Vocal symptoms in pediatric population: Validation of the Brazilian version of the Pediatric Vocal Symptoms Questionnaire

Ribeiro, Lívia Lima; Verduyckt, Ingrid; Behlau, Mara

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Original Article • CoDAS 31 (5) • 2019 • https://doi.org/10.1590/2317-1782/20192018225 copy

Vocal symptoms in pediatric population: Validation of the Brazilian version of the Pediatric Vocal Symptoms Questionnaire

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Purpose

To validate the Pediatric Vocal Symptoms Questionnaire (PVSQ) for Brazilian Portuguese.

Methods

The study was approved by the Ethics Committee (758,309). A total of 716 individuals participated in this research, of which 367 were children and adolescents, with and without vocal alteration, aged 6-18 years, and 349 were parents/guardians, who responded to the final version of the instrument. Among the interviewed of this version, 272 participated in the test-retest, and 32, of the sensitivity. Children and adolescents aged 6-18 years responded to the self-evaluation version of the PVSQ, and their parents/guardians to its parental version.

Results

The PVSQ showed acceptable reliability and reproducibility for the Brazilian population and sensitivity to vocal treatment.

Conclusion

The PVSQ was validated for Brazilian Portuguese, being a good instrument of vocal self-evaluation, both in the parental version and in the self-evaluation version.

Keywords
Dysphonia; Validation Studies; Translation (product); Voice Disorders/diagnosis; Questionnaires; Child; Adolescent; Parents

Variable	VS Score [PVSQ - SE]	VS Score [PVSQ - PE]
SE - GWVA
CC (r)	-0.494	-0.209
p	< 0.001^* * Significant values (p ≤ 0.050) – Spearman’s correlation test	0.003*
n	210	197
PE - GWVA
CC (r)	-0.279	-0.725
p	< 0.001*	< 0.001*
n	204	197
SE - GWOVA
CC (r)	-0.313	-0.090
p	< 0.001*	0.269
n	157	152
PE - GWOVA
CC (r)	-0.188	-0.279
p	0.020*	< 0,001*
n	153	152

Item	Test		Retest
Item	Cronbach’s alpha coefficient	p	Cronbach’s alpha coefficient	p
SE - PE
1 “Do/Does you/your child feel/feels that your/his/her voice gets tired when...”
a “…you/he/she talk/talks, play/plays, talk/talks on the phone... or after that?”	-0.411	0.743	0.620	0.035*
b “... you/he/she read/reads aloud, participate/participates in parties, in the school theater... Or after that? “	0.439	0.137	0.766	0.004*
c “... you/he/she sing/sings, participate/participates in choirs, or sing/sings at Karaoke bars... Or after that? “	0.532	0.077	0.000	0.500
d “...you/he/she play/plays football, dodgeball, run and catch, practise/practises sports... Or after that?”	0.256	0.287	0.564	0.060
2 “Do people ask you/your child to repeat what you/he/she said because of your/his/her voice?”	0.190	0.344	-0.640	0.826
3 “Do/Does you/your child have/has to use force for your/his/her voice to go out?	0.237	0.304	0.613	0.038*
4 “Do/Does you/your child get annoyed because of your/his/her voice?”	-0.019	0.515	0.689	0.015*
5 “Do/ Does you/your child avoid using your/his/her voice when...”
a “…you/he/she talk/talks, play/plays, talk/talks on the phone... because you do not like your voice/because his/her voice is not how he/she would like it to be?”	0.313	0.238	-0.205	0.639
b “... you/he/she read/reads aloud, participate/participates in parties, in the school theater... because you do not like your voice/because his/her voice is not how he/she would like it to be?”	0.158	0.371	0.000	0.500
c “... you/he/she sing/sings, participate/participates in choirs, or sing/sings at Karaoke bars... because you do not like your voice/because his/her voice is not how he/she would like it to be?”	0.184	0.349	-0.113	0.581
d “...you/he/she play/plays football, dodgeball (queimada), run and catch, practise/practises sports... because you do not like your voice/because his/her voice is not how he/she would like it to be?”	0.055	0.457	-0.113	0.581
6 “Do/Does you/your child have/has to use force for your/his/her voice to go out?	0.447	0.131	0.625	0.033*
7 “Have your voice and your child’s voice ever been debauched, mocked, or made a joke of?”	0.686	0.016*	0.425	0.147
8 “Have/Has you/your child ever stayed without speaking because you/he/she were/was voiceless?”	0.324	0.229	0.552	0.066
9 “Do/Does you/your child get angry because of your/his/her voice?”	0.038	0.471	0.461	0.122
10 “Are you/your/your child afraid to harm or worsen your/his/her voice?”	0.693	0.014*	-0.033	0.525
11 “Do/Does you/your child get/gets sore throat when...”
a “…you/he/she talk/talks, play/plays, talk/talks on the phone... or after that?”	0.716	0.010*	-0.421	0.748
b “... you/he/she read/reads aloud, participate/participates in parties, in the school theater... Or after that? “	0.674	0.019*	0.258	0.285
c “... you/he/she sing/sings, participate/participates in choirs, or sing/sings at Karaoke bars... or after that? “	0.241	0.300	0.478	0.110
d “...you/he/she play/plays football, dodgeball (queimada), run and catch, practise/practises sports... or after that?”	-0,294	0,688	0,874	< 0,001*
12 “Do people ask you/your child ‘what is in your voice’?”	0.120	0.404	0.615	0.037*
13 “Do/Does you/your child have to cough or clear the throat when you/he/she talk/talks even without being sick (flu or cold)? (Demonstration by physician/clinician)”	0.480	0.108	0.491	0.101
14 “Do/Does you/your child get hoarse even when you/he/she are/is not sick?”	0.348	0.209	0.067	0.447
15 “Do/Does you/your child have difficulty completing sentences, when you/he/she speak/speaks, because of your/his/her voice?”	0.427	0.146	0.442	0.135
16 “Do/ Does you/your child have to rest the voice when..”
a “…you/he/she talk/talks, play/plays, talk/talks on the phone... or after that?”	0.464	0.119	-0.168	0.616
b “... you/he/she read/reads aloud, participate/participates in parties, in the school theater... Or after that?	0.382	0.181	-0.762	0.858
c	0.139	0.388	0.253	0.290
“... you/he/she sing/sings, participate/participates in choirs, or sing/sings at Karaoke bars … or after that? d	0.042	0.467	0.530	0.078
“...you/he/she play/plays football, dodgeball (queimada), run and catch, practise/practises sports... or after that?” 17 “Do/Does you/your child feel that the throat burns or bothers you even when you are not sick (flu/cold)?”	0.381	0.182	0.582	0.051
18 “Are/Is you/your child sad because of your/his/her voice?”	0.806	0.001^* * Significant values (p ≤ 0.050) – Cronbach’s alpha test	0.460	0.122
19 “Would you/your child like to change your/his/her voice?”	0.522	0.082	0.558	0.063
VS Score	0.848	< 0.001*	0.904	< 0.001*

Type of evaluation Test %		Retest %			p
Type of evaluation Test %		Excellent	Good	Bad	p
SE
Excellent	1.50	1.50	0.00	0.00	0.081
Good	29.40	3.70	23.50	2.20
Bad	69.10	0.00	6.60	62.50
Total	100.00	30.10	5.10	64.70
PE
Excellent	11.80	5.90	5.90	0.00	0.342
Good	42.60	7.40	28.70	6.60
Bad	45.60	0.00	2.90	42.60
Total	100.00	13.20	37.50	49.30

Pair of variables	M	SD	Min	Max	M	p
SE
1 “Do you feel that your voice gets tired when...”
a “…you talk, play, talk on the phone... or after that?”
Test	0.76	0.76	0.00	2.00	1.00	> 0.999
Retest	0.76	0.76	0.00	2.00	1.00	> 0.999
b “... you read aloud, participate in parties, in the school theater... or after that?”
Test	0.68	0.72	0.00	2.00	1.00	0.046*
Retest	0.71	0.72	0.00	2.00	1.00	0.046*
c “... you sing, participate in choirs, or sing at Karaoke bars... or after that?”
Test	0.85	0.77	0.00	2.00	1.00	0.414
Retest	0.86	0.75	0.00	2.00	1.00	0.414
d “...you play football, dodgeball (queimada), run and catch, practise... or after that?”
Test	0.85	0.85	0.00	2.00	1.00	0.096
Retest	0.89	0.85	0.00	2.00	1.00	0.096
2 “Do people ask you to repeat what you said because of your voice?”
Test	0.90	0.78	0.00	2.00	1.00	0.317
Retest	0.90	0.79	0.00	2.00	1.00	0.317
3 “Do you have to use force for your voice to go out?”
Test	0.43	0.68	0.00	2.00	0.00	0.014*
Retest	0.47	0.71	0.00	2.00	0.00	0.014*
4 “Do you get irritated because of your voice?”
Test	0.53	0.77	0.00	2.00	0.00	0.083
Retest	0.55	0.78	0.00	2.00	0.00	0.083
5 “Do you avoid using your voice when...”
a “…you talk, play, talk on the phone... because you do not like it?”
Test	0.40	0.71	0.00	2.00	0.00	0.317
Retest	0.41	0.71	0.00	2.00	0.00	0.317
b “... you read aloud, participate in parties, the school theater... because you do not like your voice?”
Test	0.42	0.73	0.00	2.00	0.00	0.157
Retest	0.43	0.74	0.00	2.00	0.00	0.157
“... you/he/she sing/sings, participate/participates in choirs, or sing/sings at Karaoke bars... Or after that? “
c “... you sing, participate in choirs, or sing at Karaoke bars... or after that?” Test	0.43	0.74	0.00	2.00	0.00	0.157
Retest	0.44	0.75	0.00	2.00	0.00	0.157
d “...you play football, dodgeball (queimada), run and catch, practise sports... or after that?”
Test	0.32	0.63	0.00	2.00	0.00	0.317
Retest	0.33	0.63	0.00	2.00	0.00	0.317
6 Do you have to use force for speaking?”
Test	0.30	0.59	0.00	2.00	0.00	0.157
Retest	0.32	0.59	0.00	2.00	0.00	0.157
7 “Have your voice ever been debauched, mocked, or made a joke of?
Test	0.49	0.73	0.00	2.00	0.00	0.317
Retest	0.49	0.73	0.00	2.00	0.00	0.317
8 “Have you ever been without speaking because you were voiceless?”
Test	0.41	0.60	0.00	2.00	0.00	0.317
Retest	0.42	0.60	0.00	2.00	0.00	0.317
9 “Do you get angry because of your voice?”
Test	0.35	0.63	0.00	2.00	0.00	0.317
Retest	0.35	0.63	0.00	2.00	0.00	0.317
10 “Are you afraid to harm or worsen your voice?”
Test	1,04	0.81	0.00	2.00	1.00	0.157
Retest	1.06	0.81	0.00	2.00	1.00	0.157
11 “Do you have a sore throat when ...”
a “…you talk, play, talk on the phone... or after that?”
Test	0.59	0.79	0.00	2.00	0.00	0.025*
Retest	0.63	0.83	0.00	2.00	0.00	0.025*
b “... you read aloud, participate in parties, in the school theater... or after that? “
Test	0.46	0.70	0.00	2.00	0.00	0.083
Retest	0.49	0.71	0.00	2.00	0.00	0.083
c “... you sing, participate in choirs, or sing at Karaoke bars... or after that? “
Test	0.54	0.76	0.00	2.00	0.00	0.083
Retest	0.57	0.76	0.00	2.00	0.00	0.083
d “...you play football, dodgeball (queimada), run and catch, practise sports... Or after that?”
Test	0.51	0.76	0.00	2.00	0.00	0.180
Retest	0.53	0.75	0.00	2.00	0.00	0.180
12 “Do people ask you ‘what is in your voice’?”
Test	0.37	0.66	0.00	2.00	0.00	0.014*
Retest	0.41	0.69	0.00	2.00	0.00	0.014*
13 “Do you have to cough or clear the throat when you talk even without being sick (flu or cold)? (Demonstration by physician/clinician)”
Test	0.78	0.75	0.00	2.00	1.00	0.317
Retest	0.79	0.74	0.00	2.00	1.00	0.317
14 “Do you get hoarse even when you are not sick?”
Test	0.79	0.75	0.00	2.00	1.00	0.317
Retest	0.79	0.76	0.00	2.00	1.00	0.317
15 “Do you have difficulty completing sentences, when you speak, because of your voice?”
Test	0.64	0.75	0.00	2.00	0.00	0.046*
Retest	0.67	0.76	0.00	2.00	0.00	0.046*
16 “Do you have to rest your voice when...”
a “…you talk, play, talk on the phone... or after that?”
Test	0.74	0.79	0.00	2.00	1.00	0.317
Retest	0.74	0.79	0.00	2.00	1.00	0.317
b “... you read aloud, participate in parties, in the school theater... or after that? “
Test	0.65	0.80	0.00	2.00	0.00	0.102
Retest	0.68	0.82	0.00	2.00	0.00	0.102
c “... you sing, participate in choirs, or sing at Karaoke bars... or after that? “
Test	0.89	0.85	0.00	2.00	1.00	> 0.999
Retest	0.89	0.85	0.00	2.00	1.00	> 0.999
d “...you play football, dodgeball (queimada), run and catch, practise sports... or after that?”
Test	0.66	0.84	0.00	2.00	0.00	> 0.999
Retest	0.66	0.85	0.00	2.00	0.00	> 0.999
17 “Do you feel that the throat burns or bothers you even when you are not sick (flu/cold)?”
Test	0.71	0.79	0.00	2.00	1.00	0.317
Retest	0.73	0.80	0.00	2.00	1.00	0.317
18 “Are you sad because of your voice?”
Test	0.36	0.66	0.00	2.00	0.00	0.014*
Retest	0.40	0.69	0.00	2.00	0.00	0.014*
19 “Would you like to change your voice?”
Test	0.99	0.86	0.00	2.00	1.00	0.317
Retest	1.00	0.86	0.00	2.00	1.00	0.317
VS Score
Test	13.35	9.04	0.00	38.00	11.75	< 0.001*
Retest	26.05	17.74	0.00	74.00	23.00	< 0.001*
SE
1 “Does your child feel his/her voice gets tired when …”
a “... he/she talks, plays, talks on the phone ... or after that?”
Test	0.65	0.73	0.00	2.00	0.50	> 0.999
Retest	0.65	0.74	0.00	2.00	0.00	> 0.999
b “... you read aloud, participate in parties, in the school theater... or after that?”
Test	0.56	0.75	0.00	2.00	0.00	0.655
Retest	0.57	0.73	0.00	2.00	0.00	0.655
c “... you sing, participate in choirs, or sing at Karaoke bars... or after that?”
Test	0.57	0.78	0.00	2.00	0.00	0.655
Retest	0.57	0.76	0.00	2.00	0.00	0.655
d “...you play football, dodgeball (queimada), run and catch, practise sports... or after that?”
Test	0.66	0.82	0.00	2.00	0.00	0.035*
Retest	0.71	0.83	0.00	2.00	0.00	0.035*
2 “Do people ask your child to repeat what he/she said because of his/her voice?”
Test	0.72	0.75	0.00	2.00	1.00	> 0.999
Retest	0.72	0.76	0.00	2.00	1.00	> 0.999
3 “Does your child have to use force for his/her voice to go out?”
Test	0.38	0.67	0.00	2.00	0.00	0.157
Retest	0.39	0.67	0.00	2.00	0.00	0.157
4 “Does your child get irritated because of his/her voice?”
Test	0.27	0.57	0.00	2.00	0.00	0.083
Retest	0.29	0.60	0.00	2.00	0.00	0.083
5 “Does your child avoid using his/her voice when...”
a “... he/she talks, plays, talks on the phone ... because his/her voice is not what he/she would like it to be?”
Test	0.18	0.53	0.00	2.00	0.00	0.157
Retest	0.20	0.54	0.00	2.00	0,00	0.157
b “... he/she reads aloud, participates in parties, in the school theater... because his/her voice is not how he/she would like it to be?”
Test	0.17	0.51	0.00	2.00	0.00	0.317
Retest	0.18	0.51	0.00	2.00	0.00	0.317
c “... he/she sing/sings, participates in choirs, or sings at Karaoke bars... because his/her voice is not how he/she would like it to be?”
Test	0.20	0.53	0.00	2.00	0.00	0.317
Retest	0.21	0.53	0.00	2.00	0.00	0.317
d “...he/she plays football, dodgeball (queimada), run and catch, practises sports... because his/her voice is not how he/she would like it to be?”
Test	0.15	0.45	0.00	2.00	0.00	0.157
Retest	0.18	0.49	0.00	2.00	0.00	0.157
6 “Does your child have to use force for his/her voice to go out?
Test	0.36	0.65	0.00	2.00	0.00	> 0.999
Retest	0.36	0.65	0.00	2.00	0.00	> 0.999
7 “Has your voice’s son ever been debauched, mocked, or made a joke of?”
Test	0.40	0.70	0.00	2.00	0.00	0.317
Retest	0.41	0.71	0.00	2.00	0.00	0.317
8 “Has your child ever been without speaking because he/she was voiceless?”
Test	0.30	0.55	0.00	2.00	0.00	0.317
Retest	0.29	0.55	0.00	2.00	0.00	0.317
9 “Does your child get angry because of his/her voice?”
Test	0.32	0.60	0.00	2.00	0.00	0.564
Retest	0.32	0.63	0.00	2.00	0.00	0.564
10 “Is your child afraid to harm or worsen his/her voice?”
Test	0.35	0.65	0.00	2.00	0.00	0.317
Retest	0.34	0.65	0.00	2.00	0.00	0.317
11 “Does your child get sore throat when...”
a “…he/she talks, plays, talks on the phone... or after that?”
Test	0.36	0.66	0.00	2.00	0.00	> 0.999
Retest	0.36	0.66	0.00	2.00	0.00	> 0.999
b “... he/she reads aloud, participates in parties, in the school theater... or after that?”
Test	0.32	0.63	0.00	2.00	0.00	0.564
Retest	0.32	0.65	0.00	2.00	0.00	0.564
c “... he/she sings, participates in choirs, or sings at Karaoke bars... or after that?”
Test	0.34	0.62	0.00	2.00	0.00	0.564
Retest	0.35	0.65	0.00	2.00	0.00	0.564
d “...he/she plays football, dodgeball (queimada), run and catch, practises sports... or after that?”
Test	0.31	0.60	0.00	2.00	0.00	0.046*
Retest	0.34	0.64	0.00	2.00	0.00	0.046*
12 “Do people ask your child ‘what is in your voice’?”
Test	0.26	0.56	0.00	2.00	0.00	0.317
Retest	0.27	0.56	0.00	2.00	0.00	0.317
13 “ Does your child have to cough or clear the throat when he/she talks even without being sick (flu or cold)? (Demonstration by physician/clinician)”
Test	0.54	0.72	0.00	2.00	0.00	0.317
Retest	0.54	0.73	0.00	2.00	0.00	0.317
14 “Does your child get hoarse even when he/she is not sick?”
Test	0.73	0.76	0.00	2.00	1.00	0.414
Retest	0.74	0.78	0.00	2.00	1.00	0.414
15 “Does your child have difficulty completing sentences, when he/she speaks, because of his/her voice?”
Test	0.38	0.61	0.00	2.00	0.00	> 0.999
Retest	0.38	0.61	0.00	2.00	0.00	> 0.999
16 “Does your child have to rest his/her voice when..”
a “... he/she talks, plays, talks on the phone ... or after that?”
Test	0.40	0.69	0.00	2.00	0.00	0.083
Retest	0.43	0.71	0.00	2.00	0.00	0.083
b “... he/she reads aloud, participates in parties, in the school theater... or after that?”
Test	0.40	0.69	0.00	2.00	0.00	0.317
Retest	0.39	0.69	0.00	2.00	0.00	0.317
c “... he/she sings, participates in choirs, or sings at Karaoke bars”... or after that?
Test	0.41	0.70	0.00	2.00	0.00	0.564
Retest	0.40	0.69	0.00	2.00	0.00	0.564
d “...he/she plays football, dodgeball (queimada), run and catch, practises sports... or after that?”
Test	0.43	0.70	0.00	2.00	0.00	0.083
Retest	0.40	0.68	0.00	2.00	0.00	0.083
17 “Does your child feel that the throat burns or bothers even when he/she is not sick (flu/cold)?”
Test	0.49	0.70	0.00	2.00	0.00	> 0.999
Retest	0.49	0.70	0.00	2.00	0.00	> 0.999
18 “Does your child get angry because of his/her voice?”
Test	0.35	0.67	0.00	2.00	0.00	0.317
Retest	0.36	0.67	0.00	2.00	0.00	0.317
19 “Would your child like to change his/her voice?”
Test	0.56	0.81	0.00	2.00	0.00	0.317
Retest	0.57	0.80	0.00	2.00	0.00	0.317
VS Score
Test	8.52	9.95	0.00	36.00	4.50	< 0.001^* * Significant values (p ≤ 0.050) – Wilcoxon signed-rank test
Retest	16.55	19.19	0.00	71.00	9.38

Pair of variables	Mean	SD	Min	Max	Median	p
SE
VS Score
Pre-therapy	17.81	7.27	3.50	34.50	16.25	< 0.001^* * Significant values (p ≤ 0.050) – Wilcoxon test
Post- therapy	6.47	6.09	1.25	25.75	4.13	< 0.001^* * Significant values (p ≤ 0.050) – Wilcoxon test
PE
VS Score
Pre-therapy	15.52	9.68	0.00	36.25	16.38	0.001*
Post-therapy	4.63	4.21	0.00	12.75	5.50	0.001*

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[1] Conflict of interests: nothing to declare.