Patient-Centered Approach to Assessing Voice Impairment

Importance The Voice Handicap Index-10 (VHI-10) is an established instrument with clear utility. However, national agencies are emphasizing the importance of patient-centered assessments beyond diagnostic test results. How patients view the VHI-10 and its items is not known. Objective To understand patients’ perceptions of the VHI-10 items and to identify a potential subset of 6 items for use as a shorter patient-centered assessment. Design, Setting, and Participants This was a prospective psychometric and patient-centered study conducted at tertiary care and community-based laryngology practices with consecutive adult patients who presented for laryngology evaluation from January 1, 2023, to December 31, 2024. Consecutive responses to the VHI-10 questionnaire were evaluated using factor and item response theory (IRT) analyses. Participants ranked VHI-10 items and provided qualitative feedback, which was inductively coded. Participants were asked what is “most important to you and your voice experience” when evaluating 3 proposed shorter subsets of the VHI-10. Exposures VHI-10 questionnaire and 3 subsets of 6 items each, including item ranking (evaluated by factor analysis and item response theory). Main Outcomes and Measures Factor analysis and item response theory were used to produce 3 subsets of the VHI-10 for quantitative and qualitative assessment by participants. Results The analysis included data from 6048 consecutive patients (mean [SD] age, 52.0 [8.4] years; 3326 female [55%] and 2722 male [45%] individuals) with completed VHI-10 questionnaires that were evaluated via factor analysis and item response theory (IRT) assessment. In addition, 461 consecutive patients prioritized the VHI-10 items and 521 rated each of the 3 potential subsets. Factor analysis confirmed unidimensionality and IRT analysis demonstrated that items 4, 3, 6, and 1 had the highest discrimination parameters, while items 6, 7, and 1 were most frequently ranked as most or more important; item 5 was included in all sets because of prior clinician and patient input on its importance. Of the 3 subsets proposed, the patients favored set 1, which was composed of these items from the VH1-10: (1) my voice makes it difficult for people to hear me; (2) people have difficulty understanding me in a noisy room; (3) my voice difficulties restrict personal and social life; (6) I feel as though I have to strain to produce voice; and (7) the clarity of my voice is unpredictable; plus item (5), my voice problem causes me to lose income. Conclusion and Relevance This psychometric study identified a shorter version of the VHI-10 that may be more patient-centered and clinically sufficient for assessing patients with voice impairments. These findings may form the foundation for additional assessments that are more patient-centered, efficient, and nuanced.