Es-CoPE: Translation and Validation of the Vocal Cord Paralysis Experience Questionnaire for Spanish Speakers

Dysphonia, dysphagia, and dyspnea are frequent symptoms of unilateral vocal fold paralysis (UVFP). The CoPE patient-reported outcome measure (PROM) evaluates the disability associated with UVFP but has only been validated in English. This study aims to translate, cross-culturally adapt, and validate the Spanish version of CoPE (Es-CoPE).

This prospective, single-center study included 50 Spanish-speaking UVFP patients and 50 controls at a tertiary care voice clinic. CoPE was adapted through forward and reverse translation using rigorous methodology. Es-CoPE was evaluated for test-retest reliability, internal consistency, criterion validity (score comparison to gold standard VHI-10 and EAT-10), and construct validity through factor analysis.

UVFP and control groups had similar demographics (24 female/26 male cases vs. 22 female/28 male controls). Test-retest reliability was confirmed with a Pearson correlation of 0.87 (95% CI 0.81-0.91) and for its subscales (voice: r = 0.784 [95% CI 0.69-0.85], swallowing: r = 0.789 [95% CI 0.70-0.85], psychosocial: r = 0.704 [95% CI 0.58-0.79]). Es-CoPE showed construct validity as scores were significantly higher in UVFP patients than in controls (mean 34.68 [28.53-40.82 ± 21.63] vs. 4.94 [2.37-7.51 ± 9.04]). Factor analysis showed most items had strong factor loadings (> 0.8). Cronbach's alpha coefficient was 0.96, indicating strong internal consistency. The Es-CoPE voice subscale correlated with VHI-10 (r = 0.79 cases, r = 0.52 controls), and the swallowing subscale correlated with EAT-10 (r = 0.81 cases, r = 0.57 controls), demonstrating criterion validity.

The Spanish version of the CoPE is as reliable and valid as the English version, which fills the gap in the ability to assess the patient-reported disability associated with UVFP in patients in the Spanish-speaking population.