Elsevier

Journal of Voice

Volume 26, Issue 4, July 2012, Pages 462-465
Journal of Voice

Normative Values for the Voice Handicap Index-10

https://doi.org/10.1016/j.jvoice.2011.04.006Get rights and content

Summary

Objectives

The objective of this study was to elucidate the normative values for the Voice Handicap Index-10 (VHI-10) questionnaire.

Methods

VHI questionnaires were completed by 190 subjects without voice complaints. The results were then analyzed for mean, standard error of the mean (SEM), and standard deviation (SD) for both the original VHI and VHI-10 subset questionnaires. Outliers were defined as being more than three standard deviations above the mean.

Results

Analysis of 156 VHI questionnaires revealed a mean of 6.86 (SEM = 0.79, SD = 9.88) for the normative values. One hundred fifty-eight VHI-10 questionnaires were analyzed to show a mean of 2.83 (SEM = 0.31, SD = 3.93) for the normative values.

Conclusions

This study offers normative data for the VHI-10 that has been missing in the literature. A VHI-10 score >11 should be considered abnormal.

Introduction

Voice disorders are complex problems that can affect a patient in many different ways. Current objective measures of voice function can only assess one small component of voice production (eg, airflow or jitter). Likewise, video perceptual measures, including magnified and stroboscopic images of the larynx,1 also fail to assess the global handicap presented by a voice disorder. Even combined, these measures fail to fully elucidate the severity of a handicap produced by a voice disorder because of their subjective nature.2 For example, a teacher may perceive the handicap caused by a unilateral vocal fold paralysis to be much larger than would a retired steelworker with few social contacts, or voice demands.

A handicap, as described by the World Health Organization, is “a social, economic, or environmental disadvantage resulting from an impairment or disability.”3 Therefore, the handicap associated with a disorder of the voice must have a subjective measurement to fully assess its impact on a patient’s life. Patient-based voice-specific outcome measures can then potentially provide additional information to the anatomic and physiological variable, which can then be used as a component of assessment of voice handicap longitudinally.

In 1997, Jacobson et al4 proposed a questionnaire that subjectively measured voice handicap, which is the Voice Handicap Index (VHI) (Table 1). Several studies have shown that the data provided by the VHI is distinct from the data supplied by objective voice measures.5, 6 Additionally, the VHI was validated as meeting the criteria for reliability, validity, and availability of normative data by the Agency for Health Care Research and Quality in 2002.7 The VHI is, in fact, the only instrument on voice-related measurements reported to meet their stringent requirements for good diagnostic tools.

Although the VHI has been proven to accurately assess the voice handicap of a patient, it is a long and cumbersome questionnaire for patients to fill out on each visit to a clinic. Therefore, in 2004, Rosen et al8 designed a new shortened VHI-10 questionnaire, including 10 statements from the 30-item VHI form (Table 2). These 10 statements were selected for having the highest mean difference between the study and control groups and/or for significant clinical relevance. On further analysis, the 10 questions included in the VHI-10 were seen to exhibit the highest mean difference between pre- and posttreatment groups in comparison to the VHI.

Based on these findings, the VHI-10 may be a more concise substitute for the VHI. However, no normative data has been previously published for this new voice assessment tool. As with quality of life surveys in general, the more important comparison would seem to be the pre- to posttreatment change in scores to evaluate the treatment’s effectiveness. But, the original score can also be used to grade the degree of voice handicap. The goal of this present study is to establish normative data for the VHI-10.

Section snippets

Materials and methods

The VHI questionnaire was given to 190 family members of otolaryngology patients without voice complaints. These questionnaires were only included in the study if the subjects denied any history of past or present voice problems. All subjects were asked to complete this questionnaire without assistance. Only subjects who could read English were included in this study.

The individual item responses of each VHI were recorded into a computer spreadsheet (Microsoft Office Excel 2003). They were then

Results

After an attrition rate of 9%, the remaining 173 surveys were analyzed. Only 161 of these had all 30 questions answered. Five of the 161 VHI of 190 questionnaires were excluded for being more than three standard deviations above the mean (>54.9). Of the 156 VHI questionnaires that were included for analysis, 50 were completed by men and 106 by women. The results of these questionnaires had a mean of 6.86 (SEM = 0.79, SD = 9.88).

For the VHI-10 portion of the VHI, 163 subjects answered all 10

Discussion

In 2004, Rosen et al8 designed a new shortened version of the first and broadly used global handicap assessment tool for voice disorders, the VHI.4, 8 This new questionnaire comprises 10 questions from the original 30 questions of the VHI and was called the VHI-10; this group of questions was seen to exhibit the highest mean difference between pre- and posttreatment groups in comparison to the VHI. As this distinction is the most important factor in determining the effectiveness of different

Conclusions

The normative control group value for the VHI-10 found in this study was 2.83 (SEM = 0.31, SD = 3.93). These values could potentially help stratify voice disorder patients in the future.

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