important instrument to compose the assessment of Italian patients with dysphonia. The cutoff point that discriminates individuals with dysphonia from vocally healthy ones was 37.45 points for its total score.

Development and validation of the voice fatigue handicap questionnaire (VFHQ): clinical, psychometric, and psychosocial facets.

OBJECTIVES/HYPOTHESIS: Development and validation of the vocal fatigue handicap questionnaire (VFHQ), a self-administered brief instrument for the assessment of functional, emotional, and physical vocal fatigue (VF). STUDY DESIGN: "Outcomes research" with item generation, item reduction, and psychometric evaluation of instrument's key properties involving different subsamples of patients in content generation and item-selection pilot testing, followed by a main validation study. METHODS: Questionnaire content generation and item reduction by selection of 30 items from an initial pool of 60 during pilot testing, followed by psychometric assessment of VFHQ's internal consistency, test-retest reliability, construct validity, criterion validity, and clinical efficacy in a main validation study with 87 patients with voice disorders. Internal consistency was evaluated by means of Cronbach-alpha coefficients; construct and criterion validity through multiple regression analyses; test-retest reliability by administering 35 questionnaires to pathologic respondents after a 15 days' time-interval from first questionnaire administration; clinical efficacy, (ie, instrument's usefulness and responsiveness) by administering 20 questionnaires to patients with voice disorders before and after clinical intervention. RESULTS: Statistical analyses established VFHQ's high internal consistency, reliability, construct, and criterion validity, as well as efficacy, and usefulness in therapeutic practice for the assessment of clinical and psychosocial consequences of VF (spoken voice). CONCLUSIONS: VFHQ is a useful tool for the assessment of VF, which is able to quantify its functional, emotional, and physical components.

Cross-cultural adaptation of the Italian version of the Voice Activity Participation Profile.

The Vocal Activity Participation Profile (VAPP), originally developed in English, is a self-assessment tool used to measure individuals' voice activity limitation and participation restriction. Based on the fact that the cultural/linguistic adaptation is an essential step of validating a protocol in another language, the purpose was to linguistically and culturally adapt the VAPP into Italian. The adaptation was performed in accordance to the Scientific Advisory Committee of the Medical Outcomes Trust. The translation was performed by one bilingual speech-language pathologist and by one bilingual interpreter, who knew about the purpose of this project. A bilingual English teacher, who had not participated in the previous step, performed the back translation. A committee composed by three speech-language pathologists specialized in voice and one laryngologist compared the forward and backward translations, to assess for any discrepancies. A final version was produced and called Profilo di Attività e Partecipazione Vocale (PAPV). A "not applicable" option was included to each item and was administered to 17 individuals with voice problems, six males and 11 females, aged between 21 to 55 years. All items were relevant, as no patients chose the "not applicable" option. However, four individuals, who had a lower educational level, did not fully understand the instructions of the opening statement. Therefore, the questionnaire was further reviewed and adjusted to clarify the information. Otherwise, no items were changed and/or deleted. The PAPV kept the same structure as the original version. The cultural equivalence of the Italian VAPP was demonstrated and entitled PAPV, whose validation is currently in process.