Arabic abbreviated version of Pediatric Voice Handicap Index (preliminary study)

Hazem Y Abdelwahed; Nasser H Abdelnasser; Khalid A Al-Mazrou

doi:10.4103/1319-8491.274775

ORIGINAL ARTICLE

Year : 2012 | Volume : 14 | Issue : 2 | Page : 54-62

Arabic abbreviated version of Pediatric Voice Handicap Index (preliminary study)

Hazem Y Abdelwahed¹, Nasser H Abdelnasser², Khalid A Al-Mazrou³
¹ Department of Otolaryngology- Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
² King Saud bin A.Aziz University for Health Sciences, National Guard Health Affair, Riyadh, Saudi Arabia
³ Department of Otolaryngology- Head & Neck Surgery, College of Medicine, King Saud University; King Saud bin A.Aziz University for Health Sciences, National Guard Health Affair, Riyadh, Saudi Arabia

Date of Web Publication

3-Jan-2020

Correspondence Address:
DIS, (Fr.) MS (Eg.) Hazem Y Abdelwahed
Senior Registrar Otorhinolaryngology- Head & Neck. College of Medicine & University Hospitals King Saud University PO Box 245 Riyadh
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-8491.274775

Abstract

Background and Objectives: The Pediatric Voice Handicap Index (VHI) is a valid tool for assessing self-perceived voice handicap in children. We developed an Arabic abbreviated version of pediatric Voice Handicap Index (pVHI) for future use in Arab pediatric population.
Setting and Design: The study was conducted on nondysphonic children at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia.
Subjects and Methods: The original English pediatric VHI which is composed of 23-items was shortened to 10-items and translated into Arabic by a committee of two Pediatric Otolaryngologists and one Phoniatrician. The translated Arabic version was administered to the parents of 137 children without voice disorders or communication disorders.
Results: The subjects of our study had low scores which were comparable with control groups of different worldwide pediatric VHI studies. Also, there was an insignificant effect of gender on VHI subscales (P > 0.025). Obviously, the validity of these results may be limited by the absence of another dysphonic group. However, the preliminary results have encouraged us to report it and when a dysphonic group is available it will be possible to better validate this pVHI in term of performance.
Conclusion: Arabic version of the pVHI is a valuable tool for voice specialists dealing with Arabic speaking children. Future testing of our developed Arabic abbreviated pVHI with dysphonic groups to confirm its reliability in differentiating control subjects from dysphonic subjects is recommended.

Keywords: Pediatric Voice Handicap Index (pVHI); Arabic abbreviated version; non-dysphonic group

How to cite this article:
Abdelwahed HY, Abdelnasser NH, Al-Mazrou KA. Arabic abbreviated version of Pediatric Voice Handicap Index (preliminary study). Saudi J Otorhinolaryngol Head Neck Surg 2012;14:54-62

How to cite this URL:
Abdelwahed HY, Abdelnasser NH, Al-Mazrou KA. Arabic abbreviated version of Pediatric Voice Handicap Index (preliminary study). Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2012 [cited 2023 Jan 30];14:54-62. Available from: https://www.sjohns.org/text.asp?2012/14/2/54/274775

Introduction and Objectives

Traditionally voice disorders can be assessed by multiple tools such as endoscopic examination (stroboscopy), acoustic and aerodynamic measurements. However, these tools cannot assess the degree of disability that a person experience as a result of voice disorder. In 1997, Jacobson et al ^[1] proposed a measure of voice handicap known as the Voice Handicap Index (VHI). This patient-based self-assessment tool consists of 30 items. These items are equally distributed over three domains: functional, physical and emotional aspects of voice disorders. The functional subscale includes statements that describe the “impact of a person’s voice disorders on his or her daily activities”. The emotional subscale indicates the patient’s “affective responses to a voice disorder”. The items in the physical subscale are statements that relate to what the VHI developers thought where the patient’s “self-perceptions of laryngeal discomfort and the voice output characteristics”.

The VHI was designed to assess all types of voice disorders, even those encountered by tracheoesophageal speakers. The overall aim of the VHI is to quantify the patient’s perception of handicap because of his or her vocal function ^[2]. The VHI has been used worldwide as a valid instrument for measuring voice handicap of adults. It has been translated from English ^[1] into many different languages including Chinese ^[3],[4], Polish ^[5], Portuguese ^[6], Turkish ^[7], Dutch ^[8], Greek ^[9], Spanish ^[10], French^[11] and Arabic ^[12]. Zur et al^[13] have adapted VHI to serve a similar role in the evaluation of the effects of dysphonia on the pediatric population. Carding et al ^[14] suggest that routine voice outcome measurement should include a short self-reporting tool like the Voice Handicap Index-10 due to its high validity, best reported reliability to date, good sensitivity to change data and excellent utility ratings. The aim of this study was to develop an Arabic version of pediatric Voice Handicap Index (pVHI) for future use in Arabian pediatric population. The generated Arabic version of pediatric Voice Handicap Index (pVHI) is a reduced form (pVHI-10), adapted from pediatric English version (pVHI-23) of Zur et al ^[13].

Subjects & Methods

Development of Arabic abbreviated pediatric Voice Handicap Index:

A group of two pediatric otorlaryngologists and one phoniatrician has read the English pVHI of Zur et al13 which is composed of 23-items parental proxy (Appendix A). Then, it was shortened to 10-items (F2, F4, F6 - P5, P6, P2 - E1, E2, E6, and E4) (Appendix B). The shortened pVHI-10 subscales still focus on the functional, physical and emotional impacts of the voice disorders on the child’s daily activity.

This shortened pVHI-10 was translated by the above mentioned group into Arabic language with cultural adaptation to accommodate certain words as in P5, E2 and E4 (Appendix B). The final Arabic abbreviated pVHI-10 was then developed (Appendix C).

We found that Arabic abbreviated pVHI-10 is powerful representation of the English pVHI-23 that takes less time for patient’s parents to complete without loss of validity.

Subjects

This study included the parents of 137 normal children; 77 females and 60 males; without recent voice disorders or upper respiratory tract infection. Their age ranges between 2-18 years, mean age and standard deviation of 8.0510941(2.906823) years. Demographically, preschool age group of 45 children (24 females and 21 males) are > 2 ≤ 6 years old and school age group of 92 children (53 females and 39 males) are > 6 <18 years old. The parents of children who were younger than 2 years of age were not included in this study.

The questionnaire was presented by two speech language pathologists to parents whose children attended different outpatient clinics at King Abdul-Aziz University Hospital (KAUH); King Saud University in Saudi Arabia. The ethical and research committee has approved conducting this study. The Arabic pVHI-10 is a 10-items questionnaire in which the subjects have to rate the statements in three domains (Functional, Physical & Emotional) using a five point equal scale scored from zero (never) to four (always). The higher the score, the greater the voice-related problem will be.

Statistical Methods

The percentage of females 77/137 and males 60/137 groups was calculated. Then, Z-test of percentages drawn from one sample was used to compare between females and males groups. We assumed that the sample represents a random sample of the relevant population and that each group to be tested is independent of the other if P-Value > 0.05.

Also, the percentage of females and males groups with respect to age was calculated. Then, Chi-Square test was used to compare between females and males groups. We assumed there is a statistically significant difference if P-Value < 0.05.

The mean and standard deviation for pVHI-10 scores of total sample and for subscales (functional, physical and emotional) was measured. Then, Student t-test for independent groups was used to compare between male and female groups. We assumed there is a statistically significant difference if P-Value < 0.025 (Two-tailed). Also, the percentage of females and males groups with respecting each pVHI-10 item 0 score and collected 1-4 scores of subscales was calculated. Then, Chi-Square test and Fisher’s Exact test were used to compare between females and male groups. We assumed there is statistically significant difference if P-Value < 0.05. The statistical package of social science (SPSS) was used for statistical analysis in this study.

Results

The percentage of females 77/137 was 56.204% and the percentage of males 60/137 was 43.796% with P-Value=0.1456 by Z-test of percentages drawn from one sample. The statistical analysis revealed no significant difference between the two groups and we assumed that the sample represents a random sample of the relevant population and that each group to be tested is independent of the other as P-Value > 0.05.

Also, Females (n=77) and Males (n=60) groups’ percentages with respect to age were obtained. Preschool age group > 2 ≤ 6 years are 24 females (31.169%) and 21 males (35%) and school age group > 6 < 18 years are 53 females (68.83%) and 39 males (65%) with P-Value=0.771525 by Chi Square test. The statistical analysis revealed also no significant difference between the two groups with respect to age.

The means and standard deviations of the Arabic pVHI-10 subscales and total score are presented in [Table 1]. The subjects of our study, who were only one healthy non-dysphonic group, had low scores and this coincided with their healthy voices. Control groups (non-dysphonic) of different worldwide pediatric and adult VHI studies ^{[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13]} had also low scores while the dysphonic groups had high scores.

Table 1: Means & standard deviations with respect of each subscale total score of all children and subscales overall scores of all children.

Click here to view

Also, male and female groups’ means and standard deviations of the Arabic pVHI-10 subscales scores were obtained [Table 2]. The statistical analysis revealed no gender difference in responding to adapted Arabic version of pVHI-10.

Table 2: Male & female groups’ means score and standard deviations with respect of each subscale were compared by student t-test for independent groups.

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Females and males groups’ percentages with respecting each item of subscales were obtained [Table 3]. The statistical analysis revealed no significant difference between females and males groups except for the second item in the first subscale (functional) P-Value equals 0.052 (borderline). This is explained because 100% of males (60/60) scored 0 and 0% of males (0/60) scored 1-4 for second item in the first subscale (functional) while 93.51% only of females (72/77) scored 0 and 6.49% of females (5/77) scored 1-4 for the same item.

Table 3: Comparison between females & males groups with respecting to pVHI each item 0 scores and collected 1-4 scores:

Click here to view

Discussion

Dysphonic disorders of children can be assessed by stroboscopic examination, acoustic and aerodynamic measurements. These tools cannot assess the degree of disability that parents experience as a result of their child voice disorder.

The VHI was designed to assess all types of voice disorders. This VHI has been used worldwide as a valid instrument for measuring voice handicap of adults. Also, VHI was adapted to serve a similar role in assessing the effects of dysphonia on pediatric population. The present study has developed an Arabic version of pVHI which can be used to assess children with dysphonic disorders. We developed a shortened version of the English pVHI-23 of Zur et al(13), the Arabic pVHI-10, composed of 3 functional items, 3 physical items and 4 emotional items.

The Arabic pVHI-10 is a 10-items questionnaire in which the subjects have to rate the statements in three domains (Functional, Physical & Emotional) using a five point equal scale scored from zero (never) to four (always). The higher the score, the greater the voice-related problem will be. This Arabic pVHI version was applied on subjects without voice problems. The statistical results showed that the mean of the obtained scores of total population was low [Table 1] and this coincided with their healthy voices. Control groups (non-dysphonic) of different worldwide pediatric and adult VHI studies ^{[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13]} had also low scores while the dysphonic groups had high scores.

No test-retest was applied as the questionnaire was presented by two speech pathologists to parents of children coming from different areas of Saudi Arabia and they found no ambiguity in understanding the statements of the test by parents.

VHI has been translated from English into many different languages including Chinese ^[3],[4], Polish ^[5], Portuguese ^[6], Turkish ^[7], Dutch ^[8], Greek ^[9], Spanish ^[10], French ^[11] and Arabic ^[12]. All these studies and also the English pediatric version of Zur et al^[13] applied the VHI into a diseased voice groups and a healthy voice groups. The results demonstrated that patients with diseased voice have significantly higher VHI total scores than healthy control groups. It was found that this is also true for all VHI subscores in its three domains (emotional, functional and physical) with no significant effect of age or gender.

We found that Arabic abbreviated pVHI-10 is powerful representation of the English pVHI-23 that takes less time for patient’s parents to complete without loss of validity. The statistical analysis revealed no gender difference in responding to adapted Arabic version of pVHI-10.

The statistical results of Zur et al^[13] revealed a high correlation between the VHI and pVHI. The pVHI provides a high internal consistency and test-retest reliability. Zur et al^[13] concluded that this tool will be utilized to follow a child’s development following surgical, medical and behavioral interventions. Cheng and Woo^[15] stated that phonosurgery is an effective treatment for some vocal fold pathologies, and the Voice Handicap Index (VHI) survey has been shown to be a useful instrument for evaluating treatment effectiveness.

We believe that our study presented preliminary results. Obviously, the validity of these results may be limited by the absence of another dysphonic group. However, the preliminary results have encouraged us to report it and when a dysphonic group is available it will be possible to better validate this pVHI in term of performance. In conclusion, the Arabic version of the pVHI is a valuable tool for voice specialists dealing with Arabic speaking children. Future testing of the developed Arabic pVHI-10 with dysphonic groups to confirm its reliability in differentiating control subjects (non-dysphonic) from dysphonic subjects is recommended.

Appendix A

Pediatric Voice Handicap Index (pVHI-23)

(Zur et al)13

Instructions: Theses are statements that many people have used to describe their voices and the effects of their voices on their lives. Circle the response that indicates how frequently you have the same experience.

Part I- Functional:

Part II- Physical:

Part III- Emotional:

Appendix B

Arabic Pediatric Voice Handicap Index (pVHI-10)

(Adapted from Zur et al12)

Instructions: Theses are statements that many people have used to describe their voices and the effects of their voices on their lives. Circle the response that indicates how frequently your child (male or female) has the same experience

Part I- Functional:

Part II- Physical:

Part III- Emotional:

Appendix C

Developed Arabic Pediatric Voice Handicap Index (pVHI-10)

(Adapted from Zur et al12)

Developed Arabic Pediatric Voice Handicap Index (pVHI-10)

(Adapted from Zur et al12)

Instructions: Theses are statements that many people have used to describe their voices and the effects of their voices on their lives. Circle the response that indicates how frequently your child (male or female) has the same experience.

Part I- Functional:

Part II- Physical:

Part III- Emotional:

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