Hostname: page-component-77f85d65b8-grvzd Total loading time: 0 Render date: 2026-04-19T12:36:50.468Z Has data issue: false hasContentIssue false
  • English
  • Français

Optimising outcome assessment of voice interventions, II: sensitivity to change of self-reported and observer-rated measures

Published online by Cambridge University Press:  14 May 2007

I N Steen ,
K MacKenzie ,
P N Carding ,
A Webb ,
I J Deary  and
J A Wilson
I N Steen
Affiliation:
Institute of Health and Society, Newcastle University, Royal Infirmary, Glasgow, UK
K MacKenzie
Affiliation:
Department of Otolaryngology Head Neck Surgery, Royal Infirmary, Glasgow, UK
P N Carding
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Newcastle University, Glasgow, UK
A Webb
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Newcastle University, Glasgow, UK
I J Deary
Affiliation:
Department of Psychology, University of Edinburgh, Scotland, UK.
J A Wilson*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, Newcastle University, Glasgow, UK
*
Address for correspondence: Prof. Janet A Wilson, Dept of Otolaryngology Head Neck Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK. Fax: (44) 191 223 1246 E-mail: j.a.wilson@ncl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

A wide range of well validated instruments is now available to assess voice quality and voice-related quality of life, but comparative studies of the responsiveness to change of these measures are lacking. The aim of this study was to assess the responsiveness to change of a range of different measures, following voice therapy and surgery.

Design:

Longitudinal, cohort comparison study.

Setting:

Two UK voice clinics.

Participants:

One hundred and forty-four patients referred for treatment of benign voice disorders, 90 undergoing voice therapy and 54 undergoing laryngeal microsurgery.

Main outcome measures:

Three measures of self-reported voice quality (the vocal performance questionnaire, the voice handicap index and the voice symptom scale), plus the short form 36 (SF 36) general health status measure and the hospital anxiety and depression score. Perceptual, observer-rated analysis of voice quality was performed using the grade–roughness–breathiness–asthenia–strain scale. We compared the effect sizes (i.e. responsiveness to change) of the principal subscales of all measures before and after voice therapy or phonosurgery.

Results:

All three self-reported voice measures had large effect sizes following either voice therapy or surgery. Outcomes were similar in both treatment groups. The effect sizes for the observer-rated grade–roughness–breathiness–asthenia–strain scale scores were smaller, although still moderate. The roughness subscale in particular showed little change after therapy or surgery. Only small effects were observed in general health and mood measures.

Conclusion:

The results suggest that the use of a voice-specific questionnaire is essential for assessing the effectiveness of voice interventions. All three self-reported measures tested were capable of detecting change, and scores were highly correlated. On the basis of this evaluation of different measures' sensitivities to change, there is no strong evidence to favour either the vocal performance questionnaire, the voice handicap index or the voice symptom scale.

Keywords

VoiceVoice QualityQuality of LifeOutcome Assessment (Healthcare)Outcome Measures

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 1 , January 2008 , pp. 46 - 51
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Millar, A, Deary, IJ, Wilson, JA, MacKenzie, K. Is an organic/functional distinction psychologically meaningful in patients with dysphonia? J Psychosom Res 1999;46:497–505CrossRefGoogle ScholarPubMed
2Webb, AL, Carding, PN, Deary, IJ, Mackenzie, K, Steen, IN, Wilson, JA. Optimising outcome assessment of voice interventions, I: reliability and validity of three self-reported scales. J Laryngol Otol 2007:1–5 [Epub ahead of print]Google ScholarPubMed
3Deary, IJ, Webb, A, MacKenzie, K, Wilson, JA, Carding, PN. Short self-report voice symptom scales: psychometric characteristics of the VHI-10 and the VPQ. Otolaryngol Head Neck Surg 2004;131:232–5CrossRefGoogle Scholar
4Jacobson, BH, Johnson, A, Grywalski, C, Silbergleit, A, Jacobson, G, Benninger, MS. The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:66–70CrossRefGoogle Scholar
5Benniger, MS, Ahuja, AS, Gardner, G, Grywalski, C. Assessing outcomes for dysphonic patients. J Voice 1998;12:540–50CrossRefGoogle Scholar
6Deary, IJ, Wilson, JA, Carding, PN, MacKenzie, K. VoiSS: a patient derived voice symptom scale. J Psychosom Res 2003;54:483–9CrossRefGoogle ScholarPubMed
7Wilson, JA, Webb, AL, Carding, PN, Steen, IN, MacKenzie, K, Deary, IJ. Comparing the Voice Symptom Scale (VoiSS) and the Voice Handicap Index: structure and content. Clin Otolaryngol 2004;29:169–74CrossRefGoogle ScholarPubMed
8Hirano, M. Clinical Examination of Voice. New York: Springer-Verlag, 1981Google Scholar
9Dejonckere, PH, Obbens, C, de Moor, GM, Wieneke, GH. Perceptual evaluation of dysphonia: reliability and relevance. Folia Phoniatrica 1993;45:76–83CrossRefGoogle ScholarPubMed
10De Bodt, M, Wuyts, FL, Van de Heyning, PH, Croux, C. Test-retest of the GRBAS scale: influence of experience and professional background on perceptual ratings of voice quality. J Voice 1997;11:74–80CrossRefGoogle ScholarPubMed
11Webb, AL, Carding, PN, Deary, IJ, MacKenzie, K, Steen, N, Wilson, JA. The reliability of three perceptual evaluation scales for dysphonia. Eur Arch ORL 2004;261:429–34Google ScholarPubMed
12Jenkinson, C, Coulter, A, Wright, L. Short-form SF-36 health survey questionnaire: normative data for adults of working age. Br Med J 1993;306:1437–40CrossRefGoogle Scholar
13Brazier, JE, Harper, R, Jones, NMB, O'Cathain, A, Thomas, KJ, Usherwood, T et al. Validating the SF-36 health survey questionnaire: a new outcome measure for primary care. BMJ 1992;305:160–4CrossRefGoogle ScholarPubMed
14Wilson, JA, Millar, A, Deary, IJ, MacKenzie, K. The quality of life impact of dysphonia. Clin Otolaryngol 2002;27:179–82CrossRefGoogle ScholarPubMed
15Zigmond, AS, Snaith, RP. The hospital anxiety and depression scale. Acta Psychiatrica Scand 1983;67:361–70CrossRefGoogle ScholarPubMed
16Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd edn.Hillsdale, NJ: Erlbaum, 1988Google Scholar
17Kazis, LE, Anderson, JJ, Meenen, RF. Effect sizes for interpreting changes in health status. Med Care 1989;27(3 Suppl):S178–89CrossRefGoogle ScholarPubMed
18MacKenzie, K, Millar, A, Sellars, C, Wilson, JA, Deary, IJ. Is voice therapy an effective treatment for dysphonia? A randomised controlled trial. BMJ 2001;323:658–61CrossRefGoogle ScholarPubMed