title: Reliability and validity of the Dutch pediatric Voice Handicap Index.
abstract: BACKGROUND
  The pediatric voice handicap index (pVHI) has been developed to provide a better insight into the parents' perception of their child's voice related quality of life. The purpose of the present study was to validate the Dutch pVHI by evaluating its internal consistency and reliability. Furthermore, we determined the optimal cut-off point for a normal pVHI score.
  
  
  METHODS
  All items of the English pVHI were translated into Dutch. Parents of children in our dysphonic and control group were asked to fill out the questionnaire. For the test re-test analysis we used a different study group who filled out the pVHI twice as part of a large follow up study. Internal consistency was analyzed through Cronbach's α coefficient. The test-retest reliability was assessed by determining Pearson's correlation coefficient. Mann-Whitney test was used to compare the scores of the questionnaire of the control group with the dysphonic group. By calculating receiver operating characteristic (ROC) curves, sensitivity and specificity we were able to set a cut-off point.
  
  
  RESULTS
  We obtained data from 122 asymptomatic children and from 79 dysphonic children. The scores of the questionnaire significantly differed between both groups. The internal consistency showed an overall Cronbach α coefficient of 0.96 and an excellent test-retest reliability of the total pVHI questionnaire with a Pearson's correlation coefficient of 0.90. A cut-off point for the total pVHI questionnaire was set at 7 points with a specificity of 85% and sensitivity of 100%. A cut-off point for the VAS score was set at 13 with a specificity of 93% and sensitivity of 97%.
  
  
  CONCLUSIONS
  The Dutch pVHI is a valid and reliable tool for the assessment of children with voice problems. By setting a cut-off point for the score of the total pVHI questionnaire of 7 points and the VAS score of 13, the pVHI might be used as a screening tool to assess dysphonic complaints and the pVHI might be a useful and complementary tool to identify children with dysphonia.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: l.veder@erasmusmc.nl.
authors.forename: Laura
authors.initials: L
authors.lastname: Veder
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Pullens
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Timmerman
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Hoeve
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Joosten
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: Hakkesteegt
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D055154:Dysphonia / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007802:Language; D008297:Male; D010290:Parents; D010465:Perception; D011788:Quality of Life; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014175:Translating; D014831:Voice
keywords: Dutch version; Dysphonia; Pediatric voice handicap index (pVHI); Voice disorder in children