Adaptation and Validation of the Kannada Version of the Singing Voice Handicap Index

doi:10.1016/j.jvoice.2016.10.012

Journal of Voice

Volume 31, Issue 4, July 2017, Pages 507.e7-507.e11

https://doi.org/10.1016/j.jvoice.2016.10.012 Get rights and content

Summary

Objective

The present study aimed to adapt and validate the Singing Voice Handicap Index (SVHI) into Kannada language using standard procedures.

Study Design

This is a cross-sectional study.

Methods

The original English version of SVHI was translated into Kannada. It was administered on 106 Indian classical singers, of whom 22 complained of voice problems. Its internal consistency was determined using Cronbach's alpha coefficient (α), test-retest reliability using Pearson's product moment correlation and paired t test, and the difference in mean scores by independent sample t test.

Results

The results revealed that the Kannada SVHI exhibited an excellent internal consistency (α = 0.96) with a high item-to-total correlation. Further, excellent test-retest reliability (r = 0.99) and significant differences in SVHI scores were also obtained by singers with and without a voice problem (t = 12.93, df = 104, P = 0.005).

Conclusion

The Kannada SVHI is a valid and reliable tool for self-reported assessment of singers with voice problems. It will provide a valuable insight into the singing-related voice problems as perceived by the singers themselves.

Introduction

Voice disorders can have a handicapping impact on the quality of life of a person.¹ This impact might differ from person to person depending on the requirements from voice.² Patient-reported outcome measures (PROMs) are used to quantify this impact on the quality of life, as well as help guide therapeutic outcomes and decisions. PROMs include patient self-reported questionnaires that assess some aspects of health status in the form of overall quality of life or specific domains such as physical, social, psychological, and economic aspects.³

Singers form a special group of professional voice users who are at risk of developing voice problems that affect not only their speaking but also their singing voice. Studies have reported of voice problems in singers, such as dryness, vocal fatigue, throat tightness, choking sensation, reduced pitch range, discomfort, strain, hoarseness, pain, voice breaks, and loss of voice.4, 5, 6 These voice problems have a greater impact on their quality of life as compared with non-singers.7, 8

The Voice Handicap Index was adapted for use in the evaluation of singing voice.⁷ However, it has been reported to have poor sensitivity to evaluate singing voice problems.8, 9, 10 Therefore, the need for a more specific self-reported instrument was identified to better explore the intricacies of an impact of voice problems in singers. This led to the adaptation of Voice Handicap Index for use in singers,⁷ as well as to the development of other language versions such as French,¹¹ Swedish (RHI-S),¹² and German.¹³ Additionally, certain questionnaires have been developed exclusively for singers, such as Singing Voice Handicap Index (SVHI),¹⁴ Singing Voice Handicap Index-10,¹⁵ and Evaluation of Ability to Sing Easily,¹⁶ in the English language. The Modern Singing Voice Handicap Index¹⁷ and Classical Singing Voice Handicap Index¹⁸ are instruments available in Brazilian Portuguese language for modern and classical singers, respectively. Abou-Elsaad et al¹⁹ have recently adapted and validated the Arabic version of Classical Singing Voice Handicap Index.

SVHI was developed and validated as a specific questionnaire to assess singing voice under physical, social, emotional, and economic domains. It is a psychometrically sound tool that helps identify specific singing problems, and is sensitive to clinical changes as well as treatment outcomes.⁹ SVHI has been reported to be valid with high internal consistency and test-retest reliability.¹⁴ It has been successfully adapted and validated in several languages, such as Spanish,²⁰ Portuguese,²¹ German,²² Korean,²³ Italian,²⁴ and Turkish.²⁵

Indian music is a blend of culture, spirituality, philosophy, psychology, and aesthetics. It is unique regarding its structure, temperament, and technique, evolving a blend of melody (raga) and rhythm (tala). Indian classical singing can be broadly classified into two forms: Hindustani classical, which is popular in the northern region of India; and Carnatic classical, which is popular in the southern region. Limited studies have been carried out in this population particularly highlighting their voice problems.26, 27, 28 There are no reports of using SVHI in Indian classical singers (ICSs) to investigate their self-reported voice problems. Hence, there is a need for psychometrically valid questionnaires to be made available in different Indian languages to better understand the self-reported voice problems in these singers. Kannada is a Dravidian language mainly spoken in the state of Karnataka as well as some neighboring states. It ranks at number 32 among the top 100 spoken languages of the world, with over 38 million speakers.²⁹ It was felt that translation and validation of SVHI in Kannada would be useful to assess the impact of voice problems in ICSs speaking Kannada.

The aim of the present study was to translate and validate the English version of SVHI into the Kannada language, an official language of Karnataka state, for use as a self-report tool for assessing singing voice handicap.

Section snippets

Methods

The study was approved by the Kasturba Hospital Institutional Ethics Committee (22/2014).

Results

The study included 106 ICSs, of whom 22 complained of voice problems, whereas 84 did not complain of any difficulty. All the singers could complete the questionnaire in less than 10 minutes without any assistance.

Discussion

PROMs are often used in the clinical assessment and management of individuals with voice problems.³ Singers place high demands on their voice and are at a greater risk for developing voice-related problems. Studies have stressed the need to develop specific health status questionnaires to better measure the impact of voice problems in singers with unique requirements and concerns.7, 8 Such self-reported questionnaires would provide a better knowledge of the person's perspective about his or her

Conclusion

ICSs with voice problems had significantly higher scores on the Kannada SVHI as compared with those who did not have voice problems. The Kannada SVHI is a reliable and valid tool for assessment of self-reported impact of voice problems on singing voice. It is capable of differentiating between singers with and without voice problems. Kannada SVHI can be incorporated into the routine voice evaluation procedures used for ICSs for a more comprehensive assessment of voice.

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Cited by (12)

Extreme Vocals—A Retrospective Longitudinal study of Vocal Health in 20 Professional Singers Performing and Teaching Rough Vocal Effects
2022, Journal of Voice
Citation Excerpt :
Here, discrete acoustic impact in specific spectral regions for the vocal effects Distortion, Growl, Rattle, and Grunt was documented without interference with the phonation at the glottis, whereas Creaking, which is produced at the glottic level, was observed to affect the full spectrum.11 To study vocal health, an often-used quality of life measure has been developed called the Singing Voice Handicap Index24,41 (SVHI), which has subsequently been validated for multiple languages.42-51 The SVHI targets 36 validated questions and aspects of singing voice across three categories: Physical, Functional, and Emotional graded on a Likert-scale (0—Never, 1—almost never, 2—sometimes, 3—almost always, and 4—always) for a total range of 0-144 scores.24,41
Rough vocal effects, extreme, or extended vocal techniques to sound intentionally hoarse or rough are an integral part of many genres and styles, and research has recently demonstrated the involvement of supraglottic narrowing and vibrations to produce such sounds. The vocal health of singing with rough vocal effects is poorly documented, especially in a longitudinal manner, while much vocal pedagogy continuously treats the sounds as harming to or dangerous for the vocal mechanism.
To longitudinally investigate the vocal health of professional singers who perform the five rough-sounding vocal effects Distortion, Growl, Grunt, Rattle, and Creaking as part of their singing and teaching.
Twenty singers underwent nasoendoscopic examination, filled in SVHI questionnaires, and were assessed by GRBAS with a 14-year interval in a retrospective longitudinal study (from 2007 to 2021). Endoscopic materials were assessed by Reflux Finding Score and a hybrid version of the Stroboscopy Rating Scale.
Singers presented at initiation of study with an average SVHI of 9.2 (±9), which decreased at time of follow up 14 years later to an average of 5.12 (±6). Laryngeal assessments (RFS and SRS) revealed low averages at initiation of study as well as at conclusion of the study with only small fluctuations in averages, with findings mainly relating to arytenoid asymmetry.
The participating singers perform and teach rough vocal effects continually and present with healthy laryngeal mechanisms and within-normal SVHI and GRBAS scores. The findings suggest that controlled supraglottic narrowing and techniques to allow for supraglottic structures to engage in vibration as an additional noise source can be performed sustainable and in a healthy manner if performed with correct vocal technique.
Cross-Cultural Adaptation and Validation of the Evaluation of the Ability to Sing Easily (EASE) for Kannada-Speaking Carnatic Classical Singers
2021, Journal of Voice
Citation Excerpt :
Further, an abbreviated version of the same, SVHI-10 was developed to reduce the patient burden.9 In the Indian context, the Singing Voice Handicap Index was adapted and validated into the Kannada Language.10 The Tamil version of SVHI-10 was also successfully validated as an instrument to give an insight into singing related voice problems as perceived by the singer.11
The present study aimed to cross-culturally adapt and validate the Evaluation of the Ability to Sing Easily (EASE) into Kannada for the benefit of Carnatic classical singers.
Following a standard translation procedure, the original English version was translated to develop a prefinal EASE-K version. This was further field-tested on 12 Carnatic singers to obtain the final EASE-K version. Upon validating the same on 104 Carnatic singers, intercorrelation between EASE-K subscales- Vocal Fatigue (VF) and Pathologic Risk Indicators (PRI) were assessed using the Spearman correlation coefficient. The internal consistency of the subscales was obtained based on the Cronbach's alpha coefficient. Nonparametric tests were carried out to study the effect of age and gender on EASE-K subscales. Further, the raw scores of the English version were compared to the EASE-K.
Spearman correlation coefficient indicated a statistically significant positive correlation (P < .01) between the two subscales (r = .745). Each scale showed good internal consistency (Cronbach's alpha was .84). Test-retest reliability carried on 12 singers indicated an excellent reliability for the subscales. Nonparametric tests indicated no significant effect of age and gender on the subscales of EASE-K (P > .05). Comparison across the original and EASE-K revealed significant differences for both VF (P = .02) and PRI (P = .00) subscales.
Current findings indicate that EASE-K is a reliable and valid tool that can be used to document the subtle changes in voice in healthy Carnatic classical singers. Further, the current tool can be used to study the effect of vocal loading across different singing styles.
Validity and Reliability of the Turkish SingingVoice Handicap Index-10
2020, Journal of Voice
Citation Excerpt :
For a complete clinical voice evaluation that includes instrumental analysis, the audio-perceptual analyses of clinicians, and self-report questionnaires, using the SVHI-10 not only saves time but also helps to get more reliable information, while preventing the possibility of overburdening the singer. The SVHI has been adapted and validated into many different languages,18–23 however, a valid version of the SVHI-10 is only available in Kannada and Tamil.25,26 To provide reliable and valid tools in different languages, question-validation studies should provide experts with universal measurement tools.10
To evaluate the validity and reliability of the Turkish version of the Singing Voice Handicap Index-10 (SVHI-10).
Cross-sectional study.
Two hundred singers consisting of a control group (n = 136) without voice complaints and a study group (n = 64) diagnosed with a voice disorder served as participants. To detect test-retest reliability, 97 participants (representing a portion of both the control and study group participants) completed the index twice with a minimum of a one-week interval between each completion. Internal consistency was confirmed using Cronbach's alpha coefficient. To complete a clinical validity assessment, scores from the control group participants were compared with scores from the study group participants. To determine content validity, the correlation between the SVHI-10 and the participants’ perceptions of singing voice complaints was researched. The sensitivity and specificity of the SVHI-10/Turkish version were calculated using a receiver operating characteristic curve analysis.
Cronbach's alpha coefficient, which was equal to 0.91, proved to have excellent internal consistency. Item-total correlations were found in the range of 0.55 to 0.76. The mean SVHI-10/Turkish score for the control group was 8.14 ± 5.4, whereas this value was significantly higher in the study group (20.54 ± 6.9, P < 0.001). The Pearson product-moment correlation test indicated that the Turkish SVHI-10 is a reliable tool (r = 0.90, n = 97, P < 0.001). The area under curve of the Turkish SVHI-10 was 0.95. The optimal cut-off point was found to be 11.5, with a sensitivity of 95.8% and a specificity of 83.2%.
The Turkish version of the SVHI-10 has proven to be a reliable and valid instrument for evaluating the self-perception of a singer in relation to voice problems. It can also be used as a quick screening tool because a score on the SVHI-10 higher than 11.5 is indicative of an abnormal singer's perceived voice handicap.
The Singing Voice Handicap Index (SVHI): Validation and Adaptation Into Persian
2020, Journal of Voice
Citation Excerpt :
It is a clinical tool that helps to identify specific singing problems.13 It has been successfully adapted and validated in several languages, such as Kannada, Egyptian, Italian, Spanish, Portuguese, German, Korean, and Turkish.14,13,15–20 Currently, there is no published Persian version of the SVHI for addressing the self-reported singing voice handicap in Iranian singers.
The aim of the present study is to develop, validate, and assess the reliability of the Persian version of Singing Voice Handicap Index (SVHIp) as a self-reported questionnaire for singers with voice disorders that measure the patient's self-perceived voice handicap.
This is a cross-sectional study.
During this study, the Persian version of singing voice handicap index was administered to 115 singers (90 male and 25 female, age range: 22–45 years). Voice disorder was confirmed by video-stroboscopic evidences in 48 participants, while 67 were healthy without any voice disorders. To assess the content validity, the prefinal questions were given to 15 experts to comment on its content applicability and relevance through a Likert scale. Seventy five singers rated its importance to detect face validity. To evaluate the concurrent validity, the same 75 participants completed both the SVHIp as well as a visual analog scale. The SVHI total scores of the singers with diagnosed voice disorder and of the healthy singers were compared to test the clinical validity (discriminant validity). Also, internal consistency reliability was assessed using Cronbach α coefficient. The relative reliability was calculated by asking 40 of all singers to complete the SVHIp twice, with a week of interval between the first and the second times. To detect the absolute reliability, Standard Error of Measurement and Smallest Detected Change were calculated. Responsiveness was measured for the Persian version of SVHI by comparing the individual patient scores before and after the treatment.
The SVHI was favorably accepted with no deletions. Discriminative validity differed significantly between singers with and without voice disorder. There was a significant correlation between the SVHIp and visual analog scale total scores (P < 0.05). The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.95). The Standard Error of Measurement and Smallest Detected values were acceptable (0.39 and 1.08), respectively. The Cohens' d effect size indicates the high responsiveness for SVHIp.
The Persian SVHI was demonstrated to be a valid and reliable self-rated questionnaire for use in Persian-singers.
Translation and Validation of Tamil Version of Singing Voice Handicap Index-10 (TSVHI-10)
2020, Journal of Voice
To translate and validate the singing voice handicap index (SVHI-10) for the Tamil speaking Indian population and to evaluate the psychometric properties of the Tamil version SVHI-10 (TSVHI-10) in classically trained Carnatic singers.
Following standard translation, a total of 120 classically trained Carnatic singers: 83 singers without voice complaint and 37 singers with voice complaints answered the Tamil translation of the SVHI-10.
The TSVHI -10 scores obatined from classically trained Carnatic singers with and singers without voice complaints were analyzed. SVHI-10 has excellent internal consistency and test retest reliability. Singers without/with voice complaint scored 7.08/22.86 total scores and for each domain Emotional (E): 1.73/5.32, Functional (F): 2.11/7.08, and Physical (P): 3.3/10.35 respectively.
The TSVHI-10 questionnaire seems to be psychometrically sound and is a valuable instrument for the self-evaluation of handicaps related to voice problems in the context of singing and for making subsequent clinical decisions. The Tamil version of the SVHI-10 was successfully validated as an instrument with proper internal consistency and reliability.
Adaptation and Validation of the Kannada Singing Voice Handicap Index-10
2019, Journal of Voice
The aim of the present study was to adapt and validate the English version of the Singing Voice Handicap Index-10 (SVHI-10) into Kannada language.
Cross-sectional Comparitive study design.
The English version of SVHI-10 was translated into Kannada using standard procedure. A total of 115 singers participated in the study, including 90 singers with no voice problems (control group) and 25 singers with voice problems. The internal consistency, test-retest reliability, clinical validity, and cutoff points were calculated.
Kannada SVHI-10 has excellent internal consistency and test-retest reliability. The singers with voice problems scored significantly higher than the singers with no voice problems (t = −14.67, df = 113, P < 0.001). The optimal cutoff point of the SVHI-10 was 9.5 with a sensitivity of 96% and specificity of 84%.
The Kannada SVHI-10 is a reliable and clinically valid tool to assess the self-reported singing voice handicap among singers. It can also be used as a quick screening tool for distinguishing singers with and without voice problems as per client's perception.

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Adaptation and Validation of the Kannada Version of the Singing Voice Handicap Index

Summary

Objective

Study Design

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

J Voice

J Voice

J Voice

J Voice

J Voice

J Voice

Otolaryngol Head Neck Surg

J Voice

Acta Otorrinolaringol Esp

J Voice

Gastroenterology

Otolaryngol Clin North Am

J Voice

Quality-of-life impact of non-neoplastic voice disorders: a meta-analysis

Ann Otol Rhinol Laryngol

The Voice Handicap Index (VHI): development and validation

Am J Speech-Language Pathol

Singing voice handicap mapped by different self-assessment instruments

Codas