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Cross-cultural Adaptation and Validation of the Singing Voice Handicap Index (S-VHI) Into Spanish
Faustino Nuñez-Batalla M.D.1, Isabel Garcia-Perez M.D.2
1 HUCA, Universidad de Oviedo, Asturias (Spain), 2Hospital Universitario La Paz, Madrid (Spain)
ABSTRACT
Objectives: 1. To validate the Spanish
translation of the disorder-specific health
status instrument (Singing Voice Handicap
Index: S-VHI) in order to use it with patients
with singing problems. 2. To determine the
S-VHI threshold of a healthy population of
professional classical singers. Methods: The
S-VHI was translated into Spanish from a
validated English version. The questionnaire
was completed by 29 dysphonic singers and
81 healthy singers between January and
December 2009. Test-retest reliability, internal
consistency and construct validity were
assessed.
Results: Results showed high test-retest
reliability (r = 0.63, P = .000) and high itemtotal correlation for the Spanish version of the
S-VHI. Internal consistency demonstrated a
Cronbach´s alpha of 0.96, and the correlation
between the S-VHI and the self-rated singing
voice impairment was 0.52 (p = .000).
Dysphonic singers had worse S-VHI scores
than normal singers (ANOVA, F = 10.9, P
<002).
Conclusions: The Spanish version of the
questionnaire is a validated tool with proper
internal consistency and reliability. The
average score of the S-VHI in healthy singers
is 20% of the maximum possible score of the
questionnaire, well above the average score in
a healthy population for the spoken voice with
VHI-30 (6.7%).
INTRODUCTION
The self-evaluation of the voice, although subjective by definition, is of
growing importance in daily clinical practice since it is the patient who
has to live with his/her voice. Social and cultural aspects may also be
relevant when considering voice quality. This evaluation needs careful
quantification as it is paramount, and needs to be compared and
correlated with the data of the objective assessment.
Prior reports have demonstrated that voice disorders adversely impact
patients´ lives, specifically on their physical, social, emotional and
economic areas. A Voice Handicap Index (VHI) can be computed on
the base of the patient's answers to a carefully selected list of
questions.
Singers represent a unique patient population at a high risk for voice
impairment and more vocal disability. Voice disorders and their impact
upon the individual differ between singers and non-singers.
VHI do not adequately address the voice problems in singers,
consequently a disorder-specific health status instrument (Singing
Voice Handicap Index) was developed and validated in order to use it
with singers with voice problems.
The aim of the present study was to test the psychometric properties of
the Spanish Singing Voice Handicap Index (S-VHI) and to confirm its
validity for the Spanish-speaking population.
METHODS AND MATERIALS
A Spanish version of the original English S-VHI was developed for the
present study. After the translation of the Spanish S-VHI, a group of
voice care professionals, singing professors and singers were
interviewed to discuss the items in the Spanish S-VHI. Wordings of the
questionnaire were modified on the basis of their suggestions.
Participants: The questionnaire was completed by 29 dysphonic
singers and 81 healthy singers between January and December 2009
(95.4% professional singers: 84.5% classical and 15.4% pop-rock).
CONTACT
Faustino Nunez-Batalla
Hospital Universitario Central de Asturias
Email: [email protected]
Phone: +34630800581
Poster Design & Printing by Genigraphics® - 800.790.4001
Procedure: Each participant completed the Spanish S-VHI
questionnaire on his/her own. The patients were also asked to self-rate
their overall severity of singing related voice symptoms using a fourpoint scale. The test was administrated again 2 weeks later, the
participants did not receive therapeutic intervention within this period.
Statistical tests were performed using the SPSS 15.0 statistical
software. Test-retest reliability, internal consistency, item-total
correlation and construct validity were performed.
Spanish S-VHI
Instrucciones: A través del uso de la escala que se le provee a
continuación, enumere cada una de las aseveraciones
siguientes, según lo que aplique para su caso.
0= Nunca 1= Casi nunca
Siempre
2= A veces
3= Casi siempre
4=
1. Me cuesta mucho esfuerzo cantar.
2. Mi voz carece de fuerza y se rompe.
3. Me siento frustrado con mi forma de cantar.
4. Cuando canto, la gente me pregunta: ¿qué le pasa a tu voz?
5. Mi habilidad para cantar varía de un día para otro.
6. Mi voz se va cuando canto.
7. Mi voz cantada me disgusta.
8. Mis problemas para cantar hacen que no desee cantar/actuar.
9. Me da vergüenza cantar.
10. Soy incapaz de cantar en el registro agudo.
11. Me pongo nervioso antes de cantar debido a mis problemas para
cantar.
12. Mi voz hablada no es normal.
13. Tengo la garganta seca cuando canto.
14. He tenido que eliminar ciertos temas de mi repertorio.
15. No tengo confianza en mi voz cantada.
16. Mi voz cantada nunca es normal.
17. Me cuesta que mi voz haga lo que quiero.
18. Tengo que hacer esfuerzo para que me salga la voz cuando canto.
19. Me cuesta controlar el aire en la voz.
20. Tengo problemas para controlar la aspereza en mi voz.
21. Tengo problemas al cantar fuerte.
22. Tengo problemas para mantener la afinación mientras canto.
23. Me siento agobiado por mi forma de cantar.
24. Mi canto suena forzado.
25. Mi voz hablada suena ronca después de cantar.
26. La calidad de mi voz es variable.
27. Al público le cuesta oír mi voz cuando canto.
28. Mi forma de cantar me hace sentirme en desventaja.
29. Mi voz cantada se cansa fácilmente.
30. Siento dolor, picor o ahogo cuando canto.
31. No me siento seguro de lo que va a salir cuando canto.
32. Siento que falta algo en mi vida por mis limitaciones para cantar.
33. Me preocupa que mis problemas para cantar me hagan perder
dinero.
34. Me siento excluido de la escena musical por mi voz.
35. Mi forma de cantar me hace sentirme incompetente.
36. Tengo que cancelar actuaciones, contratos, ensayos o clases por mi
forma de cantar.
RESULTS
DISCUSSION
Test-retest reliability: Forty-two of 110 singers (38.1%) completed the
S-VHI twice over a period of 2 to 8 weeks. Strong test-retest reliability
for the total scores of the questionnaire was found (r=0.63; p=.000).
The results showed strong test-retest reliability and internal consistency
for the Spanish S-VHI. The construct validity was supported by the
findings that the total scores were significantly correlated with the
participants’ self-perceived overall singing voice condition. Dysphonic
patients had significantly higher mean total scores than the control
group, which supports the use of the S-VHI to separate dysphonic and
non-dysphonic groups.
The second aim of this study was to determine the S-VHI threshold of a
healthy population of professional classical singers. A striking fact was
that among healthy singers, when asked their opinion about their
singing voice, only nine people (8.7%) of 83 answered that it was a
perfect voice while the rest replied that it felt as a most normal voice but
could be better (score 2 of 5). This observation is also transferred to the
scores of the S-VHI, where a high basal score was found. Contrary to
what one might expect, the scores of the healthy singers do not tend to
zero, but have a mean of 28.4 ±18.5 points, 19.7% of the maximum
possible score of 144 points.
Compared to what happens in non-singers, with the baseline score of
the VHI (baseline scores of 8.1 ± 9.8 points or 6.75% of the maximum
possible score of 120 points), it is found that self-assessment of the
singing voice on controls using the S-VHI tends to have high baseline
values, therefore demonstrating the high vocal demands of this unique
patient population.
Internal Consistency and Item-Total correlation: Overall reliability
analysis included answers from all participants. Cronbach´s alpha
showed that the S-VHI was reliable (α=0.966). A review of the individual
items showed that all items in both tests had high item-total correlations
(Table 3).
Construct validity: Significant correlations were demonstrated
between the self-rated overall severity of the voice handicap and the
total scores of S-VHI (r=0.52; p=.000). The total scores for the control
group were significantly lower than those of the patients group (ANOVA
f=10.9; p=.002).
Diagnoses of final patient cohort
Table 1
♂
♀
Mean Age
(range)
13
(46.4%)
16
(53.6%)
37.8 years
(21-54 years)
N
Patient cohort:
29
Exudative lesions of Reinke`s space
Muscular tension dysphonia
Laryngitis
Vocal cyst
Vascular lesions
Granuloma
Vocal abuse
5
5
6
3
3
1
6
Control group:
81
33
(40.7%)
48
(59.2%)
36.5 years
(20-55 years)
Total
110
46
64
35.8 years
Parameter
Table 2: Acoustic
parameters
Table 3:
Item-total correlation
CONCLUSIONS
Percent
Jitter (>0.6%)
19%
Shimmer (>6.5%)
66.6%
Noise (>2.5)
38%
MPT (< 11 seg)
28.5%
s/a Index (>1.4)
47.6%
GRBAS
•Grade 1
•Grade 2
88%
12%
Yanagihara
•Grade I
•Grade II
•Grade III
•Grade IV
52%
14.2%
23.8%
4.7%
This study developed a Spanish version of S-VHI and tested its
reliability and validity. High test-retest reliability and high item-total
correlation were found. The Spanish S-VHI was also able to distinguish
between the dysphonic group and the control group of singers.
The scores of the healthy singers do not tend to zero but have a mean
of 28.4 ±18.5 points, 19.7% of the maximum possible score, well above
the average score in a healthy population for the spoken voice with
VHI-30 (6.7%).
REFERENCES
Item 1
0.72
Item 13
0.53
Item 25
0.59
2
0.62
14
0.50
26
0.61
3
0.71
15
0.71
27
0.51
4
0.61
16
0.66
28
0.68
5
0.56
17
0.63
29
0.60
6
0.65
18
0.69
30
0.60
7
0.65
19
0.62
31
0.68
8
0.49
20
0.61
32
0.64
9
0.45
21
0.58
33
0.54
10
0.61
22
0.51
34
0.56
11
0.67
23
0.70
35
0.65
12
0.50
24
0.69
36
0.60
1. Cohen SM, Jacobson BH, Garrett CG et al. Creation and validation of the
singing voice handicap index. Ann Otol Rhinol Laryngol 2007; 116: 402-406.
2. Jacobson BH, Johnson A, Grywalski C et al. The voice handicap index (VHI):
development and validation. Am J Speech Lang Pathol 1997; 6: 66-70.
3. Cohen SM, Witsell DL, Scearce L, Vess G, Banka C. Treatment
responsiveness of the singing voice handicap index. Laryngoscope 2008;
118: 1705-1708.
4. Núñez-Batalla F, Corte-Santos P, Señaris-González B et al. Adaptación y
Validación del Índice de Incapacidad Vocal (VHI-30) y su Versión Abreviada
(VHI-10) al Español. Acta Otorrinolaringol Esp. 2007; 58:386-92.