Cross-cultural adaptation of the Brazilian version of the Voice Symptom Scale: VoiSS

BRIEF COMMUNICATION COMUNICAÇÃO BREVE

Felipe Moreti^I; Fabiana Zambon^I; Gisele Oliveira^II; Mara Behlau^I

^IDepartment of Speech-Language Pathology and Audiology, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP), Brazil; Centro de Estudos da Voz - CEV - São Paulo (SP), Brazil

^IICentro de Estudos da Voz - CEV - São Paulo (SP), Brazil

Correspondence address

ABSTRACT

PURPOSE: To present the cultural equivalence of the Brazilian version of the Voice Symptom Scale - VoiSS.

METHODS: The questionnaire was translated into Portuguese by two Brazilian bilingual speech-language pathologists, who were informed about the purpose of this research. The back translation was performed by a third bilingual Brazilian speech-language pathologist, who was also an English teacher, and had not participated in the previous stage. After the comparison of translations, a final version of the questionnaire was produced and called Escala de Sintomas Vocais - ESV, which was administered to 15 individuals with vocal complaint. The inclusion criterion was the presence of dysphonia, regardless of type or degree. The option "not applicable" was added to each item of the protocol.

RESULTS: During the process of translation and cultural adaptation, no item was changed and/or eliminated from the questions. The ESV kept the same structure as the original British version with 30 questions, 15 regarding the impairment domain (functionality), eight the emotional domain (psychological effect), and seven the physical domain (organic symptoms).

CONCLUSION: The cultural equivalence of the Brazilian version of the VoiSS, entitled ESV, was demonstrated. The ESV validation is currently being concluded.

Keywords: Dysphonia; Validation studies; Quality of life; Translations; Voice quality; Voice disorders/diagnosis; Questionnaires

RESUMO

OBJETIVO: Apresentar a equivalência cultural da versão brasileira da Voice Symptom Scale - VoiSS.

MÉTODOS: O questionário foi traduzido para a língua portuguesa por duas fonoaudiólogas brasileiras bilíngues, cientes do objetivo da pesquisa. A retrotradução foi efetuada por uma terceira fonoaudióloga brasileira, bilíngue e professora de inglês, não participante da etapa anterior. Após comparação das traduções, produziu-se uma única versão denominada Escala de Sintomas Vocais - ESV, que foi aplicado a 15 indivíduos com queixa vocal. O critério de inclusão foi presença de disfonia, independentemente do grau ou tipo. A cada questão foi acrescentada a opção "não aplicável" na chave de resposta.

RESULTADOS: No processo de tradução e adaptação cultural não houve modificação e/ou eliminação de nenhuma das questões. A ESV reflete a versão original do inglês, com 30 questões, sendo 15 referentes ao domínio limitação (funcionalidade), oito ao domínio emocional (efeito psicológico) e sete ao domínio físico (sintomas orgânicos).

CONCLUSÃO: Houve equivalência cultural da VoiSS para o Português Brasileiro na versão intitulada ESV. A validação da ESV está em fase de conclusão.

Descritores: Disfonia; Estudos de validação; Qualidade de vida; Tradução (produto); Qualidade da voz; Distúrbios da voz/diagnóstico; Questionários

INTRODUCTION

Voice disorders occur from 3 to 9% in the general population⁽¹⁾ and cause important negative effect on the quality of life of these individuals. In order to quantify such impact, and to evaluate the patient's progress as well as to guide therapeutic decision making, numerous self-assessment questionnaires have been developed⁽²⁾; the majority of which is originally produced in English.

Self-assessment questionnaires quickly became popular both in the clinical and scientific settings⁽²⁾. However, the aspects related to the development of a self-assessment instrument has had more attention only for the past 15 years, when the Scientific Advisory Committee of Medical Outcome Trust produced a document that sets criteria for developing self-assessment protocols and also for validating translations into other languages different from the original⁽³⁾.

For these instruments to be used in another language, they have to be translated and adapted according to international guidelines and have their psychometric measures demonstrated into a specific contexts⁽³⁾. Thus, they have to be carefully translated and adapted, avoiding the simple literal translation that excludes cultural and social elements. By the endof this process, the translated and adapted protocol must be tested so that its adequacy is confirmed for the population, language and culture that it was proposed to, following the international guidelines of linguistic adaptation and cultural equivalence, validity, reproducibility, responsiveness and reliability⁽³⁾.

The Voice Symptom Scale - VoiSS is a robust self-assessment instrument for voice and voice symptoms that measures clinical and treatment outcomes and was conceptually developed from more than 800 patients' information^(4-6). Currently, the VoiSS is considered the most rigorous and psychometrically robust self-assessment protocol for voice that provide information about impairment, emotional impact and physical symptoms caused by a voice problem^(2,6).

The purpose of this study is to perform the cultural equivalence of the Brazilian version of the Voice Symptom Scale - VoiSS^(4-6) by means of the cultural and linguistic adaptation of the instrument.

METHODS

This research was approved by the Research Ethics Committee of Universidade Federal de São Paulo - UNIFESP (number 1946/10), and all participants signed the informed consent form.

Initially, the instrument was translated into Portuguese by two Brazilian bilingual speech-language pathologists, who were informed about the purpose of this research and performed the conceptual translation, avoiding the literal meaning of words and sentences. After this first step, the two translations were drawn together into one single document. The back translation was performed by a third bilingual Brazilian speech-language pathologist, who was also an English teacher, and had not participated in the previous stage. The translation and back translation were then compared to each other and to the original questionnaire. Any inconsistencies were analyzed and discussed by a committee of five Speech-language pathologists specializing in voice, who were proficient in English and performed all the necessary changes in consensus. Out of that process, a final version of the questionnaire was produced and called Escala de Sintomas Vocais - ESV.

In order to perform the cultural equivalence of the translated version, the ESV was administered to 15 individuals with vocal complaint selected from public services that provided voice assistance. A "not applicable" option was added to the response rating scale of each item making it a six-choice point scale: never, occasionally, some of the time, most of the time, always and "not applicable". This inclusion was implemented to enable the identification of items that were not clear enough or inappropriate to the population the instrument is intended to address and to have them modified or excluded afterwards.

Inclusion criteria were presence of dysphonia of any type or degree. Exclusion criteria were presence of neurological, psychological and/or cognitive disorders that would unable the administration of the questionnaire, lack of comprehension of instructions and illiteracy.

RESULTS

During the translation and adaptation process there were no changes or exclusion of any item. The final structure of the ESV translation (^{Appendix 1}) after the cultural and linguistic adaptation has 30 questions. The components related to impairment (15 items, i.e., "Do you lose your voice?"), emotional response (eight items, i.e., "Are you embarrassed by your voice problem?") and physical symptoms (seven items, i.e., "Do you cough or clear your throat?").

DISCUSSION

The accomplishment of cultural equivalence of a translated protocol is the essential onset for the validation of protocols into a language other than the original one⁽³⁾, since all the rest of the process must be achieve from it. Only after the cultural adaptation of a translated questionnaire is performed that it can be used to the population it is intended to address.

The literature is very clear regarding the need of developing instruments that are specifically developed to certain populations, situations and pathologies. The ESV is proven to be specific to identifying vocal symptoms that evidently shows clinical and treatment outcomes for dysphonia.

The conclusion of the validation process of the VoiSS into Brazilian Portuguese will enable its reliable utilization in the clinical and research settings, considering that the experience of carrying out all the validation steps helps to understand aspects that patients with voice disorders have in common⁽⁷⁾. Future studies using VoiSS allow the comparison of results, seeing that the use of standardized and validated instruments into our language will provide a greater scientific rigor.

CONCLUSION

There is a cultural equivalent Brazilian Portuguese version of VoiSS designated Escala de Sintomas Vocais - ESV. The validation of the ESV into Brazilian Portuguese is going through its conclusion phase.

REFERENCES

• 1. Verdolini K, Ramig LO. Review: occupational risks for voice problems. Logoped Phoniatr Vocol. 2001;26(1):37-46.
• 2. Branski RC, Cukier-Blaj S, Pusic A, Cano SJ, Klassen A, Mener D, et al. Measuring quality of life in dysphonic patients: a systematic review of content development in patient-reported outcomes measures. J Voice. 2010;24(2):193-8.
• 3. Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res. 2002;11(3):193-205.
• 4. Scott S, Robinson K, Wilson JA, Mackenzie K. Patient-reported problems associated with dysphonia. Clin Otolaryngol Allied Sci. 1997;22(1):37-40.
• 5. Deary IJ, Wilson JA, Carding PN, MacKenzie K. VoiSS: a patient-derived Voice Symptom Scale. J Psychosom Res. 2003;54(5):483-9.
• 6. Wilson JA, Webb A, Carding PN, Steen IN, MacKenzie K, Deary IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content. Clin Otolaryngol Allied Sci. 2004;29(2):169-74.
• 7. Behlau M, Oliveira G, Santos LM, Ricarte A. Validação no Brasil de protocolos de auto-avaliação do impacto de uma disfonia. Pró-Fono. 2009;21(4):326-32.

Appendix 1

Cross-cultural adaptation of the Brazilian version of the Voice Symptom Scale - VoiSS

Equivalência cultural da versão brasileira da Voice Symptom Scale - VoiSS

Publication Dates

• Publication in this collection
  09 Feb 2012
• Date of issue
  Dec 2011

History

• Received
  28 July 2011
• Accepted
  30 Aug 2011