Page 80 - Portuguese Journal - SPORL - Vol 61. Nº2

Although there are published data on the exceptionally, data on the reproducibility
clinimetric properties of the remaining of the VHI were used. A final limitation was
instruments in EP (VHI-9i, VHI-10, pVHI, and the fact that the criteria recommended by
SVHI), they have only been provided by COSMIN were not strictly applied, with an
academic studies 5,8,10-11 (not subjected to peer “adaptation” being performed. Most of the
review) , and/or are insufficient regarding the retrieved studies do not describe results using
11
10 recommended clinimetric properties, and/ the recommended measures (e.g., SEM; 95%
or do not reach the values recommended by confidence interval; ICC; Cohen’ Kappa), which
COSMIN 5,8,10-11 . However, they can potentially is in line with international reports and, for
2
be recommended, as soon as there is some this reason, the use of Spearman’s correlation,
evidence on the not yet analyzed clinimetric for example, was considered acceptable for
properties, e.g., representative target analyzing the reproducibility in the present
population (e.g., VHI-10), reproducibility (e.g., study.
VH9i), concurrent validity (e.g., ≥ 0.70 in the
pVHI), and use of the same methods as those Conclusion
used in the original version (e.g., VHI-10). Among The VHI is the only PROM recommended for
the potentially recommendable instruments, voice evaluation, to support clinical diagnosis
the pVHI presents the best conditions for and research, whereas the remaining POMs
clinical and scientific use because the missing – VHI9i, VHI-10, pVHI, and SVHI – may be
clinimetric property (sensitivity to change) is recommended in the future, especially the
not essential for cross-sectional studies and pVHI due to its greater robustness.
the remaining results were robust (with the
exception of concurrent validity) in a sample Conflicts of Interest
of more than 300 children, which is much The authors declare that there is no conflict
larger than that in the original version 6,10 . It is of interests regarding the publication of this
worth noting that a questionnaire to measure paper.
the construct was not used in the analysis of
concurrent validity because there was none Data Confidentiality
in EP. Another advantage of the pVHI is the The authors declare having followed the
existence of a cutoff value, a useful indicator protocols in use at their working center
for voice screening in children . regarding patients’ data publication.
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Limitations Protection of humans and animals
One limitation of the present study may The authors declare that the procedures
have been the choice of descriptors, which were followed according to the regulations
were possibly insufficient to find relevant established by the Clinical Research and Ethics
information in EP. For example, the descriptors Committee and to the 2013 Helsinki Declaration
“impacto da voz” and “autoavaliação” were of the World Medical Association.
used, but other descriptors such as “impacto Funding Sources
psicossocial” and “questionário de opinião” This work did not receive any contribution,
were not included. However, a search by the funding or scholarship.
names of the Portuguese authors in the field
of voice research, who were identified in the Availability of scientific data
selected documents or known to the authors, There are no datasets available, publicly related
was also performed. to this work.
An obvious limitation was the exclusion of
data from monographs for bachelor’s degrees
to reduce the probability of error; however,

222 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery