Cross-Cultural Adaptation, Validation, and Diagnostic Accuracy of the Voice Fatigue Handicap Questionnaire-Persian Version

Abstract

OBJECTIVE: The current study aimed to determine the psychometric characteristics of a translated version of the Voice Fatigue Handicap Questionnaire in Persian by examining the validity, reliability, and diagnostic accuracy using data collected from people with and without dysphonia. STUDY DESIGN: Cross-sectional study. METHOD: The original questionnaire was translated from Italian to Persian using the International Quality of Life Assessment criteria. The translated version was completed by 122 people with dysphonia and 49 people without dysphonia. The validity, reliability, and diagnostic accuracy of the Voice Fatigue Handicap Questionnaire Persian-version were evaluated. A panel of five voice-specializing Speech and Language Pathologists and 20 native Persian speakers (with dysphonia) in a pilot study confirmed the translated version for content and face validity, respectively. The internal consistency was evaluated by Cronbach's alpha and McDonald omega coefficients. The intraclass correlation coefficient was used to examine the test-retest reliability. For discriminant validity, the mean total and subscale scores of respondents with and without dysphonia were compared through independent t tests. Finally, sensitivity, specificity, and ideal cut-off value were determined using the receiver-operating characteristic curve. RESULTS: Cronbach's alpha coefficient was 0.965 for the total score (functional: alpha = 0.883, emotional: alpha = 0.944, physical: alpha = 0.917). Also, the McDonald omega coefficient was 0.966 for the total score (functional: omega = 0.889, emotional: omega = 0.933, physical: omega = 0.920). The intraclass correlation coefficient for measuring the test-retest reliability was 0.971 for the total score (functional: ICC=0.937, emotional: ICC=0.954, physical ICC=0.976). The results of the independent samples t tests indicated that the dysphonia group obtained significantly higher mean scores (total and subscale scores) than the group without dysphonia. The cutoff value of 13.5 was determined based on the optimal balance of sensitivity (0.992) and specificity (0.918). CONCLUSION: The Voice Fatigue Handicap Questionnaire-Persian version is a valid and reliable questionnaire to identify individuals at high risk of vocal fatigue and subsequent dysphonia.