Voice Activity And Participation Profile Research Articles

A Comparison of Voice Amplifiers and Personal Communication Systems for Hypophonia: An Exploration of Communicative Participation.

The primary purpose of this study was to evaluate how individuals with hypophonia (HP; also referred to as HP participants) and their primary communication partners (PCPs; also referred to as PCP participants) rate communicative participation before and after experience with a speech amplification device. A secondary purpose was to evaluate pre- and post-device effects on self-rated communicative participation for each of the three speech amplification devices trialed outside of the laboratory. Seventeen individuals with HP and their PCPs participated in a crossover design study that compared three different amplification devices: a wired belt-pack amplifier, a wireless stationary amplifier, and a personal frequency modulation (FM) system. Both the individuals with HP and their PCPs self-rated communicative participation at baseline and after trialing each device following 1-week device trial periods at home. Patient-reported outcome measures included the Communicative Effectiveness Survey (CES) and the Voice Activity and Participation Profile (VAPP). Following study completion, participants indicated whether they would like to select a specific device to continue using. Overall, HP participants rated communicative participation following device use higher than that in the pre-device condition, with the FM system resulting in the overall highest VAPP ratings and second highest CES ratings. Furthermore, HP and PCP participants rated these measures similarly. Finally, HP participants who selected a device to continue using self-reported lower total communicative effectiveness scores and greater voice activity limitations and participation restrictions at baseline in comparison to the nonselectors. This study contributes to an increased understanding of how communicative participation is experienced within this clinical population resulting from speech amplification. It is suggested that the inclusion of participation-based outcome measurement is essential to ensure a multidimensional and comprehensive approach to device prescription for individuals with HP.

Investigation of Validity and Reliability of Voice Activity and Participation Profile-Turkish Version (VAPP-TR)

A voice activity and participation profile (VAPP) is a self-assessment tool used to measure activity and participation limitations resulting from voice disorders. This study aims to demonstrate the adaptation, validity, and reliability of the Turkish version of the VAPP scale. A total of 231 individuals, 155 with voice disorders (patient group) and 76 without voice disorders (normal group), were included in this study. With reliability, internal consistency, and test-retest methods; validity was evaluated with criterion and convergent validity methods. The Cronbach α coefficient calculated for internal consistency was found to be 0.985 for the VAPP total and between 0.914 and 0.978 for the subsections. Intraclass Correlation Coefficient was found to be 0.974 for the VAPP total and between 0.800 and 0.981 for the subsections. Total and subsection scores of the VAPP scale had correlation coefficients ranged between 0.725 and 0.903 with VHIT and V-RQOLT in the whole sample (all P<0.001). The cut-off point was determined as ≥ 8 by ROC curve analysis for criterion validity. VAPP-TR is a valid and reliable tool that can be used to evaluate the quality of life of Turkish patients with voice disorders, particularly those with activity limitations and participation restrictions.

Autopercepção da voz por professores de escola pública

Introduction: The professional voice usage has some aspects that are inherent to each profession and the teachers present a high vocal risk. Purpose: To identify the perception that public-school teachers have of their own voices and the type and focus of coping strategies they use when they perceive vocal changes. Methods: Three vocal self-assessment inventories were answered by 100 teachers (EG) and 40 non-teachers (CG): 100 Word-Descriptors for Voice (WDV), Voice Activity and Participation Profile (VAPP), which allows the calculation of the Activity Limitation Score (ALS) and Participation Restriction Score (PRS), and Voice Disability Coping Questionnaire (VDCQ), that classifies the strategies used to cope with voice disorders into focus on problem and on emotion. Higher scores on VAPP and VDCQ indicate greater disability. Data were compared with a 95% level of confidence. Results: Teachers classified 53 descriptors as negative, with 1% to 40% of occurrence, against 40 descriptors of the non-teachers, with maximum 11% of occurrence. The total scores of the VAPP and VDCQ were, respectively per group, 41.95/13.37 and 37.90/10.23, and the ALS was 7.59/1.96 and PRS, 4.95/1.43. EG reported more (37.90) coping strategies than CG (10.23), and the emotion-focused (EG = 23.21 and CG = 6.53) coping strategies were more frequent than problem-focused (EG = 14.69 and CG = 3,70) ones. All data showed significant difference (p<0.05) between EG and CG. Conclusion: Teachers perceive the impact of changes in their voices, with greater impact on daily communication. They show greater occurrence of coping strategies to deal with these modifications in their voices and these are more emotion than problem-focused.

Relationship Between Laryngeal Signs and Symptoms, Acoustic Measures, and Quality of Life in Finnish Primary and Kindergarten School Teachers

This study investigated the relationship between the acoustic measure smoothed cepstral peak prominence (CPPS), teacher's quality of life as measured by the voice activity and participation profile (VAPP), laryngeal signs and symptoms, voice related health problems and laryngoscopic findings in Finnish teachers. The relationship between CPPS and sound pressure level (SPL) was also assessed. Vowel and text samples from 183 healthy Finnish teachers (99 kindergarten teachers [KT] and 84 primary school teachers [PST]) were analyzed for CPPS. Text reading was recorded in conversational loudness by PST, and KT were recorded wearing headphones, while listening to a masking noise of children talking to simulate their classroom voice and environment. CPPS values were correlated with the VAPP, self-reported laryngeal signs and symptoms, voice related health variables, and laryngoscopic findings. There was a significant difference between the two groups for CPPS text, PST showed significantly lower CPPS values (10.44) than KT (11.52). There was no difference between the two groups for CPPS vowel phonation. There was a significant correlation between SPL text and CPPS text for KT (P < 0.001, r = 0.43) but not for PST (P < 0.10, r = 0.16). There was a significant correlation between SPL vowel and CPPS vowel for both PST (P < 0.001, r = 0.47) and KT (P < 0.001, r = 0.45). CPPS did not correlate with the VAPP, laryngeal signs and symptoms, health variables or laryngeal findings. Factorial analysis of variance resulted in a significant relationship between the VAPP, laryngeal signs and symptoms, and teacher type. Teacher type and symptoms had a significant effect on VAPP scores. In the present work CPPS does not correlate with vocal health indicators of functionally healthy teachers. CPPS was significantly influenced by differences in speaking voice SPL, emphasizing the impact of recording conditions and technique. There was a significant relationship between laryngeal signs and symptoms, teacher type and the VAPP. Laryngeal signs and symptoms and teacher type are important variables and should be included in the clinical evaluation of occupational voice users, and voice problems.

Evaluation of Psychometric Properties of Voice Activity and Participation Profile (VAPP): A Spanish Version

This study aimed to analyze the psychometric properties of the Spanish version of the Voice Activity and Participation Profile (SVAPP) questionnaire. A randomized, cross-sectional sampling strategy with controls was used. Two samples with a total of 169 participants were analyzed, specifically 61 men (mean age 37.02) and 108 women (mean age 37.78). Of these participants, 112 were patients and 57 were controls. The instrument was submitted to reliability (internal consistency and corrected item-total correlations) and reproducibility analyses. Validation assessment was based on the construct validity, convergent validity, discriminant validity, and concurrent validity. The global internal consistency was excellent (Cronbach's α = 0.976), corrected item-total correlations were satisfactory and ranged 0.63-0.89, and factor loadings were above 0.50. The different subscales showed good internal consistency (alpha coefficients ranged 0.830-0.956) and test-retest values were consistently associated. The exploratory factor analysis evidenced a strongly defined five factors internal structure, with factors loadings ranging 0.51-0.86. Convergent validity demonstrated that all subscales and scores were very strongly correlated (Pearson r above 0.735) and significantly associated. The discriminant validity analysis showed that SVAPP had good specificity to distinguish dysphonic from healthy voice subjects. Concurrent validity with Voice Handicap Index Spanish version (SVHI) showed very strong correlations between total scores, and between SVHI total score and SVAPP Daily and Social Communication subscales; correlations between both tests subscales were strong; only between SVAPP Work and SVHI Physical sections correlations were moderate. The findings of the present study demonstrated evidence for the SVAPP questionnaire reliability and validity, and provided insightful implications of voice disorders on Spanish patients' quality of life. However, further investigations are required.

Efficiency and cutoff values of the Voice Activity and Participation Profile for nonteachers and teachers.

To identify the efficiency characteristics and cutoff values of the dimensions of the Voice Activity and Participation Profile (VAPP) protocol, which discriminates the dysphonic and vocally healthy individuals; to verify if the cutoff values remain the same for a sample of teachers. Efficiency characteristics and cutoff values of VAPP data from 171 subjects were analyzed by receiver-operating characteristic (ROC) curve: 90 teachers (60 dysphonic and 30 vocally healthy individuals, with a similar mean age, p=0.418) and 81 nonteachers (48 dysphonic and 33 vocally healthy individuals, with a similar mean age, p=0.934). The area under the ROC curve (AUC) and the cutoff values of the total score of VAPP for discriminating the individuals with and without dysphonia are different for the nonteachers and teachers. The nonteachers presented AUC=0.986 (p<0.001) and 4.5 points of cutoff of the total score of VAPP (sensitivity=95.8%; specificity=90.9%); the teachers presented AUC=0.872 (p<0.001) and 14.6 points of cutoff of the total score of VAPP (sensitivity=91.7%, specificity=75.9%). The cutoff values of VAPP are different for the nonteachers and teachers, being higher for the teachers but with greater sensitivity and specificity for the nonteachers, and can be used to screen large populations with the risk of voice disorders.

Vocal self-assessment: relation with the type of instrument, gender, age, and profession in individuals without vocal complaints.

To obtain the vocal self-assessment rates of individuals without vocal complaints and relate them to gender, occupation, and age range. This is an observational, analytical, and cross-sectional study. In this study, 601 individuals without vocal complaints, 241 men and 360 women, aged between 18 and 59 years (mean of 30.1 years) were included. The individuals were divided into following age groups: 18-29 years (n=353; 58.7%), 30-44 years (n=159; 26.5%), and 45-59 years (n=89; 14.8%); 136 individuals (22.6%) were voice professionals and 465 (77.4%) were nonprofessionals. The individuals answered a questionnaire with identification data and the protocols Voice-Related Quality of Life (V-RQOL), Voice Handicap Index (VHI), and Voice Activity and Participation Profile (VAPP). The data were statistically analyzed. Mean scores obtained in the V-RQOL, VHI, and VAPP were 95.5, 5.37, and 3.06, respectively. If we transfer these values to the base 100, differences were found in the scores of the VHI and VAPP. Women presented significantly lower scores in the V-RQOL and VHI. Moreover, there were no differences in the mean scores obtained by the different age groups. Regarding professional vocal use, there were differences in the VHI and VAPP, and the "nonprofessionals" presented lower VHI than professionals. The type of the instrument, gender, and profession variables can influence the vocal self-assessment results.

Factors associated with voice-related quality of life among teachers with voice complaints

This study evaluates whether the scores on the voice-related quality of life (V-RQOL) and voice activity and participation profile (VAPP) instruments show similar associations with socio-demographic characteristics, voice complaint characteristics, work-related factors, health conditions and consequences of voice complaints; and to assess agreement between V-RQOL and VAPP. In 12 primary and secondary public schools in Bogotá, we conducted a cross-sectional study among 438 Colombian school teachers with voice complaints. Participants filled out a questionnaire on socio-demographic characteristics, voice complaint characteristics, work-related factors, health conditions, economic consequences of voice complaints, and voice-related quality of life, which was assessed using the V-RQOL and the VAPP. The factors associated with the scores on the V-RQOL and VAAP were analysed using multiple linear regression. Assessment of agreement between the V-RQOL and VAPP scores was performed using the Bland–Altman plot. Simple linear regression analysis was used to examine the relationship between VAPP and V-RQOL. Results showed that individual and work-related factors that were associated with the scores derived from the questionnaires were similar for the two instruments, namely severity of voice complaints, auditory symptoms, hearing impairment, class size, and poor acoustics in the workplace. The associations between the score and the economic consequences of voice complaints were also similar for the two instruments. The V-RQOL and VAPP scores were strongly associated with one another and showed high agreement with regard to teachers’ perception of quality of life. These findings suggest that factors identified as being associated with the scores on the V-RQOL and VAPP are shared by the two instruments, showing that their approaches to quality-of-life assessment are similar. Both scales were strongly associated with one another and showed high agreement.Learning outcomes: Identify factors associated with scores on voice-related quality of life (V-RQOL) and voice activity and participation profile (VAPP). Identify whether the scores on V-RQOL and VAPP show similar associations with individual and work-related factors. Explain agreement between the scores on V-RQOL and VAPP.

Coping Strategies in Teachers With Vocal Complaint

To understand the coping strategies used by teachers with vocal complaints, compare the differences between those who seek and those who do not seek voice therapy, and investigate the relationships among coping and voice perceptual analysis, coping and signs and symptoms of voice, and coping and participation restrictions and limitations in vocal activities. Cross-sectional nonrandomized prospective study with control group. Ninety female teachers participated in the study, of similar ages, divided into three groups: group 1 (G1) comprised 30 teachers with vocal complaints who sought voice therapy, group 2 (G2) comprised 30 teachers with vocal complaints who never sought voice therapy, and group 3 (G3) comprised 30 teachers without vocal complaints. The following analysis were conducted: identification and characterization questionnaire, addressing personal and occupational description, recording speech material for voice perceptual analysis, Voice Signs and Symptoms Questionnaire, Voice Activity and Participation Profile (VAPP), and Voice Disability Coping Questionnaire (VDCQ)-Brazilian Version. In relation to the voice perceptual analysis, there was statistically significant difference between the groups with vocal complaint (G1+G2), which had showed voices with mild-to-moderate deviation, and the group without vocal complaint (G1), which showed voices within the normal variability of voice quality (mean for G1=49.9, G2=43.7, and G3=32.3, P<0.001). G1 had higher mean of voice signs and symptoms (G1=8.6, G2=6.6, and G3=2.0, P<0.001) and higher scores in almost all dimensions of VAPP (P<0.001), except for the aspects effect on job and effect on social communication. Individuals with vocal complaints who looked for voice therapy (G1) tended to use more problem-focused strategies and had higher scores in VDCQ (G1=45.4, G2=38.5, and G3=9.5, P<0.001). The aspects that were correlated with VDCQ in the three groups were degree of vocal deviation, VAPP total score, VAPP partial scores of self-perceived severity of voice problem, effect on daily communication, effect on emotion, and participation restriction for G1; VAPP total score and partial score of effect on daily communication for G2; and all VAPP scores for G3. No correlation was found between voice signs and symptoms and coping. Teachers with vocal complaints who looked for voice therapy use more coping strategies. Moreover, they present a tendency to use more problem-focused coping strategies. Voice symptoms prompt the teachers into seeking treatment; however, they are not correlated with the coping itself. In general, the higher the perception of limitation and restriction of participating in vocal activities, the greater the use of coping strategies.

EGG and Acoustic Analyses of Different Voice Samples: Comparison between Perceptual Evaluation and Voice Activity and Participation Profile

Objective: This study investigated whether different electroglottographic (EGG) parameters may be used to estimate voice quality and loading related to it, and whether voice quality is related to self-estimation of voice problems and laryngeal status. The effect of sample type was also considered. Methods: EGG and acoustic signals of a sustained vowel [a:] (90 dB_{6 cm}) and text reading during noise exposure were recorded from 93 female kindergarten teachers. Analyses were made from the sustained vowel and vowel [a:] from a stressed word. Contact quotient (CQ) was calculated. Maximum velocity of increase in contact area inferred from derivative (MDEGG) was examined. Fundamental frequency was calculated from the EGG signal. From the acoustic signal sound pressure level (SPL) was computed and pressedness in voice quality was evaluated perceptually. Self-evaluation was made with Voice Activity and Participation Profile (VAPP). Indirect laryngoscopy was also performed. Results: Pressedness in voice correlated with EGG results only for the sustained vowel, and better with MDEGG than CQ values. VAPP and laryngeal evaluation did not correlate with the acoustic or EGG parameters or with perception. Conclusions: MDEGG is worth testing as an indicator of impact stress. Sustained vowel at a controlled SPL is more suitable for voice quality evaluation than a long stressed vowel from connected speech.

Parâmetros vocais, laríngeos e de autopercepção de professoras disfônicas: análise após tratamento fonoaudiológico

OBJETIVO: analisar os resultados das avaliações vocais, laríngeas e de autopercepção após tratamento fonoaudiológico em um grupo de professoras disfônicas. MÉTODO: trata-se de estudo retrospectivo com revisão de 42 prontuários de mulheres portadoras de disfonia comportamental, com coleta de dados referente à análise perceptivo-auditiva, acústica, de avaliação laríngea e de protocolo de autopercepção vocal (PPAV) nas situações pré e pós-fonoterapia. As professoras foram atendidas por estudantes do curso de Fonoaudiologia supervisionados por um único profissional. Foram utilizadas terapia direta com a realização de técnicas vocais e indireta com orientação sobre cuidados com a saúde vocal. RESULTADOS: com relação à análise perceptivo-auditiva, 73,8% das vozes foram descritas como melhores após a fonoterapia. Os parâmetros que mais se modificaram foram o grau da disfonia (G) e a rugosidade (R). No que concerne à análise acústica, os parâmetros que melhoraram significantemente após o tratamento foram o jitter, quociente de perturbação de frequência, shimmer e quociente de perturbação de amplitude. A avaliação laríngea demonstrou que 43% das pacientes apresentaram melhora no exame após o tratamento fonoaudiológico; 38% dos exames não sofreram alteração com o tratamento e 19% pioraram no momento da alta. A partir do PPAV, constatou-se melhora estatisticamente significante para todos os domínios no momento pós-fonoterapia, sendo que a maior diferença entre as médias pré e pós-tratamento foi referente ao parâmetro "efeitos no trabalho". CONCLUSÃO: observou-se melhora dos parâmetros perceptivo-auditivos de grau geral da disfonia e rugosidade, nas medidas acústicas de jitter e shimmer, bem como melhora da imagem laríngea e impacto positivo da voz na qualidade de vida das professoras avaliadas após o tratamento fonoaudiológico.

Validação do protocolo Perfil de Participação e Atividades Vocais no Brasil

The purpose of this study was to develop the Brazilian version of the Voice Activity and Participation Profile (VAPP) protocol and to demonstrate its measure properties so that it could be used as a self-evaluation instrument about the quality of life of Brazilian patients with vocal complaints. The translation and validation were performed following the guidelines of the Scientific Advisory Committee of Medical Outcomes Trust. The instrument was administered to 50 patients, 25 with vocal complaint and 25 without it. The instrument was submitted to linguistic/cultural adaptation, validation, reliability, reproducibility, and responsiveness. The VAPP protocol is composed of 28 questions distributed into five aspects: self-perception of the vocal problem intensity, effects at work, effects at daily communication, effects at social communication, and effects at emotion. Two additional scores are included: limitation in activities (LA) and participation restriction (PR). The results showed that the Portuguese version of the VAPP protocol, called Perfil de Participação e Atividades Vocais (PPAV), is valid and reliable, presenting an acceptable reproducibility level, considering p<0.05. Responsiveness to treatment was determined by significant changes between results before and after treatment (self-awareness of the vocal problem intensity: 5.33/0.35, effects at work: 12.40/1.93, effects at daily communication: 42.55/6.75, effects at social communication: 7.05/2.42, effects at emotion: 62.5/61.9; LA: 33.3/2.81; PR: 28.7/8.28). The Brazilian version of the VAPP protocol is valid, reliable, and responsive to changes. Therefore, it can be proposed as a useful instrument to evaluate quality of life of dysphonic patients and the treatment outcomes.

Effects of Speech Therapy on Voice and Speech in Parkinson's After a 15-day Rehabilitation Course: A Pilot Study

Background/Aims: Speech and voice symptoms appear in approximately 65-74% of patients with Parkinson's disease (PD), however, only a limited part of these patients seems to be referred to speech therapy. The purpose of the present study was to evaluate the effects of a two-part, 15-day rehabilitation course on speech and voice function in PD. Methods: Daily speech therapy sessions were provided both individually and in groups. Six participants with PD, and their spouses, participated in the study. Speech samples were recorded and they were analysed perceptually and acoustically. Additionally, the participants completed the Voice Activity and Participation Profile (VAPP). The spouses filled in a version of the questionnaire where they evaluated their spouses’ voice limitations and activity and participation restrictions. Findings: The results of perceptual assessment showed that the voice quality improved significantly both in the reading and the spontaneous speech samples. Also, acoustic analysis showed that average fundamental frequency and vocal range increased in the measurements made three months postonset of treatment. In addition, the results from the VAPP showed that the quality of life improved. Conclusions: This study provides indications that the participants benefit from the rehabilitation course and further studies are needed to evaluate the effects of this type of rehabilitation.

Comparação dos escores dos protocolos QVV, IDV e PPAV em professores

OBJETIVO: Verificar como o impacto da disfonia em professores é caracterizado pelos protocolos QVV (Qualidade de Vida em Voz), IDV (Índice de Desvantagem Vocal) e PPAV (Perfil de Participação e Atividades Vocais), e analisar a correspondência das informações obtidas por esses instrumentos. MÉTODOS: Quarenta e seis professores com queixa vocal que procuraram atendimento fonoaudiológico e foram diagnosticados com disfonia de base comportamental responderam aos questionários QVV, IDV e PPAV, em ordem aleatória. RESULTADOS: Professores disfônicos apresentaram pior qualidade de vida no QVV em relação à população de disfônicos. O IDV não apresentou devantagem vocal expressiva. No PPAV, os professores disfônicos apresentaram menor escore em efeitos na comunicação social. Os domínios orgânico (IDV) e físico (QVV) foram considerados iguais. O PPAV apresenta aspectos não contemplados nos demais protocolos; a auto-percepção do grau da disfonia apresentou correlação com todos os domínios dos três protocolos. No QVV, as questões com maior impacto pertencem ao físico e no IDV, ao orgânico. Já no PPAV, as duas questões de maior ocorrência relacionam-se ao efeito da voz na emoção. Assim, para esta população, sugere-se a aplicação do PPAV, por contemplar aspectos não contemplados nos demais, e do QVV, pelo reduzido número de questões e por apresentar maior impacto (escores total, emocional) em relação ao IDV. CONCLUSÃO: QVV, IDV e PPAV não apresentam as mesmas informações em professores disfônicos. Os domínios físico (QVV) e orgânico (IDV) oferecem resultados semelhantes, contudo, o sócio-emocional do QVV evidenciou mais o impacto da alteração vocal em professores disfônicos que o IDV. O PPAV apresenta informações não contempladas nos demais protocolos.

Aplicação do Protocolo de Participação e Atividades Vocais - PPAV em duas diferentes escalas de resposta

The purpose of this study was to compare two types of rating scales using the Voice Activity and Participation Profile (VAPP) self-assessment questionnaire, in order to check their influence on the results obtained by the same instrument. Participants were 32 individuals with vocal complaints of both genders, with ages between 15 and 58 years. All subjects answered the vocal self-assessment questionnaire VAPP using with two different rating scales, randomly presented: an 11-point numerical scale (NS) and a 10-cm long (or 100 points) visual analogue scale (VAS). Response time was registered and there was a two-week interval between applications. At the end of the task, participants were asked about the difficulties found in the task to answer each rating scale version, and also to indicate their preference. The mean VAPP scores were similar in both scales. Differences were found only in partial scores, referring to Activity Limitation and Effects on Emotion, with higher mean score in the numerical scale (p=0.008), however with no clinical impact. The order in which the scales were answered did not affect the results obtained, except for the aspect Effects on Social Communication, which presented lower scores with the visual analogue scale in the group of subjects that answered the numeric scale first (p=0.049). Finally, most participants answered faster to the questionnaire when using the numerical scale (p=0.003). The scores obtained in the VAPP by the two different rating scales were similar. The questionnaire with the numeric scale takes less time to be answered, which may be useful for clinical practice.

Twelve-Month Clinical Follow-Up Study of Voice Patients' Recovery Using the Voice Activity and Participation Profile (VAPP)

To study the effects of voice treatment including brief voice therapy for 12 months in two groups of voice patients: organic and functional. A clinical prospective follow-up study with repeated measurements in five phases: medical session, first voice therapy session, last voice therapy session, and 6 months and 12 months after voice therapy. The mean number of voice therapy sessions was 3.4. The main outcome measures were the Voice Activity and Participation Profile (VAPP) and the Symptom Questionnaire. Of consenting patients (n=141) with chronic voice disorders, 46 dropped out during follow-up. Ninety-five patients formed the study group. Forty-one of them received only voice therapy, but the rest of them received combined treatment (medication, amplifiers, and voice massage), but also experienced life events affecting voice. Patients with any laryngeal pathology formed the organic group (n=47), others had a functional voice disorder. Using the improvement criterion that the change of the VAPP score should exceed standard error of measurement, the percentage of individual patients achieving improvement was 47% in the mild, 59% in the moderate, and 75% in the severe disorder groups. Effect size for VAPP total score was 0.89. The positive effect continued to progress after the therapy ended. Patients with functional or organic voice disorder improved almost equally, although minor findings indicate that functional patients benefited more. Voice treatment had a progressive effect for 1 year in half of our patients. No statistical difference was found between the functional and organic patient groups.

Voice Activity and Participation Profile in Assessing the Effects of Voice Disorders on Quality of Life: Estimation of the Validity, Reliability and Responsiveness of the Finnish Version

Aim: The purpose of this study was to evaluate the validity, reliability and responsiveness of the Finnish version of the Voice Activity and Participation Profile (VAPP), a self-assessment questionnaire to measure psychosocial limitations caused by voice disorders. Methods: The study was conducted in Tampere University Hospital in 2004 and 2005. Voice patients (n = 142) with diverse chronic voice pathologies received 3–5 sessions of voice therapy. Controls were known individuals with healthy voices (n = 127). The VAPP form was completed before attending hospital, at the first visit to hospital and before and after voice therapy. Results: When comparing patients with healthy controls significant differences were found in score means. After brief voice therapy, the VAPP values improved moderately as 60% of patients had effect size of 0.27 or over. Physicians’ advice did not improve VAPP scores. The VAPP question profile was regarded as consistent. Cronbach’s alpha for the question profile was 0.958 and for the subsections 0.865. Conclusions: VAPP appeared to be valid and responsive to the intervention. In test-retest reliability, although intraclass correlation was high (0.905), there was a trend for the second answers to be better than the first. Some proposals are given to improve the practicality of the VAPP form.

Voice Activity and Participation Profile Presenting Coordinates for Readjustment of Preventive Action of Educators

Purpose: To investigate the perception of voice impairment in professional and social contexts, to correlate these data with existing data in the literature, and to explore the perception of voice problems and the adherence to vocal health programs. Method: 502 Brazilian educators working in municipal public schools responded to the Voice Activity and Participation Profile (VAPP) questionnaire. Then a correlation was made with previous results in the literature dealing with a dysphonic and a nondysphonic group. Results: The VAPP data showed that self-perception of voice problems had a higher vocal impact on daily communication and lower scores for activity limitation and participation restriction. The educators’ scores were closer to those of the nondysphonic group with regard to daily and social communication, and emotional and activity limitation, but perception of the voice problem was closest to that of the dysphonic group. Nevertheless, the opposite was the case for participation restriction. Conclusions: The educators perceive vocal problems but do not perceive participation restriction to the same extent. This may explain the decreasing participation in the Vocal Health Program. It probably occurs because adults voluntarily apply for training when they feel that their work performance needs to improve so that they can carry out their job properly.

Possible Cross-Cultural Differences in the Perception of Impact of Voice Disorders

Perception of the impact of voice disorders may differ across different cultural backgrounds. This study investigated the difference in the perception of the impact of voice disorders between the American (Pittsburgh) and Chinese (Hong Kong) cultures. Sixty dysphonic subjects from Hong Kong, China, and 60 dysphonic subjects from Pittsburgh, USA, were recruited to complete the Chinese and English versions of the Voice Activity and Participation Profile (VAPP), respectively. Data analyses using independent t tests were conducted on (1) the total profile scores; (b) total activity limitation score (ALS) and total participation restriction score (PRS); (c) section scores of job, daily communication, and social communication; and (d) section ALS and section PRS. Hong Kong subjects showed significantly higher scores than the Pittsburgh subjects in total profile and other subsections except in the job PRS. RESULTS support the possible influence of individualist and collectivist cultures on the perceived impact of voice disorders on the activity and participation.

Voice Activity and Participation Profile (VAPP) in assessing the effects of voice disorders on patients’ quality of life: Validity and reliability of the Finnish version of VAPP

The Voice Activity and Participation Profile (VAPP) is a self-assessment questionnaire describing the limitation of activities and participation of individuals with dysphonia. In this study, the validity and reliability of the Finnish translation of the VAPP was evaluated using 43 outpatients with various functional and organic voice disorders. A control group was formed consisting of 43 subjects matched according to age, gender, and profession, with normal voices. The VAPP was sensitive for voice disorders and items in the questionnaire had high internal consistency. The VAPP had a strong correlation with the Voice Handicap Index. The results showed that the questionnaire is a valid and reliable instrument to measure voice-related quality of life. It also showed that limitations in activity and participation levels should be examined separately.