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Cross-Cultural Adaptation and Validation of the Voice Handicap Index Into Estonian
Aune Ello1, Linda Sõber2, Merje Viigand3
1Department of Special Education and Speech Therapy, University of Tartu, Tartu, Estonia.
Objectives:
This study aimed to validate the Voice Handicap Index (VHI-30) for the Estonian language and determine its psychometric properties.
Study Design:
Cross-sectional and comparative study, combining subjective and objective methods.
Methods:
The objective data included voice recordings analyzed using the PRAAT software, which calculates the Acoustic Voice Quality Index (AVQI) to assess voice quality. Subjective data were gathered using the VHI-30 (Estonian version) (VHI-30-EST) to evaluate voice-related quality of life, and videolaryngostroboscopy was performed to examine vocal fold function in patients with dysphonia. Ten percent of the participants completed the VHI again after 2-4 weeks to assess test-retest reliability. The questionnaire's internal consistency, test-retest reliability, and clinical validity were evaluated.
Results:
The VHI-30-EST demonstrated excellent internal consistency, with a Cronbach's α of 0.977 in the test group and 0.893 in the control group. The test-retest reliability was strong, with an intraclass correlation coefficient of 0.968 for the total score. Validity analysis showed significant differences between the test and control groups for both VHI-30-EST and AVQI scores. Receiver operating characteristic curve analysis identified effective cut-off scores of 15.5 for VHI-30-EST and 2.8 for AVQI, with high sensitivity for both. Moderate correlations were found between VHI-30-EST scores and AVQI in the test group.
Conclusions:
The VHI-30-EST demonstrated strong internal consistency, excellent test-retest reliability, and solid clinical validity. Significant differences were observed between the test and control groups for both VHI-30-EST and AVQI scores, with moderate correlations between them. Effective cut-off scores were identified for both VHI-30-EST and AVQI, showing high sensitivity in distinguishing voice disorders. These results confirm the reliability and validity of VHI-30-EST in assessing voice-related quality of life in Estonian-speaking individuals.
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