Page 76 - Portuguese Journal - SPORL - Vol 61. Nº2

instruments, while the remaining were studies VHI-9i only yielded Master’s dissertations 24-25 .
on the application of the instruments. In the VHI-10, the 10 items in EP correspond
to the original version, with a subsequent
Versions of the VHI in EP review by experts . It is in accordance with
4,8
Five versions were identified: VHI, VHI-9i, VHI- the original VHI format, but does not include
10, pVHI, and SVHI 3,5,8-12 . the final question on the overall perception
The VHI is in accordance with the original with of voice impairment. The pVHI maintains the
regard to instructions, number of items and original format, including instructions, item for
domains, 5-point scale, and the final question the evaluation of the type of voice disorder, a
about the overall perception of the severity questionnaire with 23 items (functional - seven;
of voice impairment on a 4-point scale . It physical - nine, and emotional - seven), and a
3
allows a total score and subscale score and the 5-point scale. Its maximum total possible score
structure with three domains was confirmed is 92, corresponding to the worst handicap. It
in the EP version . The first adaptation was has a final question on the overall perception
13
performed according to the guidelines of of the severity of the voice problem with a
1998 Health Instruments and subsequently visual analog scale (VAS) of 100 mm (from 0-no

analyzed by experts (speech therapists [ST ]), problem to 10- severe problem) . No studies
6,9
and its items were reformulated according were found on its application by authors
to the opinion of a bilingual (English- other than those who originally adapted it
Portuguese) professor of English 14-15 . It is the into EP , although the validation process was
9
most disseminated PROM (seven international conducted later by other authors . The SVHI
10
articles, four national articles, five theses, was in accordance with the original format but
and one dissertation) 3,5;8,10-23 . The VHI-9i (the it did not include the final item on the overall
letter i is the abbreviation for “international”) perception of the severity of the singing voice
was developed in an international study of problem assessed using a 100-mm VAS, as in
1,052 people with dysphonia (121 Portuguese the original; however, it was used in the study
individuals), and the selected items were of convergent validity 7,11-12 . The questionnaire
those with the best equivalence among the consists of 36 items and four domains, and the
eight versions in different languages and the 5-point scale has a maximum total score of 144,
original . It only allows a total score (36 points corresponding to the worst handicap. There
5
for the worst handicap). The search for the were no studies on its application conducted

Figure 1
Flow chart for the identification and selection of documents

218 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery