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Singing-Related Pain Scale (SRPS): Development and Evaluation of the Validity and Reliability of a New Scale to
Sahar Shirvani1, Mozhgan Asadi2, Seyed Abolfazl Tohidast1
1Neuromuscular Rehabilitation Research Center, Research Institute of Neurosciences, Semnan University of Medical Sciences, Semnan, Iran.
Objective:
Voice-related pain (VRP) is a significant concern for professional voice users, especially singers, whose intense vocal demands make them vulnerable to musculoskeletal strain and phonatory discomfort. Despite this, there is no psychometrically validated tool specifically designed to assess VRP in singers. This study aimed to develop and evaluate the Singing-Related Pain Scale (SRPS), a novel instrument for identifying the location, intensity, frequency, and timing of pain among singers.
Methods:
The study was conducted in two phases. In phase I, a literature review and semistructured interviews with 17 singers and 10 speech-language pathologists informed item generation. The resulting item pool underwent expert review for developing the initial version of the SRPS. In phase II, psychometric properties of the SRPS were evaluated in a sample of 81 singers (mean age = 37.09 ± 10.45 years), mostly male (86.4%), with an average of 14.74 years of singing experience and 2.44 hours of daily vocal practice. Content validity was assessed using the content validity ratio (CVR) and content validity index (CVI). Face validity was confirmed via cognitive interviews with 10 singers. Convergent validity was evaluated by correlating SRPS scores with the Vocal Tract Discomfort Scale (VTD). Test-retest reliability was assessed over a two-week interval to determine the reliability of the scale.
Results:
Initial scale development resulted in a scale with 20 items. In the qualitative content validity, two items (right and left shoulder) were added, and the front and back parts of the head were merged into a single item entitled the head, resulting in a 21-item scale. Following expert review to determine CVR, four items were removed from the scale, yielding a 17-item scale. The SRPS demonstrated excellent CVI (S-CVI = 0.93), with no item scoring below the acceptable threshold. Face validity was supported by feedback from target users (singers). Statistically significant correlations were observed between SRPS and VTD scores for both pain frequency (r = 0.57, P < 0.001) and intensity (r = 0.62, P < 0.001), confirming the convergent validity of the scale. Intraclass correlation coefficients (ICCs) for test-retest reliability ranged from 0.71 to 0.98 for SRPS items. Total ICC values were 0.93 for pain frequency and 0.85 for pain intensity, indicating excellent reliability.
Conclusion:
The SRPS is the first validated tool specifically designed to assess singing-related pain. Its robust psychometric properties support its use in clinical and research settings to guide assessment and treatment planning for singers experiencing VRP. Future studies should further evaluate its construct validity and responsiveness to therapeutic change.
