Abstract
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.
Dysphonia ; Validation studies ; Quality of life; Translations ; Voice quality ; Voice disorders/diagnosis ; Questionnaires
INTRODUCTION
Dysphonia is an oral communication disorder in which the voice does not perform its role
of carrying the verbal and emotional message of an individual(
11. Behlau M, Azevedo R, Pontes P. Conceito de voz normal e classificação
das disfonias. In: Behlau M. Voz: o livro do especialista. v. 1. Rio de Janeiro:
Revinter; 2001. p. 64-6.
). Usually, voice disorders indicate benign conditions and may be
transitory(
22. Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie
MB. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg.
2009;141(3 Suppl 2):S1-S31.
); however, a voice deviation has psychological elements that can affect the
individual's well-being and quality of life on a personal, social and professional
level. Ideally, the voice examination includes a clinical history and a complete
otolaryngological and voice evaluation. However, these evaluations alone are not able to
quantify the patient's voice problem. More recently, researches showed the importance of
including subjective parameters in voice evaluation to adequately measure the impact of
such deviation(
33. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G,
Benninger MS, et al. The Voice Handicap Index (VHI): development and validation. Am J
Speech Lang Pathol. 1997;6:66-70.
4. Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes
for dysphonic patients. J Voice. 1998;12:540-50.
5. Hogikyan ND, Sethuraman G. Validation of an instrument to measure
voice-related quality of life (V-RQOL). J Voice. 1999; 13(4):557-69.
-
66. 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.
).
Instruments that assess treatment outcomes and quality of life must be carefully
developed taking into consideration psychometric measures of validity, reliability and
sensitivity(
77. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of
health-related quality of life measures: literature review and proposed guidelines. J
Clin Epidemiol. 1993;46(12):1417-32.
8. Gill TM, Feinstein AR. A critical appraisal of the quality of
quality-of-life measurements. JAMA. 1994;272(8):619-26.
9. Bullinger M. International comparability of health interview surveys:
an overview of methods and approaches. In: Nosikov A, Gudex C. EUROHIS: Developing
Common Instruments for Health Surveys. Amsterdam: IOS Press; 2003.
p.1-11.
10. Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, et
al. Assessing health status and quality-of-life instruments: attributes and review
criteria. Qual Life Res. 2002;11(3):193-205.
-
1111. Behlau M, Oliveira G, Santos LMA, Ricarte A. Validação no Brasil de
protocolos de auto-avaliação do impacto de uma disfonia. Pró-Fono R Atual Cient.
2009;21(4):326-32.
). The majority of the quality of life instruments are produced in English,
thus directed to a population that speaks this language. Therefore, in order to use
these protocols in other languages, they must be culturally adapted, carefully
translated following specific guidelines, and have measure properties demonstrated in
the appropriate cultural context(
1010. Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, et
al. Assessing health status and quality-of-life instruments: attributes and review
criteria. Qual Life Res. 2002;11(3):193-205.
).
The choice of the Vocal Activity Participation Profile (VAPP)( 55. Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice. 1999; 13(4):557-69. ) was based on the importance of having a voice-related quality of life instrument translated into Italian that could address activity limitation and participation restriction in order to better conduct the intervention process.
The purpose of this study was to perform the linguistic and cultural equivalence of the Italian VAPP version.
METHODS
This research was approved by the medical direction of San Leopoldo Mandic Hospital in Merate-Lecco and all participants signed the Informed Consent.
Initially, the questionnaire was translated into Italian by one bilingual speech- language pathologist and by one bilingual interpreter, who knew about the purpose of this project. The translators were advised to perform the conceptual translation instead of using the literal meaning of words and sentences. After this first step, the two translations were compared by a pool of specialists composed by three speech- language pathologists specialized in voice and a laryngologist, who discussed discrepancies and agreed upon one single document. The back translation was performed by a bilingual English teacher, who had not participated in the previous stage of translation. The same committee of specialists compared the back translation to the original version of the VAPP, to evaluate again any discrepancies. A final version was produced and called Profilo di Attività e Partecipazione Vocale (PAPV) (Appendix 1 Appendix 1. Italian version of the Vocal Activity Participation Profile ).
For any cultural equivalence of a translated instrument, a "not applicable" option must be added to the response rating scale of each item to enable the identification of sentences that are not clear or inappropriate to the population the instrument is intended to address, and to have them modified or excluded afterwards.
The translated version of the VAPP was administered to 17 individuals with voice complaints, six males and 11 females, aged between 21 to 55 years. Inclusion criteria were the presence of dysphonia of any type or degree, diagnosed by a laryngologist. Exclusion criteria were the presence of any neurological, psychological and/or cognitive disorders that would unable the administration of the questionnaire, or interfere with the comprehension of instructions.
RESULTS
All items were relevant and appropriate 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 revised and the instruction sentence was adjusted to make the information about how the questionnaire should be answered clear. Otherwise, no items were changed and/or deleted.
DISCUSSION
Dysphonia can affect an individual on multiple levels, including personal, social, and
professional one. A comprehensive voice evaluation conducted by a laryngologist and a
voice specialized speech-language pathologist is crucial in appropriately assessing such
disorders. Moreover, within the voice evaluation process, self-assessment protocols play
an important role to adequately measure the impact of such deviations on the
individual's quality of life(
33. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G,
Benninger MS, et al. The Voice Handicap Index (VHI): development and validation. Am J
Speech Lang Pathol. 1997;6:66-70.
4. Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes
for dysphonic patients. J Voice. 1998;12:540-50.
5. Hogikyan ND, Sethuraman G. Validation of an instrument to measure
voice-related quality of life (V-RQOL). J Voice. 1999; 13(4):557-69.
-
66. 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.
).
In Italy, there is currently only one available validated self-assessment protocol: The Voice Handicap Index (VHI)( 1212. Schindler A, Ottaviani F, Mozzanica F, Bachmann C, Favero E, Schettino I, et al. Cross-cultural adaptation and validation of the Voice Handicap Index into Italian. J Voice. 2010;24(6):708-14. ). The choice of adding the VAPP to the Italian repertoire of voice self-assessment tools was based on the importance of having a voice-related quality of life instrument translated into Italian that could address activity limitation and participation restriction in order to better conduct the intervention process.
Moreover, the VAPP is the only self-assessment protocol that uses the International Classification of Impairments, Disabilities and Handicaps-2 Beta 1 (ICIDH-2 Beta 1) concept( 1313. World Health Organization. Measuring Quality of Life - The World Health Organization Quality of Life Instruments. Geneva: WHO/MSA/MNH/PSKF; 1997. p. 1-15. ). As such, the VAPP takes into account the three levels of disablement presented in the ICIDH framework when describing the impact of voice disorders on an individual: Impairment, Disability, and Handicap, with the latter two being replaced by "limitation of activities", and "restriction in participation" respectfully in the newly revised 1997 version( 1313. World Health Organization. Measuring Quality of Life - The World Health Organization Quality of Life Instruments. Geneva: WHO/MSA/MNH/PSKF; 1997. p. 1-15. ).
The validation process of the Italian version of the VAPP will allow the use of this instrument in the clinical and research setting. The experience of performing all the steps of an instrument validation process will help understand aspects that patients with voice disorders have in common.
CONCLUSION
The cultural equivalence of the Italian VAPP was demonstrated and entitled Profilo di Attività e Partecipazione Vocale (PAPV), whose validation is currently in process.
REFERENCES
-
1Behlau M, Azevedo R, Pontes P. Conceito de voz normal e classificação das disfonias. In: Behlau M. Voz: o livro do especialista. v. 1. Rio de Janeiro: Revinter; 2001. p. 64-6.
-
2Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009;141(3 Suppl 2):S1-S31.
-
3Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger MS, et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol. 1997;6:66-70.
-
4Benninger MS, Ahuja AS, Gardner G, Grywalski C. Assessing outcomes for dysphonic patients. J Voice. 1998;12:540-50.
-
5Hogikyan ND, Sethuraman G. Validation of an instrument to measure voice-related quality of life (V-RQOL). J Voice. 1999; 13(4):557-69.
-
6Ma 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.
-
7Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417-32.
-
8Gill TM, Feinstein AR. A critical appraisal of the quality of quality-of-life measurements. JAMA. 1994;272(8):619-26.
-
9Bullinger M. International comparability of health interview surveys: an overview of methods and approaches. In: Nosikov A, Gudex C. EUROHIS: Developing Common Instruments for Health Surveys. Amsterdam: IOS Press; 2003. p.1-11.
-
10Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, et al. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002;11(3):193-205.
-
11Behlau M, Oliveira G, Santos LMA, Ricarte A. Validação no Brasil de protocolos de auto-avaliação do impacto de uma disfonia. Pró-Fono R Atual Cient. 2009;21(4):326-32.
-
12Schindler A, Ottaviani F, Mozzanica F, Bachmann C, Favero E, Schettino I, et al. Cross-cultural adaptation and validation of the Voice Handicap Index into Italian. J Voice. 2010;24(6):708-14.
-
13World Health Organization. Measuring Quality of Life - The World Health Organization Quality of Life Instruments. Geneva: WHO/MSA/MNH/PSKF; 1997. p. 1-15.
-
Study carried out at ENT Department, San Leopoldo Mandic Hospital of Merate (LC), Merate, Italy.
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*
GF was in charge of the project; NPP was responsible for data collection; GO responded for the study design; MB was responsible for general guidance and correction of the final manuscript; all authors contributed to the elaboration of the manuscript.
Appendix 1. Italian version of the Vocal Activity Participation Profile
Publication Dates
-
Publication in this collection
June 2014
History
-
Received
07 June 2012 -
Accepted
28 Feb 2013