Voice Activity and Participation Profile - VAPP administered in two different scales of response

Abstracts

OBJETIVO: O presente estudo teve como objetivo comparar duas modalidades de marcação de respostas do questionário Perfil de Participação e Atividades Vocais (PPAV), para investigar a influência das diferentes modalidades nos resultados produzidos por um mesmo protocolo. MÉTODOS: Participaram 32 indivíduos com queixa vocal, de ambos os gêneros, entre 15 e 58 anos, que responderam o protocolo de autoavaliação vocal PPAV em duas escalas de respostas, uma numérica com 11 pontos (EN) e outra analógico-visual de 10 cm de comprimento ou 100 pontos (EAV), em ordem casual de apresentação. O tempo de resposta foi registrado e houve um intervalo de duas semanas entre as aplicações. Ao término da tarefa, os participantes foram questionados sobre dificuldades encontradas para responder o protocolo nas duas versões de escala, indicando também sua preferência por uma delas. RESULTADOS: A média dos escores obtidos foi semelhante em ambas as escalas. Houve diferença apenas em escores parciais referentes à Limitação de Atividades e no aspecto Efeitos na Emoção, com pontuação média maior na escala numérica (p=0,008), porém sem impacto clínico. A ordem de aplicação das escalas não interferiu nas respostas obtidas, com exceção do aspecto Efeitos na Comunicação Social, que quando respondido na escala analógico-visual produziu valores menores no grupo de sujeitos que respondeu inicialmente a escala numérica (p=0,049). Finalmente, a maior parte dos participantes respondeu mais rapidamente ao questionário com a escala numérica (p=0,003). CONCLUSÃO: Os escores obtidos por meio de marcação de resposta com EN e EAV, para o PPAV, são semelhantes, sendo que o questionário com a escala numérica para resposta é respondido em menor tempo, o que pode favorecer sua utilização na prática clínica.

Voz; Auto-avaliação diagnóstica; Disfonia; Escalas; Atividades cotidianas; Questionários

BRIEF COMMUNICATION COMUNICAÇÃO BREVE

Voice Activity and Participation Profile – VAPP administered in two different scales of response

Marcela Dutra Esteves Pires; Gisele Oliveira; Mara Behlau

Centro de Estudos da Voz – CEV – São Paulo (SP), Brasil

^{Correspondence address}

ABSTRACT

PURPOSE: The purpose of this study was to compare two types of rating scales using the Voice Activity and Participation Profile (VAPP) self-assessment questionnaire, in order to check their influence on the results obtained by the same instrument.

METHODS: Participants were 32 individuals with vocal complaints of both genders, with ages between 15 and 58 years. All subjects answered the vocal self-assessment questionnaire VAPP using with two different rating scales, randomly presented: an 11-point numerical scale (NS) and a 10-cm long (or 100 points) visual analogue scale (VAS). Response time was registered and there was a two-week interval between applications. At the end of the task, participants were asked about the difficulties found in the task to answer each rating scale version, and also to indicate their preference.

RESULTS: The mean VAPP scores were similar in both scales. Differences were found only in partial scores, referring to Activity Limitation and Effects on Emotion, with higher mean score in the numerical scale (p=0.008), however with no clinical impact. The order in which the scales were answered did not affect the results obtained, except for the aspect Effects on Social Communication, which presented lower scores with the visual analogue scale ​​in the group of subjects that answered the numeric scale first (p=0.049). Finally, most participants answered faster to the questionnaire when using the numerical scale (p=0.003).

CONCLUSION: The scores obtained in the VAPP by the two different rating scales were similar. The questionnaire with the numeric scale takes less time to be answered, which may be useful for clinical practice.

Keywords: Voice, Diagnostic self evaluation, Dysphonia, Scales, Activities of daily living, Questionnaires

INTRODUCTION

The self-perception of how much a health problem affects quality of life provides important information and is essential for the adherence to therapeutic processes⁽¹⁾. Therefore, self-assessment instruments, usually questionnaires, are developed to measure the patient's opinion about a certain aspect⁽²⁾; nevertheless the practicability during administration must be assured^(3-5).

There are two main modalities of rating those instruments: the visual-analogue scale (VAS) and the numerical scale (NS)⁽⁶⁾.

However, there are no evidences about which one of them is the most appropriate⁽⁷⁾. The VAS consists of a straight line, in which a point has to be placed by the respondent. The result is not straight forward, because the rating has to be measured afterwards. On the other hand, the NS has specific pre-determined points separated by equal interval. The respondent must chose from one of the points provided^(6,8).

The easiness of the NS is the simple adding up of the responses, yet it may influence the respondents answer by the influence of personal preferences. Some individuals, for instance, do not like the number zero and others may have a specific favorite number⁽⁹⁾. Therefore, the relationship with cognitive and sensorial factors must be taken into consideration^(5,10).

Even though the VAS provides a greater sensorial discrimination and is considered the most indicated for evaluating subjective aspects^(11,12), demands an additional operationalization for obtaining the scores, which may demand more time and limit its use for the clinical routine⁽⁴⁾. The decision about what modality is more appropriate for using in clinical and research settings must be based on systematic evaluation of validity and reliability of the different scale modalities^(9,13).

The Voice Activity and Participation Profile – VAPP⁽¹⁴⁾ is a modern instrument that was validated into the Brazilian Portuguese⁽⁸⁾ and has 28 items that investigate five aspects: self-perceived severity of voice problem; effect on job; effect on daily communication; effect on social communication; effect on emotion. The questionnaire also provide two extra scores: Activity limitation and Participation restriction. This questionnaire was originally developed to be answered with a 100-unit VAS⁽¹⁴⁾. A previous study carried out in Hong Kong that investigated the difference between results provided by the two types of scale, showed similar outcome⁽¹¹⁾.

The present study had the objective of comparing these two types of rating scales using the VAPP self-assessment questionnaire in order to check the influence of them on the results obtained by the same instrument.

METHODS

A total of 32 individuals with dysphonia participated in this study, 22 were female and 10 male, none of them had been submitted to voice treatment, they belonged to middle social-economic class and had elementary school as a minimum educational level. Mean age of participants was 32 years and 8 months (ranging from 15 to 58 years). The present study project was approved by the Ethics Committee of the Centro de Estudos da Voz (protocol #2016/08). All participants signed the Informed Consent.

Participants answered randomly the VAPP with two different rating scales: a 11-point numerical scale and a 10-cm long visual-analogue scale (100 units) with an interval of a week between administrations. Out of 32 individuals, 50% responded firstly to the NS (NS before VAS group). The response time for each of the rating scale modality was recorded in seconds. Participants were also inquired about their preference between the two types of scales and which of them was less degree of difficult to answer.

Findings were statistically assessed (SPSS 17.0) and the significance lever adopted was 5% (0.050). The Wilcoxon signed rank test was utilized to compare both scales. The Mann-Whitney test was utilized to compare the administration order of the questionnaires and the Exact Fisher test analyzed the categorical variables: preference for scale type, smaller rating time and smaller degree of rating difficulty.

RESULTS

Mean total scores were similar with both rating scales. There was only significant difference for the Activity Limitation and Effects on Emotion scores with the NS having the highest means (Table 1). The order of the questionnaires administration did not influence the results, except for the aspect Effects on Social Communication (p=0.049), which had lower scores when answered with the VAS by the "NS before VAS" group (mean 11.06) compared to the "VAS before NS" group (mean 18.77).

Preference for scale type (p=0.166) and degree of rating difficulty (p=0.500) did not have significant differences. However, the majority of the participants answered faster to the questionnaire with the numerical scale (mean of 123.2 seconds for NS and 217.6 seconds for VAS; p=0.003) (Table 2).

DISCUSSION

Rating scales are common instruments that provide a fast and easy mean of quantifying certain individual perception. The choice of the type of scale must be based on practical considerations, on the individual preferences and on the feasibility of its use in the clinical routine taking into account the time of administration^(3,4,9).

In the present study, both scales produced similar results as it happened to the Chinese study⁽¹¹⁾. Therefore, the findings suggest that the patient and/or the clinician chose their favorite modality of rating scale. It is important to highlight that the higher scores for the Effects on Emotion and Activity Limitation aspects obtained by the NS indicate that perhaps the cognitive and sensorial factors influenced the answers⁽⁵⁾. Probably, the questionnaire with the VAS under evaluated these aspects. Nonetheless, these differences is not relevant and does not change the clinician intervention planning.

The participants did not show any preference regarding the type of scale. Seemingly they also did not find any difference regarding the degree of difficulty encountered when answering the questionnaire. On the other hand, as far as the time of answering the questionnaire is concerned, the NS scale provided a faster rating^(9,12). Probably, the continuous line of the VAS, which does not have category or division support, make the individuals insecure during the rating.

CONCLUSION

We can conclude that regardless the rating scale used, there is no difference in the results of the VAPP, since the results obtained both by the NS and VAS were similar. The order of administration of the questionnaires had little influence on results. Moreover, the questionnaire with the numerical scale takes less time to be answered, which may be useful for clinical application. Therefore, the clinician can decide either to use the NS that is faster or let the patient chose each of the scales they prefer answering the questionnaire with.

REFERENCES

1. Bassi IB, Assunção AA, Brandão PV, Medeiros AM, Gama AC, Menezes LN. Análise dos parâmetros vocais, laríngeos e do protocolo do perfil de participação e atividade vocal (PPAV) em professoras da rede municipal de ensino de Belo Horizonte encaminhadas para fonoterapia. In: 16° Congresso Brasileiro de Fonoaudiologia; 2008 Set 24-27; Campos do Jordão; 2008.

2. Hogikyan ND, Rosen CA. A review of outcome measurements for voice disorders. Otolaryngol Head Neck Surg. 2002;126(5):562-72.

3. Southwood MH. Direct magnitude estimation and interval scaling of naturalness and bizarreness of the dysarthria associated with amyotrophic lateral sclerosis. J Med Speech-Lang Pathol. 1996;4(1):13-25.

4. Southwood MH, Flege JE. Scaling foreign accent: direct magnitude estimation versus interval scaling. Clin Linguist Phon. 1999;13(5):335-49.

5. O' Connor R. Issues in the measurement of health-related quality of life. Melbourne: National Centre for Health Program Evaluation; 1993. (Working Paper, 30).

6. McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press; 1996.

7. Patrick DL, Bush JW, Chen MM. Methods for measuring levels of well-being for a health status index. Health Serv Res. 1973;8(3):228-45.

8. Ricarte A, Behlau M. Validação do protocolo Perfil de Participação e Atividades Vocais (PPAV) no Brasil [monografia]. São Paulo: Centro de Estudos da Voz; 2006.

9. Schiavetti N, Sacco PR, Metz DE, Sitler RW. Direct magnitude estimation and interval scaling of stuttering severity. J Speech Hear Res. 1983;26(4):568-73.

10. Kaplan RM, Bush JW, Berry CC. Health status index: category rating versus magnitude estimation for measuring levels of well-being. Med Care. 1979;17(5):501-25.

11. Ma EP, Yiu EM. Scaling voice activity limitation and participation restriction in dysphonic individuals. Folia Phoniatr Logop. 2007;59(2):74-82.

12. Huskisson EC. Visual analogue scales. In: Melzack R. Pain measurement and assessment. New York: Raven Press; 1983. p.33-7.

13. Kasama ST, Brasolotto AG. Percepção vocal e qualidade de vida. Pró-Fono. 2007;19(1):19-28.

14. Ma EP, Yiu EM. Voice activity and participation profile: assessing the impact of voice disorders on daily activities. J Speech Lang Hear Res. 2001;44(3):511-24.

Received: 5/19/2011

Accepted: 8/2/2011

Study conducted at the Graduate Specialization in Voice, Centro de Estudos da Voz – CEV – São Paulo (SP), Brasil.

Publication Dates

• Publication in this collection
  14 Oct 2011
• Date of issue
  Sept 2011

History

• Accepted
  02 Aug 2011
• Received
  19 May 2011