Summary
Objectives
The CAPE-V is a widely used protocol developed to help standardize the evaluation
of voice. Variability of voice quality ratings has prevented development of training
protocols that might themselves improve interrater agreement among new clinicians.
As part of a larger mixed methods project, this study examines agreement and reliability
for experienced clinicians using the CAPE-V scales.
Study Design
Observational.
Methods
Experienced voice clinicians (N=20) provided ratings of recordings from 12 speakers
representing a range of overall voice quality. Participants were instructed to rate
the voices as they normally would, using the CAPE-V scales. Descriptive data were
recorded and two levels of agreement were calculated. Single rater reliability was
calculated using a 2-way random model of absolute agreement for intraclass correlations
(ICC [2,1]).
Results
Participants use of the CAPE-V scales varied considerably, although most rated overall
severity, breathiness, roughness and strain. Data from one participant did not meet
a priori agreement criteria. Because outcomes were significantly different without their data,
agreement and reliability were analyzed based on the reduced data set from 19 participants.
Interrater agreement and reliability were comparable to previous research; the mean
range of ratings was at least 47mm for all dimensions of voice quality.
Conclusions
Results indicated differential use of the components of the CAPE-V form and scales
in evaluating voice quality and severity of dysphonia, including categorical variability
among ratings of all of the primary CAPE-V dimensions of voice quality that may complicate
the clinical description of a voice as mildly, moderately or severely dysphonic.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.Am J Speech Lang Pathol. 2009; 18: 124-132
- Reliability of clinician-based (GRBAS and CAPE-V) and patient-based (V-RQOL and IPVI) documentation of voice disorders.J Voice. 2007; 21: 576-590
- Establishing validity of the consensus auditory-perceptual evaluation of voice (CAPE-V).Am J Speech Lang Pathol. 2011; 20: 14-22
- The effect of listener experience and anchors on judgments of dysphonia.J Speech Lang Hear Res. 2011; 54: 430-447https://doi.org/10.1044/1092-4388(2010/09-0205
- The role of listener experience on Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) ratings of postthyroidectomy voice.Am J Speech Lang Pathol. 2010; 19: 248-258
- Challenges to CAPE-V as a standard.Perspect ASHA Spec Interest Groups SIG. 2016; 1 (3): 47-53https://doi.org/10.1044/persp1.SIG3.47
ASHA. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) ASHA Special Interest Division 3, Voice and Voice Disorders. Published online 2009. Accessed October 13, 2019. https://www.asha.org/Form/CAPE-V-Success/
- Fidelity to the CAPE-V.ASHA, Denver, CO2015 (Poster presented at:November 13)
- Listener experience and perception of voice quality.J Speech Hear Res. 1990; 33: 103-115
- Comparing two methods for reducing variability in voice quality measurements.J Speech Lang Hear Res. 2011; 54: 803-812https://doi.org/10.1044/1092-4388(2010/10-0083
- Perceptual voice qualities database (PVQD): database characteristics.J Voice. 2020; 0https://doi.org/10.1016/j.jvoice.2020.10.001
- GRBAS” scale for evaluating the hoarse voice & frequency range of phonation.in: Hirano M Clinical Examination of Voice. Vol 5. Disorders of Human Communication. Springer-Verlag/Wien, 1981: 83-84 (88-89)
- Does the presence or location of graphic markers affect untrained listeners’ ratings of severity of dysphonia?.J Voice. 2014; 28: 469-475https://doi.org/10.1016/j.jvoice.2013.12.011
Walden P. Perceptual Voice Qualities Database (PVQD), Mendeley. Published online October 9, 2020. Accessed October 20, 2020. https://data.mendeley.com/datasets/9dz247gnyb/3
- Application of psychometric theory to the measurement of voice quality using rating scales.J Speech Lang Hear Res. 2005; 48: 323-335
- Modeling of breathy voice quality using pitch-strength estimates.J Voice. 2016; 30: 774.e1-774.e7https://doi.org/10.1016/j.jvoice.2015.11.016
- Psychometric properties associated with perceived vocal roughness using a matching task.J Acoust Soc Am. 2013; 134: EL294-EL300https://doi.org/10.1121/1.4819183
- Objective indices of perceived vocal strain.J Voice. 2019; 33: 838-845https://doi.org/10.1016/j.jvoice.2018.06.005
- Developing clinically relevant scales of breathy and rough voice quality.J Voice. 2021; 35: 663.e9-663.e16https://doi.org/10.1016/j.jvoice.2019.12.021
- Psychophysics: Introduction to Its Perceptual, Neural, and Social Prospects.Wiley, 1975
- Direct magnitude estimation and interval scaling of naturalness and severity in tracheoesophageal (TE) speakers.J Speech Lang Hear Res. 2002; 45: 1088-1096https://doi.org/10.1044/1092-4388(2002/087
- Direct magnitude estimation and interval scaling of stuttering severity.J Speech Hear Res. 1983; 26: 568-573
- Direct magnitude estimation and equal appearing interval scaling of vowel roughness.J Speech Hear Res. 1989; 32: 78-82
- Ratio scales and category scales for a dozen perceptual continua.J Exp Psychol. 1957; 54: 377-411https://doi.org/10.1037/h0043680
- Listener agreement for auditory-perceptual ratings of dysarthria.J Speech Lang Hear Res. 2007; 50: 1481-1495
- Equal appearing interval and visual analogue scaling of perceptual roughness and breathiness.Clin Linguist Phon. 2004; 18: 211-229
- Voice Problems of Children.3rd ed. Williams & Wilkins, 1987
- Perceptual evaluation of voice quality: review, tutorial, and a framework for future research.J Speech Hear Res. 1993; 36: 21-40
- Individual differences in voice quality perception.J Speech Hear Res. 1992; 35: 512-520
- Effect of experience on judgments of adductor spasmodic dysphonia.Ann Otol Rhinol Laryngol. 2007; 116: 695-701
- The role of experience on judgments of dysphonia.J Voice. 2010; 24 (S0892-1997(08)00209-9 [pii][doi]): 564-573https://doi.org/10.1016/j.jvoice.2008.12.005
- Intraclass correlations: uses in assessing rater reliability.Psychol Bull. 1979; 86: 420-428
- Foundations of Clinical Research: Applications to Practice.2nd ed. Prentice Hall Health, 2000
- Is the reliability of a visual analog scale higher than an ordinal scale? An experiment with the GRBAS scale for the perceptual evaluation of dysphonia.J Voice. 1999; 13: 508-517
- Perceptual evaluation of dysphonic voices: can a training protocol lead to the development of perceptual categories?.J Voice. 2015; 29: 304-311https://doi.org/10.1016/j.jvoice.2014.07.006
- Quantifying dysphonia severity using a spectral/cepstral-based acoustic index: comparisons with auditory-perceptual judgements from the CAPE-V.Clin Linguist Phon. 2010; 24: 742-758https://doi.org/10.3109/02699206.2010.492446
- Validity of rating scale measures of voice quality.J Acoust Soc Am. 1998; 104: 1598-1608
- Spectral-cepstral estimation of dysphonia severity: external validation.Ann Otol Rhinol Laryngol. 2013; 122: 40-48
- Development of an auditory-perceptual rating instrument for the operatic singing voice.J Voice. 2006; 20: 71-81https://doi.org/10.1016/j.jvoice.2005.01.006
- The effect of anchors and training on the reliability of perceptual voice evaluation.J Speech Lang Hear Res. 2002; 45: 111-126https://doi.org/10.1044/1092-4388(2002/009
- Effects of consensus training on the reliability of auditory perceptual ratings of voice quality.J Voice. 2012; 26: 304-312https://doi.org/10.1016/j.jvoice.2011.06.003
Article info
Publication history
Published online: December 19, 2022
Accepted:
November 10,
2022
Publication stage
In Press Corrected ProofFootnotes
I have no conflicts of interest to disclose.
This work was funded by a 2018 American-Speech-Language-Hearing Foundation New Investigators Research Grant.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
