Development of a voice disorder work productivity inventory utilizing cognitive interviewing technique

Abstract

Objectives/HypothesisVoice disorders have been shown to impair workplace productivity primarily by reduced efficiency while at work (presenteeism) versus increased days missed (absenteeism). Work productivity measures such as the Work Productivity and Activity Impairment (WPAI) Questionnaire or the World Health Organization Health ‐ Work Performance Questionnaire (HPQ) can be customized to a specific disease but do not fully capture impaired work productivity associated with voice disorders. The purpose of this study was to develop a novel questionnaire to evaluate work productivity in patients with voice disorders.Study DesignDescriptiveMethodsAt a tertiary medical center, patients with gainful employment and with chronic voice disorders were given the WPAI, HPQ, and 20 voice‐related statements (VRS‐20). Cognitive interviews were conducted and recorded with all patients.ResultsTen patients (7 females, 3 males) completed the questionnaires and subsequent cognitive interviews. One patient had spasmodic dysphonia, 6 had benign vocal fold lesions, and 3 had vocal fold motion disorders. The median VHI‐10 was 18 (9‐40). Themes that emerged during interviews include: avoiding oral communication/telephone, use of voice associated with strain/fatigue, frustration and stress at work, and workplace integrity. Conclusions: In cognitive interviews, participants felt the VRS‐20 captured the impact of their voice disorder at work better than the WPAI and HPQ. Participants also felt some statements were more important than others.Level of Evidence5.

Development of an Instrument to Assess Work Productivity in Individuals With Voice Disorders: The Work Hoarse

“…17 Furthermore, there was a disproportionate representation of patients with spasmodic dysphonia, which represents both the nature of a tertiary referral center and also that there is a high proportion of employed patients with spasmodic dysphonia in our population. Our previous work 7,9 supports that spasmodic dysphonia-related vocal dysfunction with respect to work productivity impairment accurately models that of other types of dysphonia etiologies.…”

“…10,14 Most individuals felt that the validated WPAI was the best of the numeric rating scales to quantify this impairment but that a single number did not always capture their feeling of impairment, and thus an additional descriptive instrument was created. 7 This study reduced the original VRS-20 instrument to an 8-item scale with good internal consistency, reliability, and appropriate validation. We call this new instrument the Work Hoarse (Figure 2).…”

“…6 To ensure that these statements were also generalizable to individuals with other voice disorders, the interviews were repeated in a cohort of patients diagnosed with benign voice disorders confirming the appropriateness, applicability, and generalizability of the identified themes. 7 The VRS-20 was then administered to 54 subjects. Item reduction and factor analysis were performed on the responses, 12 and the resulting 14 most appropriate statements were then further simplified to reflect an eighth grade reading level as measured by the Flesch-Kincaid Grade Level formula.…”

“…Items S2, S3, and S4 also showed high interitem correlation. According to previous cognitive interviews, 7 items S2 and S4 are statements that particularly resonate with participants, so these items were retained. Item S3 also demonstrated the highest tendency toward a floor effect and exhibited the lowest mean value in descriptive statistics for these 3 items.…”

“…6,7 We have adopted the Work Productivity and Activity Impairment Questionnaire-Specific Health Problem (WPAI-SHP) 8 and modified it for use with voice disorders to quantitate voice-related work impairment. 7,9 Although many patients feel that the WPAI can quantitate their productivity impairment and is straightforward to complete, they have also expressed that the impact of their voice disorder on the job is not fully portrayed by a single numeric value, 7 which was the impetus to develop an additional instrument to qualitatively describe how individuals feel their dysphonia affects them at work. Our previous work has also shown that individuals with vocal dysfunction may feel that their dysphonia affects them more prominently at work than in activities outside of work, and thus, although the Voice Handicap Index (VHI) reflects generalized vocal dysfunction, we felt that it was important to develop a work-specific instrument.…”