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Translation and cross-cultural adaptation of the Chilean Version of the Voice Activity and Participation Profile - VAPP

DOI:10.1590/2317-1782/20202020065
Authors:
Francisco Contreras Ruston at University of Barcelona
Francisco Contreras Ruston
 Nury Gonzalez
 Nury Gonzalez
 Nury Gonzalez
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Karol Acevedo at Pontificia Universidad Católica de Chile
Karol Acevedo
Marco Guzman at University of Chile
Marco Guzman
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Abstract

Purpose: The present study aimed to obtain the cross-culturally-adapted Chilean version of the voice activity and participation profile - VAPP. Methods: The process began a with translation of the original English version of the VAPP instrument into Spanish, carried out by two bilingual speech-language pathologists (SLP), followed by a back-translation from a third SLP who was unbiased by the previous stages. A committee of 5 SLP with experience in the area of voice compared the original version, the back translation, and the translated version, seeking divergences and discrepancies between the three versions. A consensus was reached, and they renamed the protocol "Perfil de Participación y Actividad Vocal (PPAV-CL)", with 28 questions which were answered using a visual analog scale (VAS) of 100 millimeters in length. In the process of making the cross-cultural equivalence, the protocol was applied to 24 subjects with voice disorders. For each question, the option of "Not applicable" was added to the answer choices for identification of the questions not comprehended or not appropriate for the target population. None of the subjects under assessment had difficulty answering the questions, therefore it was unnecessary to modify the translation of any of them. The final version of the PPAV-CL shows the appropriate characteristics to be understood. Results: The PPAV-CL instrument reflects the original English version in the number of questions and items. Conclusion: a cultural equivalence of the VAPP to Chilean Spanish was achieved. The validation of the PPAV-CL is currently underway.
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Brief Communication
Comunicaciones Cortas
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 1/9
ISSN 2317-1782 (Online version)
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Translation and cross-cultural adaptation of
the Chilean Version of the Voice Activity and
Participation Profile – VAPP
Traducción y equivalencia cultural de la
Versión Chilena del Voice Activity and
Participation Profile – VAPP
Francisco Contreras-Ruston1
Nury Gonzalez1
Karol Acevedo2
Marco Guzman3
Keywords
Voice
Self-Assessment
Translation
Questionnaires
Quality of Life
Speech, Language and Hearing
Sciences
Validation Studies
Descriptores
Voz
Autoevaluación
Traducción
Protocolos
Calidad de Vida
Fonoaudiología
Estudios de Validación
Correspondence address:
Francisco Contreras-Ruston
Universidad de Valparaíso
Camino La Troya, s/n, San Felipe,
Chile.
E-mail: francisco.contreras@uv.cl
Received: April 24, 2020
Accepted: July 30, 2020
Study conducted at Escuela de Fonoaudiología, Universidad de Valparaíso - San Felipe, Chile.
1 Universidad de Valparaíso - San Felipe, región de Valparaíso, Chile.
2 Universidad San Sebastián - Santiago, región metropolitana, Chile.
3 Universidad de Los Andes - Santiago, región metropolitana, Chile.
Financial support: nothing to declare.
Conict of interests: nothing to declare.
ABSTRACT
Purpose: The present study aimed to obtain the cross-culturally-adapted Chilean version of the voice activity
and participation prole - VAPP. Methods: The process began a with translation of the original English version
of the VAPP instrument into Spanish, carried out by two bilingual speech-language pathologists (SLP), followed
by a back-translation from a third SLP who was unbiased by the previous stages. A committee of 5 SLP with
experience in the area of voice compared the original version, the back translation, and the translated version,
seeking divergences and discrepancies between the three versions. A consensus was reached, and they renamed the
protocol “Perl de Participación y Actividad Vocal (PPAV-CL)”, with 28 questions which were answered using a
visual analog scale (VAS) of 100 millimeters in length. In the process of making the cross-cultural equivalence,
the protocol was applied to 24 subjects with voice disorders. For each question, the option of “Not applicable”
was added to the answer choices for identication of the questions not comprehended or not appropriate for the
target population. None of the subjects under assessment had diculty answering the questions, therefore it was
unnecessary to modify the translation of any of them. The nal version of the PPAV-CL shows the appropriate
characteristics to be understood. Results: The PPAV-CL instrument reects the original English version in
the number of questions and items. Conclusion: a cultural equivalence of the VAPP to Chilean Spanish was
achieved. The validation of the PPAV-CL is currently underway.
RESUMEN
Objetivo: Obtener la equivalencia cultural de la versión chilena del Protocolo VAPP, por medio de su adaptación
cultural y lingüística. Método: El proceso se inicia con la traducción del instrumento original del VAPP realizada
por dos Fonoaudiólogos bilingües. Seguido de una retro traducción al inglés por una tercera Fonoaudióloga
quien no presenta sesgos de etapas previas. Un comité conformado por 5 Fonoaudiólogos con experiencia en el
área de la voz comparó la versión original, retro traducida y traducida, buscando divergencias y discrepancias
entre las tres versiones. Llegando a un consenso, el protocolo se tituló “Perl de Participación y Actividad Vocal
(PPAV-CL)”, con 28 preguntas, las cuales son consignadas con escala analógica visual (EAV) de 100 milímetros
de largo. Durante el proceso de equivalencia cultural, se aplicó el protocolo a 28 sujetos con trastornos de voz.
En cada pregunta, se adicionó la opción “No aplicable” como respuesta, con el objetivo de identicar preguntas
incomprendidas o inadecuadas del grupo albo. Ninguno de los sujetos evaluados tuvo dicultad en responder las
preguntas, por lo cual no fue necesario modicar la traducción de ninguna de ellas. La versión nal del protocolo
PPAV-CL presenta las características adecuadas en su comprensión. Resultados: El instrumento PPAV-CL reeja
la versión original en inglés, en número de preguntas e ítems. Conclusion: Se logró equivalencia cultural de
VAPP para el español chileno (PPAV-CL). La validación del PPAV-CL está actualmente en curso.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 2/9
INTRODUCTION
The World Health Organization (WHO) relies on results
obtained from the application of various instruments on healthy
people and patients with various pathologies, as well as the
discussion between health professionals from dierent cultures,
to measure and determine quality of life.(1)
In relation to the voice, the rst instrument to measure
the impact on the quality of life was developed in 1993 by
Smith et al.(2) This instrument provided the theoretical support
for the creation of the Voice Handicap Index – VHI, one of
the rst and main tools based on a robust methodology for its
development and containing reliable psychometric properties for
its application
(2,3)
. Since then, a great variety of instruments have
been generated that provide information on voice self-perception
and how it inuences vocal and social well-being; considered
an indispensable edge in voice assessment(4).
Since they are considered a fundamental part of voice
assessment, development methodologies were incorporated
to provide reliability and dependability to the self-assessment
instruments in their application, such as the method provided by
the “Scientic Advisory Committee of the Medical Outcomes
Trust - SAC”.(5) The rst step of this process is the translation
and adaptation of the instrument, essential to situating them
within a context and culture. This process is present in several
creations and validations of voice self-assessment protocols,
such as the adaptation and validation of the Chilean version
of the Voice Symptom Scale, which demonstrates validity,
sensitivity and reliability(6).
Over the past few years, the variety of self-reporting instruments
has increased, as they provide relevant information on patient
behavior and their adherence to voice therapy. For this reason,
there are many self-assessment protocols with dierent approaches
and aspects to evaluate, such as the physical impact of the voice
problem, modications in voice, or social activity(7). In relation
to these, the “Voice Activity and Participation Prole (VAPP)”
protocol was created, which is specic to measuring the impact
of using the voice in social participation and vocal activity(8).
The VAPP was initially created from ICIDH 2 Beta 1 in
1997, which is the modied version of the WHO proposal,
“International Classication of Impairments, Disabilities and
Handicaps (ICIDH)”, which replaced “Activity Limitation”
with “Disability”, and “Disadvantage” with “Participation
Restriction”, reducing the confusion caused by these two terms.
The VAPP has ve sections: Self-Perception of Voice Problem,
Daily Communication, Social Communication, Use of Voice at
Work, and Emotion. Unlike other instruments, it incorporates
aspects of voice use in context, both at work and in daily life(8).
The original instrument, which was developed in Hong
Kong in English and Cantonese, currently has adaptations and
validations for dierent languages and cultures(9,10). The rst
step to obtain the tool’s validation is the cross-cultural and
linguistic adaptation, which was the initial objective of the
Chilean version of VAPP.
METHODS
The investigation was approved by the Santo Tomás
University Research Ethics Committee - CEC UST N° 49/2017
y N° 191.16. and No. 191.16. In addition, all participants signed
their informed consent.
The translation of the VAPP protocol into Chilean Spanish
consisted of dierent steps: No. 1, translation by two Chilean
bilingual speech-language therapists working in the voice area,
who will be referred to as, T1= English-Spanish translator and
T2= English-Spanish translator. No. 2, the translations made
by T1 and T2 were analyzed by a committee made up of ve
English-speaking speech-language therapists working in voice,
who arrived at a Single Version (VEU= T1+T2). No. 3, a third
English-Spanish bilingual speech-language therapist, who did
not participate in the previous stages, back-translated the VEU
into the original language. No. 4, the committee compared the
translation, back-translation and original version, observing no
discrepancies between the dierent versions. Finally, the instrument
entitled “Participation and Voice Activity Prole - PPAV-CL”
was obtained.
The next step was cultural equivalence, which consisted of
applying the protocol to 28 participants (20 women and eight
men) over 18 years of age, who used their voice at work, and
had been diagnosed with dysphonia (behavioral or organic)
by otolaryngologists. The VAPP presents 28 questions, using
a Visual Analogical Scale (VAS), with a gradual straight-line
from zero to one hundred millimeters. Zero is the absence of
the voice problem and one hundred is its continuous presence.
The answer option “Not applicable” was added to verify that
the questions were understandable and adequate for the Chilean
population.
The exclusion criteria were: illiteracy, neurological, cognitive
and psychiatric disorders that prevented a correct understanding
of the protocol, and subjects who did not use their voice in
work environments.
RESULTS
The PPAV-CL maintains the same number of questions
as the original version. The questions are organized into ve
sections: Self-perception of the voice problem (question number
1), “¿Qué tan grave es su problema de voz?”; Use of voice to
work (questions 2, 3, 4, 5), e.g., “¿Su problema de la voz le ha
generado estrés en su trabajo?”; Daily communication, (questions
6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17), e.g., “¿Su problema
de la voz afecta su mensaje cuando le habla a un grupo de
personas?”; Social communication (questions 18, 19, 20, 21),
e.g., “¿A sus familiares, amigos o colegas de trabajo les molesta
su problema de voz?”; Emotion (questions 22, 23, 24, 25, 26, 27,
28), e.g., “¿Está preocupado por su problema de voz?”. In the
application pilot, of the 28 subjects, none answered the option
“not applicable”, so the committee considered not to modify any
of the questions since the individuals did not present diculties
in understanding and consignment in the instrument.
The results obtained in Translation and cross-cultural are
summarized in Chart 1 and the version of the PPAV-CL for
Chilean Spanish is attached in Annex A.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 3/9
Chart 1. Translation process and cultural adaptation Voice Activity and Participation Profile (VAPP)(7) for Chilean Spanish
Questions Original English
version(6)
Translation for Chilean
Spanish
Back-translation of the
VE for English
Speech-Language
Pathologists
Committee: semantic
and language
equivalence
Committee of Speech-
Language Pathologists:
cultural and linguistic
equivalence
1How severe is your
voice problem now?
T1: ¿Qué tan severo es
su problema con la voz
actualmente? How serious is your
current vocal problem?
¿Qué tan grave es su
problema vocal actual?
¿Qué tan grave es su
problema vocal actual?
T2: ¿Cuán severo es su
problema?
2Is your job affected by
your voice problem?
T1: ¿Su problema con
la voz le afecta en el
trabajo? Does your voice
problem affect your
work?
¿Su problema con
la voz le afecta en el
trabajo?
¿Su problema de voz le
afecta en el trabajo?
T2: ¿Su trabajo se
ve afectado por su
problema de voz?
3
In the last 6 months,
have you thought of
changing your job
because of your voice
problem?
T1: ¿En los últimos 6
meses, ha pensado en
cambiarse de trabajo
debido a su problema
con la voz? In the past 6 months,
have you thought about
changing jobs due to
your voice problem?
¿En los últimos 6
meses, usted ha
pensado en cambiar
de trabajo debido a su
problema de voz?
¿En los últimos 6
meses, usted ha
pensado en cambiar
de trabajo debido a su
problema de voz?
T2: ¿En los últimos
6 meses, usted ha
pensado en cambiar
de trabajo debido a su
problema de voz?
4
Has your voice problem
created any pressure
on your job?
T1: ¿Su problema con
la voz le ha generado
estrés en su trabajo? Has your voice problem
caused you stress at
work?
¿Su problema con la
voz le ha generado
estrés en su trabajo?
¿Su problema de voz le
ha generado estrés en
su trabajo?
T2: ¿Su problema de
voz ha generado alguna
presión en su trabajo?
5
In the last 6 months,
has your voice problem
affected your decisions
for your future career?
T1: ¿En los últimos 6
meses, su problema
con la voz ha tenido
impacto en sus
decisiones sobre su
futuro laboral?
In the last 6 months,
has your voice problem
had an impact on your
decisions about your
professional future?
¿En los últimos 6
meses, su problema
con la voz ha tenido
impacto en sus
decisiones sobre su
futuro laboral?
¿En los últimos 6
meses, su problema de
voz ha tenido impacto
en sus decisiones
sobre su futuro laboral?
T2: ¿En los últimos 6
meses, su problema de
voz ha afectado en sus
decisiones relacionadas
al futuro de su carrera?
6
Do people ask you to
repeat what you have
just said because of
your voice problem?
T1: ¿La gente le pide
repetir lo que dijo por
su problema con la
voz? Do people ask you to
repeat what you have
just said because of
your voice problem?
¿Las personas le piden
que repita lo que acaba
de decir debido a su
problema de voz?
¿Las personas le piden
que repita lo que acaba
de decir debido a su
problema de voz?
T2: ¿Las personas le
piden que repita lo que
acaba de decir debido
a su problema de voz?
7
In the last 6 months,
have you ever avoided
talking to people
because of your voice
problem?
T1: ¿En los últimos
6 meses, ha evitado
hablar con personas
debido a su problema
con la voz?
In the last 6 months,
have you ever avoided
talking to people
because of your voice
problem?
¿En los últimos 6
meses, alguna vez ha
evitado hablar con
personas debido a su
problema de voz?
¿En los últimos 6
meses, alguna vez ha
evitado hablar con
personas debido a su
problema de voz?
T2: ¿En los últimos
6 meses, alguna vez
ha evitado hablar con
personas debido a su
problema de voz?
Caption: T1 = English-Spanish translator number 1; T2 = English-Spanish translator number 2.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 4/9
Chart 1. Continued...
Questions Original English
version(6)
Translation for Chilean
Spanish
Back-translation of the
VE for English
Speech-Language
Pathologists
Committee: semantic
and language
equivalence
Committee of Speech-
Language Pathologists:
cultural and linguistic
equivalence
8
Do people have
difficulty understanding
you on the phone
because of your voice
problem?
T1: ¿Las personas
tienen dificultades para
comprenderle al hablar
por teléfono debido
a su problema con la
voz?
Do people
have difficulties
understanding you
when talking on the
phone, because of your
voice problem?
¿Las personas
tienen dificultad para
entenderle al hablar por
teléfono debido a su
problema de voz?
¿Las personas tienen
dificultades para
entenderle al hablar por
teléfono debido a su
problema de voz?
T2: ¿Las personas
tienen dificultad para
entenderle al hablar por
teléfono debido a su
problema de voz?
9
In the last 6 months,
have you reduced the
use of the telephone
because of your voice
problem?
T1: ¿En los últimos 6
meses, habla menos
por teléfono debido
a su problema con la
voz?
In the last 6 months,
have you talked less on
the phone because of
your voice problem?
¿En los últimos 6
meses, habla menos
por teléfono debido
a su problema con la
voz?
¿En los últimos 6
meses, habla menos
por teléfono debido a
su problema de voz?
T2: ¿En los últimos 6
meses, ha reducido el
uso del teléfono debido
a su problema de voz?
10
Does your voice
problem affect your
communication in quiet
environments?
T1: ¿Su problema
con la voz le genera
dificultades para
comunicarse en
ambientes tranquilos o
silenciosos?
Does your voice
problem affect your
communication in silent
environments?
¿Su problema de voz
afecta su comunicación
en ambientes
silenciosos?
¿Su problema de voz
afecta su comunicación
en ambientes
silenciosos?
T2: ¿Su problema
de voz afecta su
comunicación en
ambientes silenciosos?
11
In the last 6 months,
have you ever avoided
having conversations
in quiet environments
because of your voice
problem?
T1: ¿En los últimos
6 meses, ha evitado
conversar en ambientes
tranquilos o silenciosos
debido a su problema
con la voz?
In the last 6 months,
have you ever avoided
talking in silent
environments because
of your voice problem?
¿En los últimos 6
meses, alguna vez ha
evitado conversar en
ambientes silenciosos
debido a su problema
de voz?
¿En los últimos 6
meses, alguna vez ha
evitado conversar en
ambientes silenciosos
debido a su problema
de voz?
T2: ¿En los últimos 6
meses, alguna vez ha
evitado conversaciones
en ambientes
silenciosos debido a su
problema de voz?
12
Does your voice
problem affect your
communication in noisy
environments?
T1: ¿Su problema
con la voz le genera
dificultades para
comunicarse en
ambientes ruidosos?
Does your voice
problem affect your
communication in noisy
environments?
¿Su problema de voz
afecta su comunicación
en ambientes ruidosos?
¿Su problema de voz
afecta su comunicación
en ambientes ruidosos?
T2: ¿Su problema
de voz afecta su
comunicación en
ambientes ruidosos?
13
In the last 6 months,
have you ever avoided
having conversations
in noisy environments
because of your voice
problem?
T1: ¿En los últimos
6 meses, ha evitado
conversar en ambientes
ruidosos debido a su
problema con la voz?
In the last 6 months,
have you ever
avoided talking in
noisy environments
because of your voice
problems?
¿En los últimos 6
meses, alguna vez ha
evitado conversar en
ambientes ruidosos
debido a su problema
de voz?
¿En los últimos 6
meses, alguna vez ha
evitado conversar en
ambientes ruidosos
debido a su problema
de voz?
T2: En los últimos 6
meses, alguna vez ha
evitado conversaciones
en ambientes ruidosos
debido a su problema
de voz?
Caption: T1 = English-Spanish translator number 1; T2 = English-Spanish translator number 2.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 5/9
Chart 1. Continued...
Questions Original English
version(6)
Translation for Chilean
Spanish
Back-translation of the
VE for English
Speech-Language
Pathologists
Committee: semantic
and language
equivalence
Committee of Speech-
Language Pathologists:
cultural and linguistic
equivalence
14
Does your voice
problem affect your
message when
speaking to a group of
people?
T1: ¿Su problema con
la voz tiene impacto
en lo que dice cuando
le habla a un grupo de
personas?
Does your voice
problem affect your
message when talking
to a group of people?
¿Su problema de voz
afecta su mensaje
cuando le habla a un
grupo de personas?
¿Su problema de voz
afecta su mensaje
cuando le habla a un
grupo de personas?
T2: ¿Su problema de
voz afecta su mensaje
cuando le habla a un
grupo de personas?
15
In the last 6 months,
have you ever avoided
having conversations
in a group because of
your voice problem?
T1: ¿En los últimos
6 meses, ha evitado
tener conversaciones
en grupo debido a su
problema con la voz?
In the last 6 months,
have you ever avoided
group conversations
because of your voice
problem?
¿En los últimos 6
meses, alguna vez ha
evitado conversaciones
grupales debido a su
problema de voz?
¿En los últimos 6
meses, alguna vez ha
evitado conversaciones
grupales debido a su
problema de voz?
T2: En los últimos 6
meses, ¿alguna vez ha
evitado conversaciones
grupales debido a su
problema de voz?
16
Does your voice
problem affect getting
your message across?
T1: ¿Su problema
con la voz le genera
dificultades para darse
a entender?
Does your voice
problem affect the
transmission of your
message?
¿Su problema de voz
afecta la transmisión de
su mensaje?
¿Su problema de voz
afecta la transmisión de
su mensaje?
T2: ¿Su problema
de voz afecta la
transmisión de su
mensaje?
17
In the last 6 months,
have you ever avoided
speaking because of
your voice problem?
T1: ¿En los últimos
6 meses, ha evitado
hablar debido a su
problema con la voz?
In the last 6 months,
have you ever avoided
talking because of your
voice problem?
¿En los últimos 6
meses, alguna vez ha
evitado hablar debido a
su problema de voz?
¿En los últimos 6
meses, alguna vez ha
evitado hablar debido a
su problema de voz?
T2: ¿En los últimos 6
meses, alguna vez ha
evitado hablar debido a
su problema de voz?
18
Does your voice
problem affect you in
social activities?
T1: ¿Su problema con
la voz le afecta en
actividades sociales? Does your voice
problem affect your
social activities?
¿Su problema de
voz le afecta en sus
actividades sociales?
¿Su problema de
voz le afecta en sus
actividades sociales
T2: ¿Su problema de
voz le afecta en sus
actividades sociales?
19
In the last 6 months,
have you ever avoided
social activities because
of your voice problem?
T1: ¿En los últimos
6 meses, ha evitado
actividades sociales
debido a su problema
con la voz?
In the last 6 months,
have you ever avoided
social activities because
of your voice problem?
¿En los últimos 6
meses, alguna vez ha
evitado actividades
sociales debido a su
problema de voz?
¿En los últimos 6
meses, alguna vez ha
evitado actividades
sociales debido a su
problema de voz?
T2: ¿En los últimos 6
meses, alguna vez ha
evitado actividades
sociales debido a su
problema de voz?
20
Are your family, friends,
or co-workers annoyed
by your voice problem?
T1: ¿A su familia,
amigos o compañeros
de trabajo les molesta
su problema con la
voz?
Are your relatives,
friends of coworkers
bothered by your voice
problem?
¿A sus familiares,
amigos o colega de
trabajo les molesta su
problema de voz?
¿A sus familiares,
amigos o colega de
trabajo les molesta su
problema de voz?
T2: ¿A sus familiares,
amigos o compañeros
de trabajo les molesta
su problema de voz?
Caption: T1 = English-Spanish translator number 1; T2 = English-Spanish translator number 2.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 6/9
Chart 1. Continued...
Questions Original English
version(6)
Translation for Chilean
Spanish
Back-translation of the
VE for English
Speech-Language
Pathologists
Committee: semantic
and language
equivalence
Committee of Speech-
Language Pathologists:
cultural and linguistic
equivalence
21
In the last 6 months,
have you ever avoided
communicating with
your family, friends, or
co-workers because of
your voice problem?
T1: ¿En los últimos
6 meses, ha evitado
comunicarse con
su familia, amigos o
compañeros de trabajo
debido a su problema
con la voz?
In the last 6 months,
have you ever avoided
communicating with
your family, friends or
coworkers due to your
voice problem?
En los últimos 6 meses,
¿alguna vez ha evitado
comunicarse con
su familia, amigos o
compañeros de trabajo
debido a su problema
de voz?
En los últimos 6 meses,
¿alguna vez ha evitado
comunicarse con
su familia, amigos o
compañeros de trabajo
debido a su problema
de voz?
T2: ¿En los últimos 6
meses, alguna vez ha
evitado comunicarse
con su familia, amigos
o compañeros de
trabajo debido a su
problema de voz?
22 Do you feel upset about
your voice problem?
T1: ¿Se siente molesto
por su problema con
la voz? Are you upset because
of your voice problem?
¿Se siente molesto por
su problema de voz?
¿Se siente molesto por
su problema de voz?
T2: ¿Se siente molesto
en relación a su
problema de voz?
23 Are you embarrassed
by your voice problem?
T1: ¿Está avergonzado
de su problema con la
voz? Are you embarrassed of
your voice problem?
¿Se avergüenza por su
problema de voz?
¿Está avergonzado de
su problema de voz?
T2: ¿Se avergüenza por
su problema de voz?
24
Do you have low self-
esteem because of your
voice problem?
T1: ¿Tiene baja
autoestima debido a su
problema con la voz? Have you a low self
esteem due to your
voice problem?
¿Tiene baja autoestima
debido a su problema
de voz?
¿Tiene baja autoestima
debido a su problema
de voz?
T2: ¿Siente baja
autoestima debido a su
problema de voz?
25 Are you worried about
your voice problem?
T1: ¿Está preocupado
por su problema con
la voz? Are you concerned
about your voice
problem?
¿Se encuentra
preocupado por su
problema de voz?
¿Está preocupado por
su problema de voz?
T2: ¿Se encuentra
preocupado por su
problema de voz?
26
Do you feel dissatisfied
because of your voice
problem?
T1: ¿Se siente
insatisfecho por su
problema con la voz? Are you unsatisfied
because of your voice
problem?
¿Se siente insatisfecho
debido a su problema
de voz?
¿Se siente insatisfecho
por su problema de
voz?
T2: ¿Se siente
insatisfecho debido a
su problema de voz?
27
Does your voice
problem affect your
personality?
T1: ¿Su problema
con la voz afecta su
personalidad? Does your voice
problem affect your
personality?
¿Su problema de voz
afecta su personalidad?
¿Su problema de voz
afecta su personalidad?
T2: ¿Su problema
de voz afecta su
personalidad?
28
Does your voice
problem affect your self
image?
T1: ¿Su problema con
la voz afecta la imagen
que tiene de sí mismo? Does your voice
problem affect the
image you have about
yourself?
¿Su problema de voz
afecta la imagen que
tiene de sí mismo?
¿Su problema de voz
afecta la imagen que
tiene de sí mismo?
T2: ¿Su problema de
voz afecta su auto-
imagen?
Caption: T1 = English-Spanish translator number 1; T2 = English-Spanish translator number 2.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 7/9
DISCUSSION
There is a wide variety of professions and jobs that require
a comfortable, clear and loud voice to perform their work.
However, in this context, we can distinguish between two concepts,
occupational voice and professional voice. The rst refers to using
the voice and the working conditions for its use, and the second
refers to specic personal conditions
(11)
. In the case of adaptation
and validation of vocal self-assessment instruments, we will use
the terminology of professional voice since the information they
provide refers to the subjects’ self perception and conditions.
The etiology of voice disorders is multifactorial and can occur
in persons who do not have a high vocal demand(12). However,
voice professionals are at a greater risk to the prevalence of a
voice disorder, as they have a raised vocal load, regardless of
vocal quality and endurance(11). Consequently, the quality of
life in these persons is aected.
According to the World Health Organization (WHO),
quality of life is a broad concept referred to by the patient,
which incorporates physical and mental well-being and social
function. Therefore, we need to consider the voice self-assessment
protocols that play a role in evaluation(1,13).
Currently in Chile, there are three adapted voice self-assesment
protocols: “Índice de Desventaja Vocal para Canto Popular
(IDVCP-Ch)”; “Medición de la Calidad de Vida en Relación
a la Voz (MCV-RV)”; and the “Escala de síntomas Vocales
(ESV-CL)” which was only one adapted and validated for
Chilean Spanish and culture
(6,14,15)
. However, There are no
protocols with the VAPP characteristics, which focuses on the
participation and activity of the subjects(8).
For the cross-cultural adaptation of the “Prole of Participation
and Vocal Activity - PPAV-CL” instrument to Chilean Spanish, we
used the Scientic Advisory Committee of Medical Outcome Trust
criteria, which we are continuing to use for the validation process
(5)
.
CONCLUSION
Through the methodology proposed by the SAC committee,
the cultural and linguistic equivalence for the instrument “Prole
of Participation and Vocal Activity (PPAV-CL)”, based on its
original version “Voice Activity and Participation Prole - VAPP”,
was achieved. The validation and psychometric aspects of the
PPAV-CL are under development.
REFERENCES
1. The WHOQOL Group. The World Health Organization quality of life
assess-ment (WHOQOL): development and general psychometric properties.
Soc Sci Med. 1998;46(12):1569-85. http://dx.doi.org/10.1016/S0277-
9536(98)00009-4. PMid:9672396.
2. Countryman S, Ramig LO. Effects of intensive voice therapy on speech
deficits associated with bilateral thalamotomy in Parkinson’s disease: a
case study [Internet]. Iowa: NCVS; 1994. (NCVS Status and Progress
Report) [citado 2020 abril 24]. Disponible en: http://citeseerx.ist.psu.edu/
viewdoc/download?doi=10.1.1.738.6451&rep=rep1&type=pdf#page=139
3. Jacobson BH, Johnson A, Grywalski C, Silbergleit A, Jacobson G, Benninger
MS, et al. The Voice Handicap Index (VHI). Am J Speech Lang Pathol.
1997;6(3):66-70. http://dx.doi.org/10.1044/1058-0360.0603.66.
4. Yiu EML, Ho EM, Ma EPM, Verdolini Abbott K, Branski R, Richardson
K, et al. Possible cross-cultural differences in the perception of impact of
voice disorders. J Voice. 2011;25(3):348-53. http://dx.doi.org/10.1016/j.
jvoice.2009.10.005. PMid:20335004.
5. 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. http://dx.doi.
org/10.1023/A:1015291021312. PMid:12074258.
6. Contreras F, Moreti F, Vivero M, Malebran C, Behlau M. Cross-cultural
adaptation, validation, and cutoff values of the Chilean version of the
Voice Symptom Scale: VoiSS. J Voice. 2021;35(3):498.e31-8. http://dx.doi.
org/10.1016/j.jvoice.2019.09.020. PMid:31699541.
7. Behlau M. The 2016 G. Paul Moore lecture: lessons in voice rehabilitation:
journal of voice and clinical practice. J Voice. 2019;33(5):669-81. http://
dx.doi.org/10.1016/j.jvoice.2018.02.020. PMid:29567050.
8. 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. http://dx.doi.org/10.1044/1092-4388(2001/040).
PMid:11407557.
9. Sukanen O, Sihvo M, Rorarius E, Lehtihalmes M, Autio V, Kleemola L.
Voice Activity and Participation Profile (VAPP) in assessing the effects of
voice disorders on patients’ quality of life: validity and reliability of the
Finnish version of VAPP. Logoped Phoniatr Vocol. 2007;32(1):3-8. http://
dx.doi.org/10.1080/14015430600784386. PMid:17454654.
10. Ricarte A, Oliveira G, Behlau M. Validação do protocolo Perfil de
Participação e Atividades Vocais no Brasil. CoDAS. 2013;25(3):242-9.
http://dx.doi.org/10.1590/S2317-17822013000300009. PMid:24408335.
11. Morawska J, Niebudek-Bogusz E. Risk factors and prevalence of voice
disorders in different occupational groups-a review of literature Występowanie
zaburzeń głosu w różnych grupach zawodowych-przegląd piśmiennictwa.
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state of the science review. J Laryngol Otol. 2009;123(8):823-9. http://
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Author contributions
FCR was responsible for conducting research, data collecting, tabulating data
analysis, and drafting the text; NG was responsible for conducting research,
data analysis and review of text; KA was responsible for data collection and
drafting of the text; MG was responsible for conducting research, data collecting
and drafting the text.
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 8/9
Annex A. Translated and culturally adapted version Voice Activity and Participation Profile (VAPP)(7), called Profile de Participation y Actividad
Vocal - PPAV
Perl de Parcipación y Acvidad Vocal – PPAV
Nombre:_________________________________________Fecha_________________
Edad__________________ Ocupación________________ Diag.ORL_______________
Instrucciones
Por favor conteste las siguientes preguntas marcando con una “X” sobre la línea que mejor represente su respuesta. Una “X” hacia el lado
izquierdo quiere decir que usted nunca se ve afectado, mientras que una “X” hacia el lado derecho quiere decir que usted siempre se ve
afectado.
Auto-percepción de la severidad del problema
1- ¿Qué tan grave es su problema vocal actual?
Normal_________________________________________________________Severo
Impacto en el trabajo
2-¿Su problema de voz le afecta en el trabajo?
Nunca_________________________________________________________Siempre
3-¿En los últimos 6 meses, usted ha pensado en cambiar de trabajo debido a su problema de voz?
Nunca_________________________________________________________Siempre
4-¿Su problema de voz le ha generado estrés en su trabajo?
Nunca_________________________________________________________Siempre
5-¿En los últimos 6 meses, su problema de voz ha tenido impacto en sus decisiones sobre su futuro laboral?
Nunca_________________________________________________________Siempre
Impacto en la comunicación diaria
6-¿Las personas le piden que repita lo que acaba de decir debido a su problema de voz?
Nunca_________________________________________________________Siempre
7-¿En los últimos 6 meses, alguna vez ha evitado hablar con personas debido a su problema de voz?
Nunca_________________________________________________________Siempre
8-¿Las personas tienen dicultades para entenderle al hablar por teléfono debido a su problema de voz?
Nunca_________________________________________________________Siempre
9-¿En los últimos 6 meses, habla menos por teléfono debido a su problema de voz?
Nunca_________________________________________________________Siempre
10-¿Su problema de voz afecta su comunicación en ambientes silenciosos?
Nunca_________________________________________________________Siempre
11-¿En los últimos 6 meses, alguna vez ha evitado conversar en ambientes silenciosos debido a su problema de voz?
Nunca_________________________________________________________Siempre
12-¿Su problema de voz afecta su comunicación en ambientes ruidosos?
Nunca_________________________________________________________Siempre
13-¿En los últimos 6 meses, alguna vez ha evitado conversar en ambientes ruidosos debido a su problema de voz?
Nunca_________________________________________________________Siempre
14-¿Su problema de voz afecta su mensaje cuando le habla a un grupo de personas?
Nunca_________________________________________________________Siempre
Contreras-Ruston et al. CoDAS 2021;33(4):e20200065 DOI: 10.1590/2317-1782/20202020065 9/9
15-¿En los últimos 6 meses, alguna vez ha evitado conversaciones grupales debido a su problema de voz?
Nunca_________________________________________________________Siempre
16-¿Su problema de voz afecta la transmisión de su mensaje?
Nunca_________________________________________________________Siempre
17-¿En los últimos 6 meses, alguna vez ha evitado hablar debido a su problema de voz?
Nunca_________________________________________________________Siempre
Impacto en la comunicación social
18-¿Su problema de voz le afecta en sus actividades sociales?
Nunca_________________________________________________________Siempre
19-¿En los últimos 6 meses, alguna vez ha evitado actividades sociales debido a su problema de voz?
Nunca_________________________________________________________Siempre
20-¿A sus familiares, amigos o colega de trabajo les molesta su problema de voz?
Nunca_________________________________________________________Siempre
21-En los últimos 6 meses, ¿alguna vez ha evitado comunicarse con su familia, amigos o compañeros de trabajo
debido a su problema de voz?
Nunca_________________________________________________________Siempre
Impacto emocional
22-¿Se siente molesto por su problema de voz?
Nunca_________________________________________________________Siempre
23-¿Está avergonzado de su problema de voz?
Nunca_________________________________________________________Siempre
24-¿Tiene baja autoestima debido a su problema de voz?
Nunca_________________________________________________________Siempre
25-¿Está preocupado por su problema de voz?
Nunca_________________________________________________________Siempre
26-¿Se siente insatisfecho por su problema de voz?
Nunca_________________________________________________________Siempre
27-¿Su problema de voz afecta su personalidad?
Nunca_________________________________________________________Siempre
28-¿Su problema de voz afecta la imagen que tiene de sí mismo?
Nunca_________________________________________________________Siempre
... La muestra fue definida por conveniencia tomando en consideración la cantidad de participantes en otros estudios realizados de adaptación lingüística y cultural al español chileno (Contreras et al., 2019;Contreras-Ruston et al., 2021;Correa et al., 2018Correa et al., , 2020. Un total de 26 personas, 21 mujeres cisgénero (77%) y 5 hombres cisgénero (23%), de un rango etario entre 20 y 76 años con una media de 38 años respondieron el IDV-Cl. ...
... En Chile, el proceso de adaptación lingüística y cultural en el área de voz está en plena explosión de desarrollo. Actualmente, se cuenta con varias pruebas adaptadas, como por ejemplo la Escala de Síntomas Vocales (Ruston et al., 2016), el Índice de Desventaja para el Canto Popular (Correa et al., 2018), la Medición de la Calidad de Vida relacionada con la Voz (Contreras et al., 2019), el EASE Chile (Correa et al., 2020), Perfil de Participación y Actividad Vocal (Contreras-Ruston et al., 2021). ...
Adaptación lingüística y cultural chilena del Voice Handicap Index (VHI) y del Voice Handicap Index 10 (VHI-10)
Article
  • Mar 2023
El presente estudio buscó adaptar lingüística y culturalmente el cuestionario de autovaloración vocal norteamericano Voice Handicap Index (VHI) al español chileno. Para esto se realizaron cuatro traducciones directas del VHI al español chileno de forma independiente. Luego, se consensuó una traducción general (TG) a partir del juicio de tres profesionales de la fonoaudiología. Esta TG fue traducida inversamente al idioma original para ser comparada con la versión original por el mismo grupo de profesionales de la fonoaudiología, llegando a la primera versión del Índice de Desventaja Vocal Chileno (IDV-Cl). Esta versión fue aplicada a veinte personas con diagnóstico de disfonía, considerando una escala Likert de frecuencia. Durante la adaptación, se consideró pertinente dejar constancia de las consignas no comprendidas o que resultaron inapropiadas culturalmente para el vocabulario chileno. De acuerdo con las observaciones recogidas, se revisó y modificó el instrumento, dando paso a la segunda versión del IDV-Cl, que fue aplicada a seis personas con diagnóstico de disfonía. En esta etapa no se plantearon nuevas sugerencias de cambio. El IDV-Cl refleja la versión original del inglés, tanto en la cantidad de ítems, como en los subcomponentes físico, funcional y emocional que lo conforman. Mediante la síntesis de esta encuesta se pudo obtener también una versión abreviada, que consta de diez ítems (IDV-Cl-10). En conclusión, se establece la equivalencia cultural y lingüística del cuestionario VHI en español chileno, del que se origina la versión IDV-Cl e IDV-Cl-10.
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Mapping of the characteristics in the CoDAS journal publications in the voice area: a scoping review
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Purpose To map and describe the characteristics present in the publications of the CoDAS journal in the voice segment. Research strategies The research was carried on the Scielo database using the descriptor voice. Selection criteria CoDAS publications in the field of voice. Data analysis Specific data collected according to delineation, summarized by descriptive analysis and analyzed in narrative format. Results Studies published in 2019 and with cross-sectional delineation were more frequent. The most frequent result in the cross-sectional studies was the vocal self-assessment. Most intervention studies were of immediate single-session-only effect. The most frequent procedures in the validation studies were translation and transcultural adaptation. Conclusion There was a gradual increase in the number of publications of voice studies, though these had heterogeneous characteristics. Keywords: Voice; Outcomes; Procedures; Dysphonia; Voice Disorders
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Mapeamento das características das publicações da revista CoDAS na área de voz: uma revisão de escopo
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Purpose To map and describe the characteristics present in the publications of the CoDAS journal in the voice segment. Research strategies The research was carried on the Scielo database using the descriptor voice. Selection criteria CoDAS publications in the field of voice. Data analysis Specific data collected according to delineation, summarized by descriptive analysis and analyzed in narrative format. Results Studies published in 2019 and with cross-sectional delineation were more frequent. The most frequent result in the cross-sectional studies was the vocal self-assessment. Most intervention studies were of immediate single-session-only effect. The most frequent procedures in the validation studies were translation and transcultural adaptation. Conclusion There was a gradual increase in the number of publications of voice studies, though these had heterogeneous characteristics. Keywords: Voice; Outcomes; Procedures; Dysphonia; Voice Disorders
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Cross-Cultural Adaptation, Validation, and Cutoff Values of the Chilean Version of the Voice Symptom Scale: VoiSS
Article
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  • Nov 2019
Summary: Objective. To evaluate psychometric properties of the Voice Symptom Scale (VoiSS) − Chilean Spanish version. Study Design. Cross-sectional, nonrandomized, prospective study with controls. Methods. The validation of the Chilean Spanish VoiSS version met the criteria of the Scientific Advisory Committee of the Medical Outcomes Trust: Cultural and linguistic adaptation, by translation into Chilean Spanish and back-translation. Validity, employed external criteria (excellent, very good, fair, and poor). Reliability was made by test-retest and responsiveness to treatment, the initial voice and after vocal treatment of 12 dysphonic patients were analyzed, by GRBAS. The Chilean Spanish adapted VoiSS protocol, Escala de Síntomas Vocales (ESV-CL), was applied to 205 subjects, 89 with dysphonia and 116 of them vocally healthy. A cutoff value for the total score was determined by the efficiency characteristics. Results. The ESV-CL demonstrates high validity, reliability, and responsiveness. A cutoff score of 35.5 was determined by using the high sensitivity (90%) and specificity (75%) found in subjects with dysphonia compared to vocally healthy subjects. Conclusions. The results of the Chilean version of VoiSS, renamed the ESV-CL, revealed it to be culturally equivalent to the original version, and to be a valid, reliable, and responsive instrument for voice symptoms in the Chilean population. Chilean speech-language pathologists can benefit from this adapted protocol in clinical research and voice management.
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Cross-cultural adaptation of the Chilean version of the Modern Singing Handicap Index: MSHI
Article
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  • Jun 2018
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The 2016 G. Paul Moore Lecture: Lessons in Voice Rehabilitation: Journal of Voice and Clinical Practice
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Functional dysphonia: Strategies to improve patient outcomes
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  • Dec 2015
Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient's perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient's recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem.
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The Voice Handicap Index
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Validation of the Voice Activity and Participation Profile protocol in Brazil
Article
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The purpose of this study was to develop the Brazilian version of the Voice Activity and Participation Profile (VAPP) protocol and to demonstrate its measure properties so that it could be used as a self-evaluation instrument about the quality of life of Brazilian patients with vocal complaints. The translation and validation were performed following the guidelines of the Scientific Advisory Committee of Medical Outcomes Trust. The instrument was administered to 50 patients, 25 with vocal complaint and 25 without it. The instrument was submitted to linguistic/cultural adaptation, validation, reliability, reproducibility, and responsiveness. The VAPP protocol is composed of 28 questions distributed into five aspects: self-perception of the vocal problem intensity, effects at work, effects at daily communication, effects at social communication, and effects at emotion. Two additional scores are included: limitation in activities (LA) and participation restriction (PR). The results showed that the Portuguese version of the VAPP protocol, called Perfil de Participação e Atividades Vocais (PPAV), is valid and reliable, presenting an acceptable reproducibility level, considering p<0.05. Responsiveness to treatment was determined by significant changes between results before and after treatment (self-awareness of the vocal problem intensity: 5.33/0.35, effects at work: 12.40/1.93, effects at daily communication: 42.55/6.75, effects at social communication: 7.05/2.42, effects at emotion: 62.5/61.9; LA: 33.3/2.81; PR: 28.7/8.28). The Brazilian version of the VAPP protocol is valid, reliable, and responsive to changes. Therefore, it can be proposed as a useful instrument to evaluate quality of life of dysphonic patients and the treatment outcomes.
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Assessing health status and quality-of-life instruments: Attributes and review criteria
Article
  • May 2002
The field of health status and quality of life (QoL) measurement has been evolving for the better part of 30 years. To identify health status and QoL instruments and review them against rigorous criteria as a precursor to creating an instrument library for later dissemination, the Medical Outcomes Trust in 1994 created an independently functioning Scientific Advisory Committee (SAC). In the mid-1990s, the SAC defined a set of attributes and criteria to carry out instrument assessments; 5 years later, it updated and revised these materials to take account of the expanding theories and technologies upon which such instruments were being developed. This paper offers the SAC's current conceptualization of eight key attributes of health status and QoL instruments (i.e., conceptual and measurement model; reliability; validity; responsiveness; interpretability; respondent and administrative burden; alternate forms; and cultural and language adaptations) and the criteria by which instruments would be reviewed on each of those attributes. These are suggested guidelines for the field to consider and debate; as measurement techniques become both more familiar and more sophisticated, we expect that experts will wish to update and refine these criteria accordingly. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Measuring voice outcomes: State of the science review
Article
Researchers evaluating voice disorder interventions currently have a plethora of voice outcome measurement tools from which to choose. Faced with such a wide choice, it would be beneficial to establish a clear rationale to guide selection. This article reviews the published literature on the three main areas of voice outcome assessment: (1) perceptual rating of voice quality, (2) acoustic measurement of the speech signal and (3) patient self-reporting of voice problems. We analysed the published reliability, validity, sensitivity to change and utility of the common outcome measurement tools in each area. From the data, we suggest that routine voice outcome measurement should include (1) an expert rating of voice quality (using the Grade-Roughness-Breathiness-Asthenia-Strain rating scale) and (2) a short self-reporting tool (either the Vocal Performance Questionnaire or the Vocal Handicap Index 10). These measures have high validity, the best reported reliability to date, good sensitivity to change data and excellent utility ratings. However, their application and administration require attention to detail. Acoustic measurement has arguable validity and poor reliability data at the present time. Other areas of voice outcome measurement (e.g. stroboscopy and aerodynamic phonatory measurements) require similarly detailed research and analysis.
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Voice Activity and Participation Profile: Assessing the Impact of Voice Disorders on Daily Activities
Article
  • Jul 2001
Traditional clinical voice evaluation focuses primarily on the severity of voice impairment, with little emphasis on the impact of voice disorders on the individual's quality of life. This study reports the development of a 28-item assessment tool that evaluates the perception of voice problem, activity limitation, and participation restriction using the International Classification of Impairments, Disabilities and Handicaps-2 Beta-1 concept (World Health Organization, 1997). The questionnaire was administered to 40 subjects with dysphonia and 40 control subjects with normal voices. Results showed that the dysphonic group reported significantly more severe voice problems, limitation in daily voice activities, and restricted participation in these activities than the control group. The study also showed that the perception of a voice problem by the dysphonic subjects correlated positively with the perception of limitation in voice activities and restricted participation. However, the self-perceived voice problem had little correlation with the degree of voice-quality impairment measured acoustically and perceptually by speech pathologists. The data also showed that the aggregate scores of activity limitation and participation restriction were positively correlated, and the extent of activity limitation and participation restriction was similar in all except the job area. These findings highlight the importance of identifying and quantifying the impact of dysphonia on the individual's quality of life in the clinical management of voice disorders.
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