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Similarities and differences across patient completed voice case history questionnaires – A scoping review

  • Renee Krosch
    Affiliations
    Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Susan Wakil Health Building, D18 Western Avenue, Camperdown, NSW, Australia
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  • Patricia McCabe
    Affiliations
    Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Susan Wakil Health Building, D18 Western Avenue, Camperdown, NSW, Australia
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  • Catherine Madill
    Correspondence
    Address correspondence and reprint requests to Catherine Madill, Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Susan Wakil Health Building, D18 Western Avenue, Camperdown NSW, Australia, 2006.
    Affiliations
    Discipline of Speech Pathology, Sydney School of Health Sciences, The University of Sydney, Susan Wakil Health Building, D18 Western Avenue, Camperdown, NSW, Australia
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Open AccessPublished:May 24, 2022DOI:https://doi.org/10.1016/j.jvoice.2022.03.023

      Summary

      Background

      Case history assessments are ubiquitously performed across various health professions for diagnostic purposes. Questionnaires are considered a valuable tool within this process. There is currently no standardized tool available to collect such information in the assessment of voice disorders. Conflicting advice from peak bodies and research evidence makes the process heterogenous, haphazard and difficult to compare findings.

      Objective

      To systematically identify existing case history questionnaires available for general clinical practice and provide synthesis and analysis of the questions within.

      Methods

      A scoping review was conducted across published and unpublished literature using the PRISMA Extension for Scoping Reviews framework. The broad search included research papers within six electronic databases, textbooks, online publishing sites, voice clinic websites and peak body websites. Search criteria were uniformly applied. Descriptive analysis and content analysis was conducted. At each stage, transparency and replicability was achieved through an independent review process.

      Results

      Identified voice case history questionnaires were few (n = 23) with 80% from unpublished sources. A total of 581 unique questions were identified. No single question was common across all 23 questionnaires. The most frequently asked questions, excluding demographics, included medicines taken (n = 21), smoking (n = 20) and alcohol (n = 19). These questions were not reflected in the highest frequency categories: Health Status/Medical Conditions/Reports (n = 200), Vocal Symptoms (n = 88), Voice Use (n = 51) despite these categories representing 58% of all questions asked. Within the highest frequency category, the subcategory of Systemic Diseases was the highest, representing 19% of all questions within the category.

      Conclusions

      This study illuminates the similarities yet many differences that exist across identified voice case history questionnaires in terms of number of questions, number of categories, preference for question-type and structure. It demonstrates the need for standardization of a voice case history questionnaire which would potentially enable more accurate diagnosis and data comparison between voice clinics to aid future research.

      Keywords

      Introduction

      Background

      Case history assessment information is widely regarded by voice clinicians as an essential element to the diagnosis of voice disorder.
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      • Fleming D.J.
      Medical and vocal history in the evaluation of dysphonia.
      A detailed case history is thought to constitute the basis of every voice diagnosis
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      Vocal diagnosis from the phoniatric point of view.
      as many voice problems evade detection or are difficult to diagnose using laryngoscopy alone.
      • Simpson C.B.
      • Fleming D.J.
      Medical and vocal history in the evaluation of dysphonia.
      for example, voice disorders including spasmodic dysphonia, muscle tension dysphonia, mild vocal paresis, functional neurological and intracordal lesion require information provided by the patient for accurate differential diagnosis.
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      Case history assessments often include a case history questionnaire followed by a face-to-face interview. In this scenario, the use of a case history questionnaire allows for a more patient focused, individualized and nuanced case history interview,
      • Sataloff R.T.
      where aspects not explored in the questionnaire can be revealed and investigated using open questions to gather more information. Capturing patient information through questionnaire is arguably preferable as it allows the patient unlimited opportunity to record responses in their own time, providing greater accuracy of information, increased efficiency for clinicians and removal of the risk of interviewer bias.
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      Researching Society and Culture.
      Questionnaires also provide for a routine way of collecting information, ensuring no questions are inadvertently missed.
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      Standardization of case history assessment questionnaires in other health disciplines has been achieved and adopted. For example, in the assessment of tinnitus, the development of a self-reported standardized questionnaire is preferred by audiologists to a structured case history interview.
      • Langguth B.
      • Goodey R.
      • Azevedo A.
      • et al.
      Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006.
      There appears to be however, little consensus across voice related peak bodies regarding the importance of case history assessment information in the diagnosis of voice disorder and little guidance is provided to clinicians as to which case history questionnaire to use and what questions should be asked. For example, while the American Speech-Language-Hearing Association recommends the use of case history assessment and provides a template to collect such information,

      American Speech-Language-Hearing Association. Voice evaluation 2020; Available from: https://www.asha.org/uploadedFiles/AATVoiceEvaluation.pdf.

      the European Laryngological Society and other voice evaluation medical protocols omit the case history assessment entirely from their ‘List of Basic Requirements for Assessment’.
      • Dejonckere P.H.
      • Bradley P.
      • Clemente P.
      • et al.
      A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques.
      Interestingly, the American Laryngologists Society has updated it is ‘Comprehensive Laryngology Curriculum’ to include patient (case) history with the rationale that such information is important for the purposes of treatment but gives no mention of the value of such information to diagnosis.

      American Laryngological Association. Taking the voice specific patient history 2020; Available from: https://alahns.org/wp-content/uploads/CLC/8_Taking-Voice-Specific-Patient-History.pdf.

      Across the literature there is a paucity of high level and at times conflicting evidence regarding the value of case history information to voice disorder diagnosis. A study of functional voice disorders showed a positive association with selected case history assessment information, namely teaching activity and gender.
      • Angelillo M.
      • Di Maio G.
      • Costa G.
      • et al.
      Prevalence of occupational voice disorders in teachers.
      In contrast, a study of the organic voice disorder, mucosal bridge, showed that diagnosis did not correlate with some case history measures (smoking, alcohol intake, sino-nasal symptoms) and was inconsistent with others.
      • Martins R.H.G.
      • Tavares E.L.M.
      • Fabro A.T.
      • et al.
      Mucosal bridge of the vocal fold: difficulties in the diagnosis and treatment.
      Whilst these examples highlight the differences between voice disorder types and the complexity of diagnostic assessment, a systematic review investigating a range of clinical diagnostic voice assessments concluded that few studies examined the contribution of the case history assessment.
      • Roy N.
      • Barkmeier-Kraemer J.
      • Eadie T.
      • et al.
      Evidence-based clinical voice assessment: a systematic review.
      It was noted that the paucity of information should not be interpreted to mean there is no clinical merit in the case history assessment, but rather that this should be a focus for future studies.
      • Roy N.
      • Barkmeier-Kraemer J.
      • Eadie T.
      • et al.
      Evidence-based clinical voice assessment: a systematic review.
      Despite the conflicting advice from peak bodies and lack of high level evidence regarding the value of this information to diagnosis, a study of the assessments used to evaluate voice disorders in teachers, found case history questionnaires were used 80% of the time compared to the next most frequently used assessments, perceptual measures (40%) and videostroboscopy (40%).
      • Serey J.P.
      • Araya V.O.
      Instrumentos aplicados en la evaluación de la voz en profesores: estudio bibliográfico.
      Such high frequency use suggests case history questionnaires are both commonly used and considered by voice clinicians to provide some clinical, if not diagnostic, value. Additionally, case history information has been found to impact the interpretation of other, more objective voice assessment measures. For example, knowledge of case history assessment information was found to have an effect on how clinicians interpreted the videolaryngostroboscopic (visual) assessment and ultimately the accuracy of the voice disorder diagnosis.
      • Sauder C.
      • Nevdahl M.
      • Kapsner-Smith M.
      • et al.
      Does the accuracy of case history affect interpretation of videolaryngostroboscopic exams?.
      ,
      • Teitler N.
      Examiner bias: influence of patient history on perceptual ratings of videostroboscopy.
      Across the voice professions, standardized protocols have been developed for visual, acoustic, perceptual, and aerodynamic assessments.
      • Patel R.R.
      • Awan S.N.
      • Barkmeier-Kraemer J.
      • et al.
      Recommended protocols for instrumental assessment of voice: American speech-language-hearing association expert panel to develop a protocol for instrumental assessment of vocal function.
      However no such protocol has been developed for collecting case history assessment information.
      • Patel R.R.
      • Awan S.N.
      • Barkmeier-Kraemer J.
      • et al.
      Recommended protocols for instrumental assessment of voice: American speech-language-hearing association expert panel to develop a protocol for instrumental assessment of vocal function.
      It is hard to establish why this might be the case. Historically it may be that because these tools have not been widely reported in the literature a circular absence was created with no research on the topic because the topic is not present in the existing literature. Alternately, each clinical setting has built their own questionnaires through iterative processes based on clinical experience and received wisdom and the local utility of questions, without need to reference a standardized format. Whichever it is, there is no ‘gold standard’ case history questionnaire for voice clinicians to use in the general assessment of voice disorder. Without standardization between voice clinics, the process remains heterogenous making the comparison of data across settings difficult.
      • Serey J.P.
      • Araya V.O.
      Instrumentos aplicados en la evaluación de la voz en profesores: estudio bibliográfico.
      More broadly, the design of self-reporting case history questionnaires has been investigated across numerous health disciplines and contexts.
      • Aghaei H.N.
      • Azimi P.
      • Shahzadi S.
      • et al.
      Role of the self-administered, self-reported history questionnaire to identify types of lumbar spinal stenosis: a sensitivity analysis.
      • Hamilton L.
      • Macgregor A.
      • Newman D.
      • et al.
      Validation of a patient self-reported screening questionnaire for axial spondyloarthropathy in a UK population.
      • Pistorius A.
      • Kunz M.
      • Jakobs W.
      • et al.
      Validity of patient-supplied medical history data comparing two medical questionnaires.
      • Somerville L.E.
      • Willits K.
      • Johnson A.M.
      • et al.
      Diagnostic validity of patient-reported history for shoulder pathology.
      • Edwards P.
      Questionnaires in clinical trials: guidelines for optimal design and administration.
      Specific recommendations for the development of case history questionnaires used for data collection and health care-research include clear identification of what will be measured, use of an appropriate response style, consideration of item generation, wording and order, pilot testing, reliability and validity assessment, and a range of factor analysis and extraction processes.
      • Rattray J.
      • Jones M.C.
      Essential elements of questionnaire design and development.
      The need to diagnose, triage, or supplement other assessment data with questionnaire responses needs also to be considered in the design of the questionnaire.
      • Somerville L.E.
      • Willits K.
      • Johnson A.M.
      • et al.
      Diagnostic validity of patient-reported history for shoulder pathology.
      Whilst many patient reported outcome measures (PROMs) for voice have reported methodical design processes, (for example, the Voice Handicap Index
      • Rosen C.A.
      • Lee A.S.
      • Osborne J.
      • et al.
      Development and validation of the voice handicap index-10.
      ), others have less methodological rigour.
      • Francis D.O.
      • Daniero J.J.
      • Hovis K.L.
      • et al.
      Voice-related patient-reported outcome measures: a systematic review of instrument development and validation.
      The purpose of the current study is to identify, through broad and systematic searching and review, the case history questionnaires available to voice clinicians for general assessment purposes. This research attempts to identify the questions and question-categories most frequently asked across the identified case history questionnaires to begin the process toward standardization.
      A standardized voice case history questionnaire would ultimately provide for better evaluation of results, potentially more accurate diagnosis, and allow for comparisons across voice clinics. Standardization of data collection will enable higher quality treatment and research into the future.

      Material and methods

      A scoping review was identified as the most suitable review type to systematically map the broad landscape of existing case history questionnaires.
      • Levac D.
      • Colquhoun H.
      • O’Brien K.K.
      Scoping studies: advancing the methodology.
      The methodology for this scoping review was based on the PRISMA Extension for Scoping Reviews framework (PRISMA-ScR) guidelines.
      • Tricco A.C.
      • Lillie E.
      • Zarin W.
      • et al.
      PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.
      Key search terms were identified in consultation with a librarian from The University of Sydney Health Sciences. The relevant electronic databases, library catalogues, web-based search engines, online voice publishing sites and peak body organizations were identified by the authors as places to search; and search criteria were established. The content of the records identified for final inclusion was then analyzed using descriptive statistics and content analysis.
      • Drisko J.W.

      Research questions

      The review was guided by the following questions: (1) What case history questionnaires are available to voice clinicians for the use of general clinical assessment of voice disorder? (2) What similarities and differences exist across them? (3) What are the most frequently asked questions and question-categories across the identified questionnaires?

      Data sources

      To enable a thorough search of relevant sources both the peer reviewed and gray literature were searched and the following five sources were included: (1) published for purposes of research and found within electronic databases, (2) published in voice disorder textbooks (most recent editions) and accessible via library database, internet search engines and voice publishing websites, (3) used currently or previously in clinical practices and freely available via internet search engines (4) unpublished theses found within the electronic database Proquest Dissertations & Theses Global, or (5) recommended by peak bodies via their websites (American Speech-Language-Hearing Association (ASHA), European Laryngological Society (ELS), American Laryngological Society (ALS), British Voice Association (BVA), Royal College of Speech and Language Therapists (RCSLT), and The Voice Foundation (TVF)).

      Search strategy

      Each of the five sources listed above required a different search strategy as follows:
      • 1)
        Published for the purposes of research: The first author conducted a literature search systematically in March 2020 using five electronic databases: MEDLINE via Ovid (biomedical sciences, 1946-present), EMBASE via Ovid (biomedical sciences, 1947-present), CINAHL (nursing and allied health, 1981-present), Scopus (multidisciplinary, 1823-present) and Web of Science Core Collection (multidisciplinary, 1900-present). The search strategy included the key terms ‘case history questionnaire’, ‘patient history questionnaire’, ‘voice questionnaire’, ‘voice disorder’, ‘vocal disorder’ and ‘adult’. The key search terms were used consistently across all databases, however with MEDLINE the MeSH term ‘surveys and questionnaires’ was used in addition to allow for as broad searching as possible. Refer to Appendix 11.1 for the MEDLINE search strategy. A replication of the MEDLINE search was undertaken by a health sciences librarian with 100% of the search results matched.
      • 2)
        Published in voice disorder textbooks (most recent editions): The first author conducted a literature search in March 2020 using The University of Sydney library database, a broad internet search via Google search engine's ‘shopping’ tab, and three specific voice textbook publishers: Plural Publishing, Compton Publishing and Blue Tree Publishing. The search strategy included the term ‘voice disorder textbook’. For the library search, limiters included ‘book’, ‘held in health sciences library’, ‘publication date 2000-2019’. The Health Sciences library was chosen as it is the primary custodian of all allied health resources at the university. All searches were repeated by a health sciences librarian with 100% of the search results matched.
      • 3)
        Voice clinic websites via internet search engines: A review of case history questionnaires found online that were once used or currently being used in clinical practice was undertaken. The first author conducted a search in March 2020 of freely available, case history questionnaires using the search engines Google, Bing and Yahoo. Data from 2020 showed that Google was the most popular search engine worldwide with a market share of 86%, followed by Bing (4%) and Yahoo (<1%).
        ICT-Enabled business promotion approach through search engine optimization.
        The search terms ‘voice case history questionnaire’ and ‘voice patient history questionnaire’ were used across all search engines.
      • 4)
        Unpublished theses: The first author conducted a search of unpublished theses in April 2020 using the electronic database Proquest Dissertations & Theses Global (1997-present). The search strategy included the terms ‘case history questionnaire’, ‘patient history questionnaire’, ‘voice questionnaire’, ‘voice disorder’, ‘vocal disorder’ and ‘adult’. The ‘abstract’ search function was applied. A replication of the search was independently undertaken by a health sciences librarian with 100% of the search results matched.
      • 5)
        International professional bodies: A review of any case history questionnaires recommended by the internationally recognized peak bodies across the profession was undertaken. Six organizations (ASHA, ELS, ALS, BVA, RCSLT, TVF) were contacted via email and followed up with a second email where no response was received. The relevant websites were also searched for case history questionnaires/templates available for download.

      Citation management

      All citations from electronic databases were imported into EndNote8 software which was used to identify and remove duplicates as well as preview titles and abstracts. From the 2343 articles imported from MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science, 1086 duplicates were removed. From the 22 articles imported from Proquest Dissertations & Theses Global, no duplicates were found.

      Eligibility criteria

      The specific inclusion and exclusion criteria were applied to all potential case history questionnaires irrespective of their origin.

      Inclusion criteria

      Included in the review were case history questionnaires: (1) accessible to voice clinicians, (2) replicable for general clinical use, (3) able to be used in the current form, (4) relating to human adults (+18 years), (5) originally written or translated into English.

      Exclusion criteria

      Excluded from the review were those case history questionnaires: (1) published only in part, (2) described in narrative form but available as a tool for clinical use, (3) designed for a specific sub-population or to answer a specific research question, (4) designed to be completed by an experienced voice clinician rather than the patient themselves, (5) not exclusively designed for the purposes of voice assessment but including other speech pathology or laryngology practice areas (eg swallowing and upper airway difficulty).

      Screening

      A two-stage screening process was used to assess the inclusion of case history questionnaires identified by the search. The title and abstract of each citation were screened by the first author. The remaining titles were then subject to full text review using the following questions: (1) Does a case history questionnaire exist? (2) If so, does it meet the defined search criteria? A randomly selected 20% of records were reviewed by an independent reviewer to ensure inter-rater reliability. The first author and the independent reviewer met through the screening process to discuss any uncertainties and resolve any conflicts related to study selection. The flow of records from identification to final inclusion is represented in Fig. 1.
      FIGURE 1
      FIGURE 1PRISMA flow diagram of systematic search.
      The screening process occurred across the five sources as follows:
      • 1)
        Published in research papers: The first author screened the titles and abstracts of 1257 records. 967 records were excluded based on the inclusion criteria. A randomly selected 20% of articles were independently reviewed with 100% agreement. One research paper29 made reference to a patient questionnaire used within the study. However the questionnaire was missing from the published appendix. The author was contacted and the questionnaire was obtained. This questionnaire was then subject to full text review.
      • 2)
        Published in voice disorder textbooks: A total of 33 records were identified in The University of XX Health Sciences library including both hardcopy and online books. Records were screened by title and description. For example, where titles included terms as ‘children’, ‘paediatrics’, ‘treatment’, ‘visual examination’ they were excluded. A total of 19 records were excluded. A randomly selected 20% of articles were independently reviewed with 100% agreement. The search engine ‘Google’ yielded 11 results from a total of 50, after a similar screening process was conducted through consecutive pages until redundancy (no new items emerged). Searches within the online publishing sites yielded 11 results after screening until redundancy and included Plural Publishing (n = 10), Compton Publishing (n = 1) and Blue Tree Publishing (n = 0). Some records appeared across multiple sites.
      • 3)
        Voice clinic websites via internet search engines: The search results from the search engines: Google (n = 633M), Yahoo (n = 6.84M) and Bing (n = 311,000) were screened by title and description until redundancy was achieved as evidenced by consistently irrelevant search results. For all search engines this was achieved within 20 pages of the respective search results. Hand searches of each identified website were conducted to confirm whether an adult voice case history questionnaire was available for download. A total of 24 records resulted: Google (n = 13), Yahoo (n = 8), Bing (n = 17) with some records appearing across multiple search engines.
      • 4)
        Unpublished Theses: The first author screened the titles and abstracts of the 22 search results and excluded 21 records. On a randomly selected 20% of articles an independent reviewer achieved 100% agreement.
      • 5)
        International professional bodies: Only two professional bodies, ASHA and BVA responded to an email request, despite follow up requests. ASHA suggested the Princeton University Case History Questionnaire, Louisiana University's Voice Patient Case History and Boston University's Aphasia Centre form. The first two were previously identified and subject to full review. The latter did not meet the inclusion criteria. BVA suggested the personal voice history form of one of their voice specialists. This did not meet the inclusion criteria as it was designed to be completed by a clinician during patient interview. The search of peak body websites yielded only two results: (1) ASHA ‘voice evaluation’ template and (2) ALS ‘voice specific patient history’. Both were subject to full text review.

      Data summary and synthesis

      Data was compiled separately for each source using excel spreadsheets and word tables. Identical record forms were created for the independent reviewer to enable comparison of findings.

      Coding

      Across all questionnaires, the questions were individually extracted and documented in an excel spreadsheet. Questions were recorded verbatim until redundancy, that is until no new questions emerged. Where questions had the same intended meaning but used slightly different wording, they were recorded as the same question. Questions were recorded as being either open or closed (refer to Appendix 11.3). The number of sections within each questionnaire was also recorded. An independent review of a 20% randomly selected sample was conducted with 100% agreement reached.
      Questions were initially inductively coded into 13 mutually exclusive, clearly defined categories by the first author (refer to Appendix 11.2 for category definitions). Inductive coding creates categories without reference to a pre-existing set of codes. Once the codes or categories are created, the resultant list can be used to deductively code by allocating the data to the created codes. In this case, the first author analyzed the questions into themes and used the themes to create categories. The second author, then independently and blindly coded the questions into the initial defined categories. Comparisons were made and disagreements discussed. To ensure replicability, the third author, independently and blindly coded the questions into the defined subcategories. Overall inter-rater reliability was 78% (Health Status/Medical Conditions/Reports (64%), Vocal Symptoms (92%), Vocal Use (78%).
      Due to the low level of agreement in the initial coding, several changes were made to the coding procedure including (1) the adoption of International Statistical Classification of Diseases and Health Related Problems ICD
      • Huffman M.K.
      Measures of phonation type in Hmong.
      as the agreed standard for disease description to categorise items which were related to disease and disease processes and (2) discussion of the remaining superordinate categories to ensure a joint understanding of the coding. Following this revision to the procedure, both the first and second author coded the questions again with the third author conducting an independent, blind coding prcedure for replicability. Overall inter-rater reliability was 85% - Vocal Symptoms (92%), Vocal Use (78%). and consensus was achieved through discussion.

      Results

      From the systematic search process conducted across March-June 2020, a total of 23 case history questionnaires were included. Sources were as follows: 20% originated from published sources: research papers (n = 2) and textbooks (n = 3); 80% originated from unpublished sources (not searchable across academic databases nor peer reviewed): clinic websites (n = 18), unpublished theses (n = 0), peak body websites (n = 0). These records were analyzed using descriptive statistics and content analysis.
      • Drisko J.W.

      Selection for inclusion

      • 1)
        Published research papers: Of the 290 articles subject to full text review, 288 articles were excluded for multiple reasons including: (1) the authors reported on the findings of a questionnaire used but did not include it in full within the body of the report or as an appendix (n = 240), (2) the questionnaire was included but was not a case history questionnaire eg VHI, VRQL, The Health Omnibus Survey, Voice Related Survey (n = 12), and/or (3) the questionnaire was designed for a specific population or to answer a specific research question (n = 36). One retrospective study used patient history forms from a specified clinic, the Massachusetts Voice and Speech Laboratory, however the form was not included in the research paper or as an appendix and was thus excluded. One questionnaire
        • Thomas G.
        Prevalence of voice complaints, risk factors and impact of voice problems in female student teachers.
        was included, despite being designed for the specific population of teachers, as it made provision for the inclusion of the general population with “question modifications for the general population” as part of the questionnaire.
        • Thomas G.
        Prevalence of voice complaints, risk factors and impact of voice problems in female student teachers.
        An independent reviewer conducted a review of a randomly selected 20% of records using a separate excel spreadsheet. When results were compared there were no disagreements regarding the number of papers to be excluded, however there were minor uncertainties regarding the specific exclusion criteria that applied. These uncertainties were resolved with discussion and 100% consensus achieved.
      • 2)
        Published in textbooks: 23 records were subject to a full text review. Twenty records were excluded based on the exclusionary criteria of: (1) no questionnaire was included (n = 11), (2) the included questionnaire was identical to a previous questionnaire in a different voice textbook by the same author (n = 2), (3) questionnaire was intended to be filled out by a clinician during interview rather than the patient (n = 6), (4) questionnaire was described in narrative form but not for clinical use in its current form (n = 1). On a 20% randomly selected sample reviewed by an independent reviewer, there was disagreement regarding the inclusion of one questionnaire
        • Sataloff R.T.
        because it was designed for ‘professional voice users’. It was agreed this term referred to many voice populations rather than one specific population as defined by the search criteria, and thus should be included.
      • 3)
        Voice clinic websites via internet search engines: 24 records were subject to a full text review. Six records were excluded with the following reasons: (1) not exclusively designed for the purposes of voice assessment but included language, speech, hearing and/or swallowing assessment questions (n = 4), (2) questionnaire designed to be filled out by clinician during interview rather than patient (n = 2).
      • 4)
        Unpublished Theses: Only one thesis was subject to a full review. After discussion between reviewers it was resolved that the case history questionnaire did not meet the search criteria on the basis that it was designed for a specific population and to answer a specific research question.
      • 5)
        International professional bodies: Two records were subject to full text review but excluded by both reviewers; ASHA's template was excluded as it is designed to be filled out by a clinician. ALS's form was excluded as it is described in narrative form only and related to treatment rather than assessment.

      Content analysis

      The 23 identified case history questionnaires were analyzed using descriptive statistics and content analysis.
      • Drisko J.W.
      | Primary analysis – descriptive statistics

      A total of 581 unique questions were recorded. The frequency of each question was calculated. No individual question was common across all 23 questionnaires. The highest frequency questions, excluding demographics (name/date), included the consumption of medicines taken (n = 21), smoking (n = 20), alcohol (n = 19), history of allergies (n = 18), caffeinated beverages (n = 16) and describing the voice problem (n = 16). The number of questions, including open questions and closed questions, as well as number of sections per questionnaire was determined and the mean for each was calculated. The results are shown in Fig. 2.
      FIGURE 2
      FIGURE 2Mean value of total questions, open questions, closed question and sections per questionnaire.
      The mean number of questions was 77.61 (range 27–151). The mean number of open questions was 27.57 (range of 1–62) and closed questions was 50.04 (range 12–133). The mean number of sections was 4.13 (range 0-17). There were eight questionnaires with no sections at all.

      Secondary analysis – analysis of question categories

      The question categories are represented in Fig. 3 which shows the total number of questions per category. The highest category represented one third of all questions asked. The highest three categories represented 58% of all questions asked: (1) Health Status/Medical Conditions/Reports (n = 200, 34%), (2) Vocal Symptoms (n = 88, 15%), (3) Voice Use (n = 51, 9%). Seven questionnaires (30%) had questions across all categories (refer to Table 1) however these questionnaires varied considerably in terms of total number of questions asked. The Patient History: Professional Voice Users
      • Sataloff R.T.
      questionnaire had the highest number of questions across all 23 analyzed questionnaires (n = 151), however the Voice Patient Case History

      Southern Eastern Louisiana University. Voice patient case history 2020; Available from: http://www.southeastern.edu/acad_research/depts/hhs/programs/slh_clinic/assets/voice_form.pdf.

      questionnaire (n = 60) ranked only 14th in terms of total number of questions asked (refer to Appendix 11.3).
      FIGURE 3
      FIGURE 3Category analysis - total number of questions per category.
      TABLE 1Missing Categories Across Case History Questionnaires
      Questionnaires With All CategoriesQuestionnaires With One Missing CategoryQuestionnaires With Two Missing CategoriesQuestionnaires With Three Missing CategoriesQuestionnaires With Four Missing CategoriesQuestionnaires With Five Missing Categories
      Voice Case History Form - Adult

      University of Houston. Voice case history form - adult 2020; Available from: https://www.uh.edu/class/comd/_docs/case_history_voice_adult.pdf.

      Adult Voice Case History Form

      Eastern Kentucky University. Adult voice case history form 2020; Available from: https://slhclinic.eku.edu/sites/slhclinic.eku.edu/files/files/documents/CD-5_Adult_Voice_Case_History.pdf.

      Voice Case History for AdultsCase History Form-Voice
      • Sapienza C.
      • Ruddy B.H.
      Voice Disorders.
      Voice Intake Form

      Santa Rosa Speech & Language Services. Voice intake form 2020; Available from: http://santarosaspeechtherapy.com/wp-content/uploads/2017/09/NP-VOICE-CASE-HISTORY.pdf.

      Patient History: Professional Voice Users
      • Sataloff R.T.
      Voice Evaluation Case HistoryVoice Case History Form

      Illinois State University - Eckelmann-Taylor Speech and Hearing Clinic. Voice case history form 2020; Available from: https://isuspeechandhearing.com/file/34/isu_voice_case_history_v2.pdf.

      Adult Case History FormVoice Case HistoryCase History Form
      Voice Diagnostic PacketSLP Service Voice Case History Form

      Health Quest Speech-Language Pathology. Voice case history form 2019 Available from:https://patients.healthquest.org/wp-content/uploads/2019/01/SLP-Voice-Case-History-2-pages-revised-Jan-2019.pdf.

      Adult Confidential Case History Questionnaire

      Frankly Speaking SLP. Adult confidential case history questionnaire 2020; Available from: http://www.franklyspeakin.com/docs/pdf/AdultConfCaseHistory.pdf.

      New Patient Voice QuestionnaireVoice Intake Sheet

      Hackensack Meridian Health. Voice intake sheet 2020; Available from:https://mountainsidehosp.com/services/rehabilitation-services/speech-therapy.

      SLP Case History Attachement

      Stony Brook Medicine. Voice case history attachment 2020; Available from:https://www.stonybrookmedicine.edu/sites/default/files/Voice%20Case%20History%202020.pdf.

      Voice Patient Case History

      Southern Eastern Louisiana University. Voice patient case history 2020; Available from: http://www.southeastern.edu/acad_research/depts/hhs/programs/slh_clinic/assets/voice_form.pdf.

      Sample Case History Form for an Adult
      • Ferrand C.T.
      Voice Disorders: Scope of Theory and Practice.
      Questionnaire for the General Population Group
      • Thomas G.
      • de Jong F.I.
      • Cremers C.W
      • et al.
      Prevalence of voice complaints, risk factors and impact of voice problems in female student teachers.
      Adult Patient Intake Questionnaire

      Boulder Community Health. Voice adult patient intake questionnaire 2020; Available from: https://www.bch.org/documents/Voice-Therapy-Adult-Patient-Intake-Questionnaire.pdf.

      Patient Report Form
      • Cohen S.M.
      Self-reported impact of dysphonia in a primary care population: an epidemiological study.
      Voice Intake Form
      Of the three highest frequency categories, representing 58% of all questions asked: The Health Status/ Medical Conditions/ Reports category was represented across all 23 questionnaires (range 2–72 questions). The Vocal Symptoms category was represented across all 23 questionnaires (range 1–33 questions). The Voice Use category was represented across 21 questionnaires, with two questionnaires having no questions in this category (range 0-14 questions) (refer to Appendix 11.3).

      Secondary analysis – analysis of open questions per category

      The number of open questions per category was calculated (refer to Table 2). Some categories favored the use of open questions more than others. These included Identifying information, Onset, Perception of the Problem, Treatment, and Medicines Taken. By contrast, categories including Health Status/Medical Conditions/Reports, Vocal Use, Psychological Factors, Lifestyle Factors and Environmental Factors favored the use of closed questions.
      TABLE 2Total Number of Questions, Number of Open Questions and Percentage of Open Questions Per Category Across Analyzed Case History Questionnaires
      Question CategoryTotal Number of QuestionsMean Number of QuestionsSD of Mean Number of QuestionsMean Number of Open QuestionsSD of Mean Number Open QuestionsNumber of Open Questions (%)
      Total Number of Questions/Questionnaire58177.6136.5127.5718.7637.16
      Health Status/Medical Conditions/Reports20024.7017.385.787.8526.53
      Vocal Symptoms8811.179.352.652.9930.95
      Voice Use517.293.571.621.7523.23
      Associated Symptoms416.824.791.412.2628.43
      Identifying Information3910.043.888.174.0080.98
      Lifestyle factors386.263.151.742.7822.32
      Perception of problem323.222.861.832.3659.07
      Psychological Factors242.942.540.470.7218.14
      Treatment222.501.372.091.5485.61
      Environmental Factors131.601.050.300.6618.33
      Other131.771.171.000.9156.92
      Onset112.131.751.250.6869.27
      Medicines91.430.811.000.7770.24

      Tertiary analysis – Subcategory analysis of three highest categories

      The three highest frequency categories, representing 58% of all questions, were further analyzed. These included Health Status/Medical Conditions/Reports (n = 200), Vocal Symptoms (n = 88), and Vocal Use (n = 51). Questions within the highest category ‘Health Status/Medical Conditions/Reports’ were deductively coded by the first author using the categories defined in the International Statistical Classification of Diseases and Health Related Problems ICD (10)
      • Huffman M.K.
      Measures of phonation type in Hmong.
      which was chosen as the agreed standard for disease description. The other two categories, ‘Vocal Symptoms’ and ‘Vocal Use’ were inductively coded into mutually exclusive, clearly defined categories as defined by the first author (refer to Appendix 11.2 for subcategory definitions). The second author independently and blindly coded all questions into the defined subcategories. Comparisons were made and consensus was achieved through discussion. To ensure replicability, the third author, independently and blindly coded the questions into the defined subcategories. Overall inter-rater reliability was 85% - Vocal Symptoms (92%), Vocal Use (78%).

      Subcategory analysis - Health status/ medical conditions/ Reports

      The subcategories for the category of Health Status/ Medical Conditions/ Reports are represented below in Fig. 4 and show the number of questions per subcategory. The highest subcategory, ‘Symptoms/ Signs/ Abnormal Clinical Findings’, represented 14% of all questions asked within this category (n = 28).
      FIGURE 4
      FIGURE 4Subcategory analysis of the health/medical conditions/reports category.

      Subcategory analysis - Vocal symptoms

      The subcategories for the category of Vocal Symptoms are represented below in Fig. 5, and show the number of questions per subcategory. The highest subcategory, Physical Descriptors of Voice, represented 47% of all questions asked within this category (n = 41).
      FIGURE 5
      FIGURE 5Subcategory analysis of the vocal symptoms category.

      Subcategory analysis - Vocal use

      The subcategories for the category of Vocal Use are represented below in Fig. 6 and show the number of questions per subcategory. The highest subcategory, Daily Use of Voice, represented 61% of all questions asked within this category (n = 31).
      FIGURE 6
      FIGURE 6Subcategory analysis of the vocal use category.

      Discussion

      Search results

      There were surprisingly few case history questionnaires identified for analysis (n = 23) from the broad, systematic search process. Those included were 80% from unpublished sources (voice clinic websites) and 20% from published sources (research papers, textbooks). Although the three most popular search engines were used in the search for unpublished voice case history questionnaires, 100% of records came from voice clinics within the US, with 60% of these from university voice clinics. By contrast, the electronic databases used to search for published research articles yielded a much more representative selection of global research. This suggests that other voice clinics around the world either do not have websites searchable via these search engines or do not have case history questionnaires available for download. An alternate explanation could be a systematic bias due to the search engines algorithms which are designed to preference the most visited websites.

      Similarities and differences across analyzed questionnaires

      There were similarities across the 23 case history questionnaires analyzed but also differences in terms of number of questions, number of categories, number of open versus closed questions, and number of sections. For example, the majority of questionnaires (56%) included questions from all categories or were only missing one category; and the highest two frequency categories of Health Status/ Medical Conditions/ Reports, and Vocal Symptoms were included across all questionnaires. There was a general preference for the use of closed questions and for the use of sections. There was however a marked difference in the number of questions asked by the questionnaires, ranging from 27 to 151 questions (refer to Appendix 11.3). No single question was common across all 23 questionnaires. The number of questions within categories was also variable. For example, in the highest frequency category of Health Status/ Medical Conditions/ Reports the range was 2 to 72 questions.

      Analysis of categories and the questions within each category

      Following the synthesis and analysis of the questionnaires, the highest frequency questions and the highest frequency categories were identified. Interestingly the three highest frequency questions were not reflected in the three highest frequency categories of Health Status/ Medical Conditions/ Reports (n=200), Vocal Symptoms (n = 88), Voice Use (n = 51), despite these categories representing 58% of all questions asked (refer to Table 3).
      TABLE 3Highest Frequency Questions
      Highest Frequency QuestionsCategory
      Medications taken (n = 21)Medicines
      Smoking (n = 20)Lifestyle Factors
      Alcohol (n = 19)Lifestyle Factors
      History of allergies (n = 18)Health Status/ Medical Conditions/ Reports
      Caffeinated beverages (n = 16)Lifestyle Factors
      Describe the voice problem (n = 16)Vocal Symptoms
      The explanation may lie in the clinical value of the question. Questions with well documented, diagnostic evidence for voice disorder may be regarded by clinicians as high value questions, thus explaining their frequency. Questions with little or no diagnostic evidence may be regarded as low value questions and less frequently asked. Despite not having high level evidence of the overall value of case history assessment information to diagnosis of voice disorder, there is substantial evidence of the many risk factors for voice disorders. for example, the most commonly asked question of ‘Medications Taken’ may be justified by the evidence linking the potential side effects and unique interactions of medications when taken in combination, to voice problems.
      • Abaza M.M.
      • Levy S.
      • Hawkshaw M.J.
      • et al.
      Effects of medications on the voice.
      Antibiotics, steroids, and anti-reflux medication in particular have been linked to oropharyngeal dryness, voice changes, mood disturbances and perceptual disturbances in the voice.
      • Abaza M.M.
      • Levy S.
      • Hawkshaw M.J.
      • et al.
      Effects of medications on the voice.
      ,
      • Best S.R.
      • Fakhry C.
      The prevalence, diagnosis, and management of voice disorders in a National Ambulatory Medical Care Survey (NAMCS) Cohort.
      Similarly, factors such as smoking and alcohol have traditionally been considered as laryngeal irritants.
      • Roy N.
      • Merrill R.M.
      • Gray S.D.
      • et al.
      Voice disorders in the general population: prevalence, risk factors, and occupational impact.
      The reporting of chronic voice disorder increases when smoking and alcohol are combined together with esophageal reflux.
      • Roy N.
      • Merrill R.M.
      • Gray S.D.
      • et al.
      Voice disorders in the general population: prevalence, risk factors, and occupational impact.
      This suggests, not only the questions of smoking and alcohol will be frequently asked, but the question of ‘History of Reflux/ Heartburn’ (currently only seen across 14 questionnaires) might also be included as a frequently asked question.

      Analysis of question-type (open versus closed)

      Questionnaire effectiveness demands comprehensive patient information be obtained while questionnaire efficiency demands a minimum number of questions to be answered by the patient.
      • Yaddanapudi S.
      • Yaddanapudi L.N.
      How to design a questionnaire.
      The solution to this contrast in requirements may lie in how the questions are asked, that is, open versus closed. Open questions allow provision of indepth information
      • Yaddanapudi S.
      • Yaddanapudi L.N.
      How to design a questionnaire.
      with relative efficiency, in that much information is potentially collected by the one open question, despite the onus being on the respondent.
      • Yaddanapudi S.
      • Yaddanapudi L.N.
      How to design a questionnaire.
      On the other hand, closed questions enable the clinician to prompt the patient with predetermined, specific responses.
      • Yaddanapudi S.
      • Yaddanapudi L.N.
      How to design a questionnaire.
      In this study, there was an overall preference for the use of closed questions across the voice case history questionnaires analyzed. However, within entire categories there was a preference for questions to be either mostly open or mostly closed. for example, the most frequently asked question ‘(list all the) medications taken?’ was an open question from the category of Medicines, where the mean number of questions was only 1.4 and 70% of all questions within this category were open questions. By contrast, the category of Health Status/ Medical Conditions/ Reports used open questions only 26% of the time and the category of Environmental Factors used open questions only 18% of the time, which suggests these categories are better served by closed questions. In fact, the three highest frequency categories demonstrated a strong preference for the use of closed questions. The reason may be explained by the clinicians’ need to acquire a lot of specific patient information in these categories, best achieved by prompting the response with closed questions.

      Analysis of highest frequency category

      The largest number of questions, despite their closed type, was in the highest frequency category Health Status/ Medical Conditions/ Reports. This category represented 34% of all questions asked. At such a large number, the notion of questionnaire efficiency is certainly challenged. However, there is well documented evidence of the innumerable health conditions and diseases that adversely affect the voice. In fact, changes in the voice often signal the first manifestation of a wide variety of systemic, neurological, and structural disorders.
      These include, but are not limited to, a variety of airway, gastro-intestinal, endocrine, auto-immune and neurological diseases.
      As such, the need for accuracy of information in this category would seem to justify the large number of questions asked, especially where the voice disorder is considered holistically rather than in isolation of the rest of the body. This need must be balanced however with efficiency and our understanding of questionnaire fatigue; being the longer the questionnaire the higher the risk of patients’ not answering questions reliably, if at all.
      • Bethlehem J.
      Applied Survey Methods: A Statistical Perspective.

      Analysis of question content and grammatical structure

      The question content and grammatical structure determines how the respondent interprets the question and the response they subsequently provide. Without specificity, questions may be misinterpreted and incorrect responses may result.
      • Bethlehem J.
      Applied Survey Methods: A Statistical Perspective.
      for example the question: ‘Problems with Mucosa?’ in the Questionnaire for the General Population Group
      • Thomas G.
      • de Jong F.I.
      • Cremers C.W
      • et al.
      Prevalence of voice complaints, risk factors and impact of voice problems in female student teachers.
      allows for misinterpretation by the respondent due to the ambiguity of the word mucosa to a general population. Other issues in good questionnaire design include avoiding jargon, long questions, and double questions.
      • Bethlehem J.
      Applied Survey Methods: A Statistical Perspective.
      If a question asks for more than one piece of information, it may be unclear what the answer means. for example, the question in the Patient History: Professional Voice Users
      • Sataloff R.T.
      questionnaire: ‘Have you noticed confusion or loss of consciousness? is a double question demanding a yes/no answer. Similarly, the complex wording in the Questionnaire for the General Population Group
      • Thomas G.
      • de Jong F.I.
      • Cremers C.W
      • et al.
      Prevalence of voice complaints, risk factors and impact of voice problems in female student teachers.
      question: ‘How many years do you have to load your voice during practizing your profession?’ is difficult to interpret and suggests a possible grammatical error.

      Analysis of overall questionnaire structure

      The structure of the questionnaire as a whole should be considered.
      • Bethlehem J.
      Applied Survey Methods: A Statistical Perspective.
      To avoid questionnaire fatigue and improve the chances of completion, it is recommended that questionnaires begin with the easier-to-answer questions (open) and the more sensitive questions (financial situation, health status) sequenced toward the end.
      • Bethlehem J.
      Applied Survey Methods: A Statistical Perspective.
      A structure orients the respondent and promotes memory recall by chunking questions into sections.
      • Bethlehem J.
      Applied Survey Methods: A Statistical Perspective.
      The use of sections by the questionnaires analyzed in this study was mixed. The mean number of sections was 4.13 (range 0–17) and 8 questionnaires (34%) had no sections at all.

      Limitations

      A number of limitations were noted in the research. All searches were conducted in English. It is acknowledged there is an inherent bias toward research from English speaking countries as a result. Strict inclusion and exclusion criteria were applied which posed necessary limitations on search results given the timeframe and resources available. It is acknowledged that different search criteria would have yielded different outcomes. In the online searching of unpublished voice case history questionnaires, 100% of records identified were from voice clinics within the US, with 60% of these from voice clinics attached to universities. This may mean that these results are specific to the US. Different results may be achieved from analyzing questionnaires from other geographical areas if they could be obtained.

      Future directions

      It is clear from this scoping review that more work is needed to move the field from the current state of individual, and highly varied case history questionnaires to standardized questionnaires that facilitate wide-spread data harmonization thus allowing for greater collaboration in interpretation of clinically acquired data. Research is needed to (1) establish firm categories and classifications of questions, (2) establish an evidence base for the clinical utility of those categories and (3) discover what information clinicians believe is worth collecting and for what purpose. This would facilitate the development of a standard minimum data set to which clinicians and researchers can add additional, context specific questions but which will provide a consistent underpinning across studies and clinics.
      Once established, this standard minimum questionnaire derived dataset can be collected from all voice patients and will enable the development of shared databanks and repositories containing both the newly standardized questionnaire data and the well-established standard visual, acoustic, perceptual, aerodynamic, and patient reported outcome measures.
      • Patel R.R.
      • Awan S.N.
      • Barkmeier-Kraemer J.
      • et al.
      Recommended protocols for instrumental assessment of voice: American speech-language-hearing association expert panel to develop a protocol for instrumental assessment of vocal function.

      Conclusions

      This scoping review highlights that not only is there is no standardized approach to gathering voice history information via patient-completed questionnaire but that few voice case history questionnaires are available to clinicians for general clinical assessment of voice disorder. Whilst clinicians may perceive case history questionnaires to be a commonly used and an essential part of the diagnostic process, there is little guidance from the field at large as to what questions to ask, how and why to ask them. This scoping review also examines the commonalities and differences that exist between the identified voice case history questionnaires with the purpose of beginning a process toward standardization. It highlights the need for a standardized voice case history assessment questionnaire to enable consistency of assessment content and wording of questions. Standardization would also enable comparison between voice clinics worldwide, permitting future voice diagnostic research and ultimately better patient outcomes. This research contributes to the process of standardizing voice case history questionnaires. The next steps include a Delphi consensus process between experienced voice clinicians and researchers to determine both the content and structure of a standardized voice assessment questionnaire as well as a determination of the specific diagnostic value of each question category, and the questions within, to the assessment of voice disorder.

      Author contributions

      All authors were involved in the design of the study and analysis of data. All authors were involved in the interpretation and revision of the manuscript critically for its intellectual content. All authors have agreed to investigate and resolve any questions relating to the work.

      Declaration of Competing Interest

      The authors declare that no financial support has been received in conducting the research nor in the development of this manuscript.

      Acknowledgments

      The first author would like to acknowledge the support and expertise of Elaine Tam, Academic Liaison Librarian at The University of Sydney, who provided advice regarding the design of the research.
      The authors would like to acknowledge the support of the Dr Liang Voice Program at The University of Sydney.

      Appendix

      Search Strategy for Ovid MEDLINE
      Database: Ovid MEDLINE(R) ALL <1946 to March 20, 2020>
      Search Strategy:
      Tabled 1
      1case history question*.mp. (28)
      2patient history question*.mp. (12)
      3(voice adj2 question*).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms] (183)
      4questionnaire.mp. or “Surveys and Questionnaires”/ (666468)
      51 or 2 or 3 or 4 (666510)
      6Voice Disorders/ or voice disorder*.mp. (6493)
      7Voice Disorders/ or vocal disorder*.mp. (5643)
      86 or 7 (6539)
      95 and 8 (881)
      10Adult/ or adult.mp. (5532707)
      119 and 10 (595)
      Definitions of Question Categories and Subcategories
      Tabled 1
      CategoryDefinition
      Identifying informationThe identifying characteristics used to broadly define a population for the purposes of understanding their health status and/or the means by which to contact them. Includes demographic information, contact information, socio-economic information, education information, genetic/family history
      Perception of the Voice ProblemHow the patient describes, understands or rates the voice problem. Includes what other people say about the voice problem or how they react to it as well as the impact of the voice problem on Quality of Life beyond the structural/functional impairment itself (as understood by the ICF framework)
      OnsetAny details surrounding how and when the voice problem first began
      Vocal SymptomsPerceptual descriptors of the voice as well as changes in the voice (both positive and negative) experienced from hour to hour or day to day. Includes variability, duration and frequency of problem
      Associated SymptomsNon-voice factors, experiences or feelings the patient perceives to be linked to the voice problem
      Health Status/Medical Conditions/ReportsPhysical health descriptors of the patient, diagnosed conditions or disorders reported on by a health professional, with current or previous. Includes previous surgeries, previous voice problems, and any medical report findings
      MedicinesAny medically prescribed or over the counter pharmaceutical (non-prescription) currently being taken by the patient
      Lifestyle FactorsThe adaptable behaviors and life choices that influence the patient's health and wellbeing. Includes smoking, alcohol, caffeine, sleep, social and family factors
      Environmental FactorsEnvironmental influences on the voice
      Vocal UseUse of voice for work or recreational purposes, including singing.
      Psychological FactorsEmotional influences on the voice and wellbeing
      TreatmentPrognostic variables affecting whether a patient would be capable of engaging in and benefiting from treatment for their voice problem. Includes goals, patient motivation, suitability to treatment, previous treatment
      OtherQuestions that do not fit into any other category and cannot of themselves form a distinct category
      *Based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version; 2019
      Tabled 1
      Health Status/Medical Conditions/Reports
      Sub-CategoryDefinition
      Diseases of the earDisorders of the external, middle and inner ear
      Diseases of the eyeDisorders of conjunctiva, glaucoma, visual disturbances and blindness
      Diseases of the skinDisorders of the skin and subcutaneous tissue
      Diseases of the respiratory systemUpper and lower respiratory infections, diseases of upper or lower respiratory tract, lung diseases
      Diseases of the digestive systemDiseases of oral cavity, oesophagus and stomach, appendix, liver, gall bladder and intestines.
      Endocrine, nutritional and metabolic diseasesDisorders of hormone producing glands. Includes obesity, metabolic disorders, nutritional deficiency
      Diseases of the nervous systemCNS inflammatory diseases, degenerative disorders of nervous system, Extrapyramidal and movement disorders eg cerebral palsy, PNS disorders
      Diseases of the circulatory systemHeart disease, rheumatic fever, hypertension, diseases of veins, lymph nodes/vessels
      Diseases of the musculoskeletal system and connective tissueSoft tissue, joint or muscle disorders, disorders of bone density and structure
      Certain infectious and parasitic diseasesDiseases generally recognized as communicable or transmissible including viral and bacterial diseases eg tuberculosis and infections with a predominantly sexual mode of transmission ie chlamydiae, human immunodeficiency virus [HIV] disease
      Injuries and external causes of morbidity/mortalityAccidents or injuries to head, neck or body, including falls and transport accidents
      Pregnancy, childbirthMaternal disorders predominantly related to pregnancy and labor
      Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedIncludes clinical symptoms and signs involving cognition, perception, emotional state and behavior (excluding voice)
      Symptoms and signs of VoiceSymptoms and signs specific to voice
      Mental and behavioral disordersIncludes mental and behavioral disorders due to psychoactive substance use, mood disorders, behavioral syndromes associated with physiological disturbances and physical factors, behavioral and emotional disorders with onset usually occurring in childhood and adolescence
      Contact with health services/medical reports or diagnosisEncounters with health services for examination and investigation eg hospitalization, including reports prepared by a medical practitioner
      OtherQuestions that do not fit into any other category and cannot of themselves form a distinct category
      Tabled 1
      Vocal Symptoms
      Sub-CategoryDefinition
      Physical descriptors of VoicePerceptual describers of the voice problem
      VariabilityAny changes that have a positive or negative affect on the voice
      Duration/FrequencyHow long the voice problem/how often the voice problem has been observed
      SeverityHow affecting the voice problem has been
      OtherQuestions that do not fit into any other category and cannot of themselves form a distinct category
      Tabled 1
      Vocal Use
      Sub-CategoryDefinition
      Daily use of voiceUse of voice for daily activities including talking, debating, presentations
      Singing/acting/performanceUse of the voice for singing, acting, performance including cheerleading, yodeling
      Vocal TrainingCurrent or previous vocal training received
      OtherQuestions that do not fit into any other category and cannot of themselves form a distinct category
      Total number of questions, number of open questions and percentage of open questions per category across case history questionnaires
      Tabled 1
      Question CategoryIdentifying Info.Vocal SymptomsAssociated SymptomsEnviron FactorsLifestyle factorsVoice UseOnsetPerception of problemPsych FactorsTreat-mentHealth Status/ Medical/ ReportsMedicinesOtherTotal Nos Questions/ Questionnaire
      Patient History: Professional Voice Users
      • Sataloff R.T.
      1314142101411317242151
      Open Questions710012010131118
      % Open Questions547001014010001004255012
      Voice Diagnostic Packet113316181026323812133
      Open Questions610000110230014
      % Open Questions55300005017010080011
      Adult Voice Case History Form

      Eastern Kentucky University. Adult voice case history form 2020; Available from: https://slhclinic.eku.edu/sites/slhclinic.eku.edu/files/files/documents/CD-5_Adult_Voice_Case_History.pdf.

      1514738101224362104
      Open Questions11137283110416268
      % Open Questions739310067100301005001004410065
      New Patient Voice Questionaire12331719825213711129
      Open Questions730110110180023
      % Open Questions589010011050200100220018
      Adult Voice Case History Form11264159312364412127
      Open Questions11400223101671249
      % Open Questions1001500402210083331001610010039
      Voice Case History Form - Adult

      University of Houston. Voice case history form - adult 2020; Available from: https://www.uh.edu/class/comd/_docs/case_history_voice_adult.pdf.

      1017715786454625123
      Open Questions631013252541235
      % Open Questions601814020432583501009504028
      Adult Patient Intake Questionnaire

      Boulder Community Health. Voice adult patient intake questionnaire 2020; Available from: https://www.bch.org/documents/Voice-Therapy-Adult-Patient-Intake-Questionnaire.pdf.

      158511712211234121120
      Open Questions700081110332127
      % Open Questions47000478501000100710010023
      Adult Confidential Case History Questionnaire

      Frankly Speaking SLP. Adult confidential case history questionnaire 2020; Available from: http://www.franklyspeakin.com/docs/pdf/AdultConfCaseHistory.pdf.

      8761784337182
      Open Questions810010136020
      % Open Questions10014001402510016024
      Sample Case History Form for an Adult
      • Ferrand C.T.
      Voice Disorders: Scope of Theory and Practice.
      13872810111419175
      Open Questions1367284110411158
      % Open Questions100751001001004010010001005810077
      Voice Case History for Adults119473342272173
      Open Questions107411212272057
      % Open Questions917810014336725100100100078
      Case History Form - Voice
      • Sapienza C.
      • Ruddy B.H.
      Voice Disorders.
      12586811128171
      Open Questions11046611128159
      % Open Questions920501007510010010010010083
      Voice Intake Sheet

      Hackensack Meridian Health. Voice intake sheet 2020; Available from:https://mountainsidehosp.com/services/rehabilitation-services/speech-therapy.

      9114142533261170
      Open Questions92100130221021
      % Open Questions10018250050600678100030
      Voice Case History1184157131211164
      Open Questions112101111111122
      % Open Questions10025250201410033100510010034
      Voice Patient Case History

      Southern Eastern Louisiana University. Voice patient case history 2020; Available from: http://www.southeastern.edu/acad_research/depts/hhs/programs/slh_clinic/assets/voice_form.pdf.

      1734157233273360
      Open Questions1724011132233342
      % Open Questions100671000201450100671004310010070
      Case History Form67131692212159
      Open Questions510005023117
      % Open Questions83140005601002510029
      SLP Service Voice Case History Form

      Health Quest Speech-Language Pathology. Voice case history form 2019 Available from:https://patients.healthquest.org/wp-content/uploads/2019/01/SLP-Voice-Case-History-2-pages-revised-Jan-2019.pdf.

      1114613612351255
      Open Questions112000011211120
      % Open Questions1001400001005067201005036
      SLP Voice Case History Attachment

      Stony Brook Medicine. Voice case history attachment 2020; Available from:https://www.stonybrookmedicine.edu/sites/default/files/Voice%20Case%20History%202020.pdf.

      22111262322152
      Open Questions250000211112
      % Open Questions10024000067505010023
      Voice Intake Form

      Santa Rosa Speech & Language Services. Voice intake form 2020; Available from: http://santarosaspeechtherapy.com/wp-content/uploads/2017/09/NP-VOICE-CASE-HISTORY.pdf.

      78952119152
      Open Questions7310013116
      % Open Questions1003811001001610031
      Voice Evaluation Case History711162111222146
      Open Questions61111211020117
      % Open Questions86100100100171001001000100010037
      Voice Intake Form7137111251139
      Open Questions700010130113
      % Open Questions100000905060010033
      Questionnaire for the General Population Group
      • Thomas G.
      • de Jong F.I.
      • Cremers C.W
      • et al.
      Prevalence of voice complaints, risk factors and impact of voice problems in female student teachers.
      231527423837
      Open Questions10000210004
      % Open Questions500000292500011
      Voice Case History Form

      Illinois State University - Eckelmann-Taylor Speech and Hearing Clinic. Voice case history form 2020; Available from: https://isuspeechandhearing.com/file/34/isu_voice_case_history_v2.pdf.

      1441231118136
      Open Questions1440000110121
      % Open Questions1001000000100100010058
      Patient Report Form
      • Cohen S.M.
      Self-reported impact of dysphonia in a primary care population: an epidemiological study.
      721121138127
      Open Questions10000000001
      % Open Questions140000000004
      Total Number of Questions/Category39884113385111322422200913581

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      9. Emory Healthcare. Voice evaluation case history 2020; Available from:https://www.emoryhealthcare.org/ui/pdfs/voice-center-patient-forms/voice-evaluation-form.pdf.

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      14. A Tempo Voice Center. Voice diagnostic packet 2020; Available from:https://static1.squarespace.com/static/5429c0dfe4b041fc9d87d529/t/59b741f44c0dbfd18f29b873/1505182199249/NewPatientPacketVoiceAdult.pdf.

      15. Health Quest Speech-Language Pathology. Voice case history form 2019 Available from:https://patients.healthquest.org/wp-content/uploads/2019/01/SLP-Voice-Case-History-2-pages-revised-Jan-2019.pdf.

      16. Frankly Speaking SLP. Adult confidential case history questionnaire 2020; Available from: http://www.franklyspeakin.com/docs/pdf/AdultConfCaseHistory.pdf.

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      18. Hackensack Meridian Health. Voice intake sheet 2020; Available from:https://mountainsidehosp.com/services/rehabilitation-services/speech-therapy.

      19. Stony Brook Medicine. Voice case history attachment 2020; Available from:https://www.stonybrookmedicine.edu/sites/default/files/Voice%20Case%20History%202020.pdf.

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      20. Boulder Community Health. Voice adult patient intake questionnaire 2020; Available from: https://www.bch.org/documents/Voice-Therapy-Adult-Patient-Intake-Questionnaire.pdf.

      21. University of Washington. Voice intake form 2020; Available from:https://sphsc.washington.edu/sites/default/files/documents/Voice%20Intake%20Form_Questionnaires_Fillable_101119.pdf.

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