Summary
Background
Acoustic measurements are useful tools to objectively measure overall voice quality.
The Acoustic Voice Quality Index (AVQI) has shown to be a valid multiparametric tool
to objectify dysphonia severity. The increasing number of validity studies investigating
AVQI's validity demands a comprehensive synthesis of the available outcomes.
Objective of review
The aim of the present meta-analysis is to quantify the evidence for the diagnostic
accuracy of the AVQI, including its sensitivity, specificity and likelihood ratio
statistics, and its concurrent validity and sensitivity to changes in auditory-perceptual
voice quality ratings.
Type of review
Meta-analysis
Search strategy
MEDLINE, EMBASE, the Cochrane library and Web of Science were searched from 2010 till
April 2021 with an additional manual search, using keywords related to AVQI and common
terminologies of validity outcomes. Studies considering the clinical validity of AVQI
(ie, diagnostic accuracy, concurrent validity and sensitivity to change), using auditory-perceptual
voice quality evaluation as reference, were included.
Evaluation method
The Preferred Reporting Items for Systematic reviews and Meta-Analyses of Diagnostic
Test Accuracy Studies (PRISMA-DTA) guidelines were used. Quality assessment of included
studies was conducted using the QUADAS-2 tool. For the diagnostic accuracy of AVQI,
the pooled sensitivity, specificity and likelihood ratio statistics were determined
using a summary receiver operating characteristic approach. Weighted correlation coefficient
measures () were used to assess the concurrent validity and sensitivity to change.
Results
A total of 198 studies were screened and 33 articles were included. In total, voice
samples of 11447, 10272, and 367 different subjects were considered for analysis of
diagnostic accuracy, concurrent validity and change responsiveness, respectively.
Satisfying diagnostic accuracy results were found with a pooled sensitivity of 0.83
(95% CI: 0.82-0.83), a pooled specificity of 0.89 (95% CI: 0.88-0.90), a pooled positive
LR of 7.75 (95% CI: 6.04-9.95), a pooled negative LR of 0.20 (95% CI: 0.16-0.23),
and a pooled diagnostic odds ratio of 47.13 (95% CI: 34.82-63.79). Summary receiver
operating characteristic curve analysis showed an excellent AUC value of 0.937 and
Q* index of 0.874. Strong correlations of = 0.838 for concurrent validity and = 0.796 for sensitivity to change were found.
Conclusions
Our results confirm the general clinical utility of the AVQI as a robust and valid
objective measure for evaluating overall dysphonia severity across languages and study
methods.
Key Words
Abbreviations:
AUC (area under the curve), AVQI (acoustic voice quality index), CAPE-V (consensus auditory-perceptual evaluation of voice), CPPS (smoothed cepstral peak prominence), dOR (diagnostic odds ratio), EAI (equal-appearing interval scale), FN (false negatives), FP (false positives), G (grade), GRBAS scale (grade, roughness, breathiness, asthenia and strain scale), H (parameter hoarseness of the GRBAS scale), HNR (harmonics-to-noise-ratio), ICC (intraclass correlation coefficient), LR (likelihood ratio), LR+ (positive likelihood ratio), LR– (negative likelihood ratio), PRISMA (preferred reporting items for systematic reviews and meta-analyses standards), QUADAS-2 (quality assessment of diagnostic accuracy studies, revised version), RBH scale (roughness, breathiness and hoarseness scale), ROC curve (receiver operating characteristics curve), SL (shimmer local), SLdB (shimmer local dB), Slope (general slope of the long-term average spectrum), SROC curve (summary receiver operating characteristics curve), Tilt (tilt of the regression line through the long-term average spectrum), TN (true negatives), TP (true positives), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 22, 2022
Accepted:
April 27,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
