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Evaluation of the Ability to Sing Easily (EASE-PT): Instrument validation process to European Portuguese



Introduction: Evaluation of the Ability to Sing Easily is a vocal function self-report instrument. Its goal is to reflect how singer’s voice is felt and sounds at the time of the administration. This scale measures singer’s perceptions of the current status of their singing voice. EASE is an innovative instrument since the respondents are expected to evaluate their voice based on their current perception and not rely on the recall of past experiences. It eliminates potential for recall bias and makes it more reliable for symptom evaluation. It’s composed by 20 items (with four possible answers: no, mildly, moderately and extremely) split in two sub-scales: vocal fatigue and pathologic-risk indicators. Aim: To present the process of the one-way and backward translation, cross-cultural equivalence, as well as the pilot testing of the instrument into European Portuguese. Methods: The one-way translation was done by two Portuguese native speakers with professional translation skills in English. The backward translation was performed by two native English speakers with professional translation skills in Portuguese. The versions were compared and a consensus was merged by an expert panel, assuming the name EASE-PT. The pilot test was conducted with ten subjects (2 Fado singers, 8 choir singers) to evaluate the instructions, items and response format clarity. The EASE-PT is measured by a 4-item likert type scale and three of them are reversed scored. Results: After the administration of the pre-test, 6 questions out of 20 questions (36%) were classified as unclear and needed adjustments regarding terminology and semantic ambiguity (eg, scratchy to harsh, strain to hyper contraction, breathy to voice with air, onsets to beginnings). The expert panel reviewed the comments of each singer and reached a final version of the instrument, based on psychometric analysis and conceptual grounds. Conclusions: The authors achieved a cultural and linguistic equivalent version of he original instrument. In Portugal there is a gap on formal and reliable assessment tools that explore singing voice. In future, EASE is hoped to be useful to measure vocal load effects in singing voice and to screen for singers at risk. Validation of the EASE-PT for European Portuguese is being concluded.
Evaluation of the Ability to Sing Easily (EASE-PT):
Instrument validation process to European Portuguese
EASE measures the singing voice function based on self-report,
which reflects how singers’ voices are perceived at the time of the
Its goals are to determine load thresholds and vocal doses,
determine recovery times to assist performance scheduling and
quotas, predict voice problems evolution, monitor therapeutic
outcomes, and determine performance fitness (Phyland et al,
The authors point as advantage: is quick and user-friendly, takes a
snapshot of current status, eliminates recall bias, does not
assumes that there is an already established alteration.
It is composed by 3 subscales and 22 items: Vocal Fatigue (VF),
Pathologic Risk Indicators (PRI) and Vocal Concern (VC).
Pedro Pestana, Susana Vaz-Freitas, Maria Conceição Manso | Esposende and Porto, Portugal
i. Cross-cultural adaptation
Two Fado singers and eight choir singers
Seven items were classified as unclear by at least 20% of the
Seven items (2, 4, 5, 6, 7, 11, 20) needed further revision
ii. Descriptive Statistics for the Sample
120 singers: 70 females; 42 Fado singers; 78 choir singers; 8%
(1624 yo), 38% (2544 yo), 32% (4564 yo), 22% (>65 yo)
Different results were obtained for Fado and Choir singers, in
several items
iii. Descriptive Statistics for Scales
Scales are positively skewed: VF for Fado singers; PRI for choir
iv. Tests of Scaling Assumptions
Item-scale correlations are comparable and substantial ( >
Higher range of item-scale correlations for total and sub-scales
a. Reliability: all scales demonstrated high internal
consistencies (>0.8), and ranged from 0.765 (VF) to 0.890
(VC) for Fado singers and from 0.796 (VC) to 0.846 (Vocal
Fatigue) for Choir singers.
b. Known groups validity: only the PRI scale showed
significant differences between groups, higher for the Choir
group (p=0.042); no significant differences were found for
gender, the self-classification of the use of voice in the last 24
hours and age; a negative relation (rs=-0.252, p=0.026) was
obtained between the vocal load and the PRI, for Choir singers.
To adapt the tool to the European Portuguese language
To compare scores according to singing style, voice use and
demography variables
To conduct psychometric tests
i. Cross-cultural adaptation (Sousa and Rojjanasrirat, 2011):
one-way translation, comparison of the two translated
versions, blind backward translation, comparison of the two
back-translated versions, pilot testing of the pre-final version.
ii. Data collection: 25st April 10th June; convenience/snowball
sampling technique; inclusion criteria singer of Fado or
choir singer; older than 18 years old; an active singer.
iii. Analytic Methods: descriptive statistics, Mann-Whitney test,
Spearman correlation coefficient; scaling properties and
construct validity: (a) item-internal consistency, (b) equality of
item-scale correlations within a scale, (c) approximate
equality of item means and standard deviations; internal
consistency reliability was estimated through Cronbach’s
alpha coefficient.
Fado singers are more prone to report vocal fatigue and choir singers have higher prevalence of indicators related to the risk of pathology.
EASE-PT showed a very favorable psychometric performance meeting the criteria that had been suggested for reliability and proved to be
a reliable instrument to assess its original aim and constructs, whether with Fado or Choir singers. The outcome supports the ability of
EASE-PT to measure the same constructs in a way similar to the original version.
Phyland, D. J., Pallant, J. F., Benninger, M. S., Thibeault, S. L., Greenwood, K. M., Smith, J. A., & Vallance, N. (2013). Development and preliminary validation of the EASE: A tool to measure perceived singing voice function.
Journal of Voice, 27(4), 454462.
Sousa, V. D., & Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. Journal of Evaluation in Clinical
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