Validation of the Voice Handicap Index (VHI) by assessing equivalence of European translations

IM Verdonck-de Leeuw et al.

Objective : Assessing equivalence of translations of The Voice Handicap Index (VHI)
Patients and methods : Confirmatory Factor Analysis was used to assess equivalence of the USA version and several translations including 1) Dutch, 2) Flemish Dutch (Belgium), 3) GB English 4) French, 5) German, 6) Italian, 7) Portuguese, and 8) Swedish. VHI questionnaires were gathered from 1281 subjects. Patients were classified into 11 voice lesion categories. Patients with incomplete response (4%) and patients within voice lesion categories with small numbers were left out of further analyses, leaving a cohort of 1052 patients from 8 countries.
Results : Internal consistency of the VHI proved to be good. Confirmatory Factor Analysis across country revealed that a three-factor fixed measurement model best fitted the data; the three subscales appeared to highly inter-correlated, especially in the USA data. The underlying structure of the VHI was also equivalent regarding various voice lesions, but distinct groups were recognized regarding the height of the VHI scores, indicating that various voice lesions lead to a diversity of voice problems in daily life.
Conclusion : The USA Voice Handicap Index and the translations appeared to be equivalent which means that results from studies from the various included countries can be compared.

IM Verdonck-de Leeuw PhD1, DJ Kuik MSc2, M De Bodt PhD3, I Guimaraes PhD4, EB Holmberg PhD5, T Nawka MD, PhD6, CA Rosen MD, PhD7, A Schindler MD, PhD8 , R Whurr PhD9, V Woisard MD, PhD10
1Dept of Otolaryngology-Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
2Dept of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
3Dept of Otolaryngology and Communication Disorders, University of Antwerp, Edegem, Belgium
4Speech Therapy Department, Escola Superior de Saude do Alcoitao, Lisbon, Portugal
5Karolinska Institute, Dept of Logopedics & Phoniatrics, Karolinska University Hospital, Huddinge, Sweden
6Dept of Phoniatrics and Paedaudiology, University of Greifswald, Greifswald, Germany
7Dept of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Voice Center, Pittsburgh, USA
8Dept of Clinical Sciences "L. Sacco”, University of Milan, Milan, Italy
9NationalHospital for Neurology and Neurosurgery, London, Great Britain
10Dept of Otorhinolaryngology, Head and Neck Surgery, Larrey University Hospital of Toulouse, Toulouse, France

All correspondence can be send to:
IM Verdonck-de Leeuw, PhD
VU University Medical Center, Dept of Otolaryngology — Head & Neck Surgery
PO Box7057, 1007 MB Amsterdam, The Netherlands
tel +31 20 4443690, fax +31 20 4443688,
im.verdonck@vumc.nl