Thermal Evaluation Protocol for Vocal Function: Development, Content Validity, and Reliability
Natallia Simões1, Patricia Maria Mendes Balata1, Daniel Santana Andrade1
1Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil.
Objectives:
To develop and validate the Thermal Evaluation Protocol for Vocal Function (TEP-VF), a standardized infrared thermography protocol for assessing the anterior cervical musculoskeletal system during phonation, addressing the methodological fragmentation that limits the clinical use of thermography in voice.
Methods:
The protocol was developed in two phases. In Phase I, items were generated through source triangulation-a PRISMA-ScR scoping review, expert input, and a pilot study-defining criteria for participant preparation, environmental control, and image acquisition specific to vocal function. Phase II, structured according to the COSMIN guidelines, comprised content validation through a two-round consensus process with ten experts using the Content Validity Ratio (CVR), the item- and scale-level Content Validity Indices (I-CVI, S-CVI/Ave), and the corrected Content Validity Coefficient (CVCc), and reliability testing with the intraclass correlation coefficient (ICC) on 40 cervical thermograms.
Results:
The final six-item protocol covered participant preparation, thermal camera specifications, environmental and positioning control, thermogram capture at rest and during phonation, region-of-interest analysis, and qualitative-quantitative evaluation, addressing the suprahyoid, infrahyoid, sternocleidomastoid, and trapezius regions. All retention thresholds were met in the second round (CVR = 1.00; I-CVI ≥ 0.70; S-CVI/Ave = 0.85; CVCc ≥ 0.72). Reliability showed good inter-rater (ICC > 0.84) and excellent intra-rater agreement (ICC > 0.90).
Conclusions:
The TEP-VF is a standardized, reliable, and software-independent protocol aligned with international thermography standards. It enables objective, reproducible analysis of the anterior cervical region and positions infrared thermography as a complementary tool for clinical screening and functional monitoring in voice assessment.
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