The Voice-Related Quality of Life (V-RQOL) Instrument: Cross-Cultural Translation and Test of Validity and Reliability of the Danish Version

Published:February 11, 2020DOI:



      To translate the voice-related quality of life (V-RQOL) questionnaire into Danish and to test the validity and reliability of this Danish version of the V-RQOL instrument.


      The translation process was done using forward and backward translation followed by pretesting interviews, performed on 21 participants. The final Danish version was then tested for validity and reliability on 80 cases with voice disorders and 21 controls without voice disorders.


      The Danish version proved to be valid and reliable. Validity was confirmed by convergent and discriminant validity, known-groups validity, clinical validity (Spearman correlation coefficient 0.64), confirmatory factor analysis, and Rasch analysis. The instrument showed no ceiling effects, but all items and the Social-Emotional domain showed substantial floor effects. The item-total correlations were all high (0.58–0.82) and none of the interitem correlations were low. Reliability was confirmed with regard to internal reliability (Cronbach's alpha 0.92) and test–retest reliability (interclass correlation coefficient 0.89).


      Our study shows that the Danish translation of the V-RQOL questionnaire is a valid and reliable instrument suitable for the assessment of the dysphonic patient. The high floor effects, however, indicate that minor differences in voice problems between patients may not be captured in the lower end of the scale with regard to the individual item and the Social-Emotional domain.

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        • Dejonckere P.H.
        • Bradley P.
        • Clemente P.
        • Cornut G.
        • Crevier-Buchman L.
        • Friedrich G.
        • et al.
        A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques.
        Eur Arch Oto-Rhino-Laryngology. 2001; 258: 77-82
        • Benninger MS
        • Ahuja AS
        • Gardner G
        • et al.
        Assessing outcomes for dysphonic patients.
        J Voice. 1998; 12: 540-550
        • Krischke S.
        • Weigelt S.
        • Hoppe U.
        • Köllner V.
        • Klotz M.
        • Eysholdt U.
        • et al.
        Quality of life in dysphonic patients.
        J Voice. 2005; 19: 132-137
        • Cohen SM
        • Dupont WD
        • Courey MS
        Quality-of-life impact of non-neoplastic voice disorders: a meta-analysis.
        Ann Otol Rhinol Laryngol. 2006; 115: 128-134
        • Wilson JA
        • Deary IJ
        • Millar A
        • et al.
        The quality of life impact of dysphonia.
        Clin Ototlaryngology. 2002; 27: 179-182
        • Hogikyan ND
        • Sethuraman G
        Validation of an instrument to measure voice-related quality of life (V-RQOL).
        J Voice. 1999; 13: 557-569
        • Jacobson B.H.
        • Johnson A.
        • Grywalski C.
        • Silbergleit A.
        • Jacobson G.
        • Benninger M.S.
        • et al.
        The voice handicap index (VHI): development and validation.
        Am J Speech-Language Pathol. 1997; 6: 66-70
        • Franic DM
        • Bramlett RE
        • Bothe AC
        Psychometric evaluation of disease specific quality of life instruments in voice disorders.
        J Voice. 2005; 19: 300-315
        • Tezcaner ZÇ
        • Aksoy S
        Reliability and validity of the Turkish version of the voice-related quality of life measure.
        J Voice. 2017; 31: 262.e7-262.e11
        • Aaby C
        • Heimdal JH
        The voice-related quality of life (V-RQOL) measure - a study on validity and reliability of the Norwegian version.
        J Voice. 2013; 27: 258.e29-258.e33
        • Gustafsson E.
        • Larsson F.
        Översättning och validering av Voice-Related Quality of Life.
        Institutionen för klinisk och experimentell medicin, Linköpings universitet, 2012
        • Gasparini G
        • Behlau M
        Quality of life: validation of the Brazilian version of the voice-related quality of life (V-RQOL) measure.
        J Voice. 2009; 23: 76-81
        • Contreras F.
        • Gonzalez N.
        • Vivero M.
        • et al.
        Equivalencia cultural de la versión chilena del voice-related quality of life (V-RQOL).
        CoDAS. 2019; 31: 1-6
        • Moradi N.
        • Saki N.
        • Aghadoost O.
        • Nikakhlagh S.
        • Soltani M.
        • Derakhshandeh V.
        • et al.
        Cross-cultural adaptation and validation of the voice-related quality of life into Persian.
        J Voice. 2014; 28: 842.e1-842.e9
        • Sielska-Badurek E
        • Rzepakowska A
        • Sobol M
        • et al.
        Adaptation and validation of the voice-related quality of life measure into polish.
        J Voice. 2016; 30: 773.e7-773.e12
        • Deshpande M.S.
        • Kakade A.C.
        • Chaukar D.A.
        • Gore V.T.
        • Pai P.S.
        • Chaturvedi P.
        • et al.
        Validation and assessment of voice-related quality of life in Indian patients undergoing total laryngectomy and primary tracheoesophageal puncture.
        Head Neck. 2009; 31: 37-44
        • Rangarajan A
        • Selvaraj JL
        • Santhanam DP
        The voice-related quality of life: a study on the reliability and validity of the Tamil version.
        Clin Med Insights Ear, Nose Throat. 2019; 12: 1-7
        • Schwanfelder C
        • Eysholdt U
        • Rosanowski F
        • et al.
        Stimmbezogene lebensqualität: Struktur, gültigkeit und bedingungsfaktoren des deutschen fragebogens.
        Folia Phoniatr Logop. 2008; 60: 241-248
        • Beaton DE
        • Bombardier C
        • Guillemin F
        • et al.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine (Phila Pa 1976). 2000; 25: 3186-3191
        • Kuli D
        • Bottomley A
        • Velikova G
        • et al.
        EORTC quality of life group translation procedure 2017.
        Eur Organ Res Treat Cancer. 2017; : 1-26
        • Terwee C.B.
        • Bot S.D.M.
        • de Boer M.R.
        • van der Windt D.A.W.M.
        • Knol D.L.
        • Dekker J.
        • et al.
        Quality criteria were proposed for measurement properties of health status questionnaires.
        J Clin Epidemiol. 2007; 60: 34-42
        • Long JS
        Confirmatory Factor Analysis.
        Sage, Beverly Hills1983
        • Holland PW
        • Wainer H
        Differential Item Functioning.
        Erlbaum, Hillsdale, NJ1993
        • Lucke JF
        “Rassling the Hog”: the influence of correlated Item error on internal consistency, classical reliability, and congeneric reliability.
        Appl Psychol Meas. 2005; 29: 106-125
        • Christensen KB
        • Makransky G
        • Horton M
        Critical values for Yen's Q 3 : identification of local dependence in the rasch model using residual correlations.
        Appl Psychol Meas. 2017; 41: 178-194
        • Christensen K.B.
        • Kreiner S.
        • Mesbah M.
        Rasch Models in Health.
        John Wiley & Sons, Inc., New York2013
      1. Muthén LK, Muthén BO. Mplus User's Guide. 6th Edition Los Angeles, CA: Muthén & Muthén: 1998–2010

        • Kreiner S
        • Nielsen T
        Item Analysis in DIGRAM 3.04: Part I: Guided Tours.
        Department of Biostastistics, University of Copenhagen, Copenhagen2013
        • Branski R.C.
        • Cukier-Blaj S.
        • Pusic A.
        • Cano S.J.
        • Klassen A.
        • Mener D.
        • et al.
        Measuring quality of life in dysphonic patients: a systematic review of content development in patient-reported outcomes measures.
        J Voice. 2010; 24: 193-198
        • Lohr KN
        Assessing health status and quality-of-life instruments: attributes and review criteria.
        Qual Life Res. 2002; 11: 193-205