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

Abstract

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.

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

“…According to our previous work, VAPP is a robust instrument with a Cronbach's alpha coefficient of 0.958 and the test-retest reliability of 0.905. 24,25 In our previous work, it was found that the medical consultation did not have essential effect on VAPP (effect size À0.03), but significant improvement was found immediately after brief voice therapy (effect size 0.43). The results showed that 70% of the patients experienced a slight to moderate effect and 20% a strong effect (effect size more than 0.87).…”

“…28 SEM for VAPP total score was 15.1 mm (N ¼ 76). 25 For effect size calculations, Cohen's d was used. Effect size equal to 0.2 was taken to mean a slight effect, equal to 0.5 a moderate effect, and 0.8 a strong effect.…”

“…The effect size for change in VAPP total score during follow-up was 0.89, whereas the effect size for the immediate therapy result was poorer (0.43). 25 This means that the positive effect increased until 12 months after therapy ended. The patient compliance to independent voice care at home was equal in the ''improved'' and the ''not improved'' groups.…”

“…The results showed that 70% of the patients experienced a slight to moderate effect and 20% a strong effect (effect size more than 0.87). 25 Standard error of measurement (SEM ¼ 15.1) was calculated for VAPP between repeated measurements before interventions and is used in this study as one criterion for improvement.…”

“…Our earlier study showed that VAPP and VHI had a strong correlation (0.854). 25 In this study, as a quality-of-life outcome measure, the VAPP was preferred to the VHI, because it provides a better description of the extent of functional handicap, as opposed to physical symptoms. The lack of long-term efficacy studies on the voice field and our finding that the voice treatment was immediately effective motivated us to study the durability of the effect.…”