The Voice Problem Impact Scales (VPIS)

Abstract

Introduction: Patient-reported outcome measures (PROMs) are important for systematically assessing a person's perspectives and experiences with disease to inform clinical decision-making. However, PROMs can occasionally fail to capture subtle differences amongst subgroups. In response to this problem, the aim of the current study was to examine the convergent validity of four patient-reported voice activity and participation scales to better reflect and describe the impact of a voice problem in a patient's work, home, social and overall life. It was hypothesized that augmenting the validated PROM with a directed situational short instrument may enhance patient and clinician communication. This would allow for further description of individual areas of activity limitations or participation restrictions that are relevant to the patient, potentially informing therapeutic goals.

Methods: The Voice Problem Impact Scales (VPIS) were developed following the criteria outlined by Francis et al (2016). A retrospective chart review was completed for voice therapy treatment seeking patients at the USC Voice Center. Results from the Voice Handicap Index-10 (VHI-10) and VPIS scores were recorded at the time of the evaluation. Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) assessment was performed by an SLP with fellowship training in voice.

Results: Three hundred four charts were reviewed, and 198 met inclusion criteria. When considering all patients, VHI-10 scores were significantly correlated with each domain of the VPIS, including overall (R = 0.635, P < 0.001), work (R = 0.436, P < 0.001), social (R = 0.714, P < 0.001), and home (R = 0.637, P < 0.001). For females aged 18-39 and aged ≥60, the VHI-10 was correlated with all domains except work. CAPE-V score was significantly correlated with the social domain (R = 0.236, P = 0.001). Using the corrected significance level, it was not correlated with the overall (R = 0.165, P = 0.022), home (R = 0.197, P = 0.006), or work domains (R = 0.042, P = 0.567). The VHI-10 was not correlated with any of the VPIS domains for males aged 18-39, was correlated with all domains for males aged 40-59, and was correlated with all domains except work for males aged ≥60. Age was the only significant predictor of the work domain (β = -4.631 P < 0.001), with a model fit of R² = 0.101.

Conclusions: Scores from each domain of the VPIS are significantly correlated with VHI-10 scores thus confirming the instrument's convergent validity. There are certain groups for which currently used questionnaires may underrepresent the impact of dysphonia on the patient's life. The VPIS represents a broad tool that might allow the patient to interpret each scale within their individual context and cultural background. The VPIS emphasizes the significance of the dysphonia on quality of life in four common environments. Using this instrument can augment questionnaires and initiate conversations between the provider and patient to determine the area(s) where voice impairment is most important enhancing shared decision-making on therapeutic goals for plan of care.

Keywords: Dysphonia—Patient-reported outcomes measures—PROM—Activities limitations—Participation restrictions—Voice quality of life—Shared decision-making model.