Page 74 - Portuguese Journal - SPORL - Vol 61. Nº2

the perception of an individual’s health with Given the wide international dissemination
regard to functioning and/or quality of life.
Accordingly, patient-reported outcome
measures (PROMs) and Proxies (reports by
carers) have been created, which are subjective
and individualized measures that are different
from the instruments of clinical evaluation.
One of the first attempts to develop a voice-
related PROM was made in the 1980s to
measure the perception of the quality of life
of patients with laryngeal cancer . Four more
1
voice-related PROMS were created in the 1990s,
including the Voice Handicap Index (VHI) ,
1
and the number has increased exponentially
in the 21st century. In a systematic review of
the literature in English, 67 adult voice-related
PROMs and Proxies were found, and the VHI
with 30 items (VHI-30) was deemed to be the
most promising, with the criterion being the
taxonomy of the COnsensus-based Standards
for the selection of health measurement
INstruments (COSMIN) .
2
The VHI, a closed-ended questionnaire with 30
items, has three domains (physical, emotional,
and functional), each containing 10 items .
1
For each item, the patient marks the level of
agreement in a 5-point Likert-type scale. The
total score allows the determination of the
index of voice handicap (maximum of 120
points corresponding to the worst handicap).
It also includes a question on the overall
perception of voice classified on a 4-point
scale. It is a voice-related PROM that has
been linguistically and culturally adapted to
more than 25 languages, including European
Portuguese (EP) .
1,3
Based on the assumption that a shorter
questionnaire is more convenient in clinical
practice because the patients are subjected to
several assessments, the abbreviated version
of the VHI (with 10 items selected from the
original 30) was developed . The original
4
VHI-10 was shown to be as robust as the VHI-
30 for the detection of differences among a
wide range of voice disorders . Subsequently,
4
abbreviated versions, such as the VHI-9i, and
adaptations, such as the pediatric (pVHI) and
singing (SVHI), were published .
5-7
216 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
and use of the VHI and its expansion into
abbreviated and adapted versions, it is
pertinent to identify the versions used in
EP, the procedures used for the linguistic
and cultural adaptation, and validation, as
well as clinical and scientific utility. Thus, the
objectives of the present study on VHI in EP
were to: (i) identify the versions currently in
use; (ii) analyze the procedures used for the
linguistic and cultural adaptation; (ii) evaluate
the clinimetric properties, and (iii) determine
its clinical and scientific utility.
Materials and Methods
Search Strategy
A search was conducted in Pubmed, SciElo
Portugal, “Index das Revista Médicas
Portuguesas” (IndexRMP), and “Repositórios
Científicos de Acesso Aberto de Portugal”
(RCAAP) databases. Descriptors were used
in English combined by Boolean operators.
The search in IndexRMP and RCAAP was
performed by using descriptors in Portuguese
(“impacto da voz” and “autoavaliação”), as
well as the names of the Portuguese authors
of the retrieved documents. Subsequently,
articles on the topic of voice were searched
in the archives of the “Revista Portuguesa
da Sociedade de Otorrinolaringologia” and
“Revista Portuguesa de Terapia da Fala” and
on voice instruments in the “Repositório de
Instrumentos de Medição e Avaliação em
Saúde” (RIMAS) of the Centro de Estudos e
Investigação em Saúde (CEISUC). The search
was conducted in November 2022 and no
time limit was defined.
Eligibility criteria
During the selection of PROMs, only studies
conducted in the Portuguese population
and published in national and international
peer-reviewed journals, doctoral theses, and
Master’s dissertations were considered.
Data selection
We conducted a search by title independently
and then compared the selected articles to