Research Article|Articles in Press

Validation of the Brazilian Scale of Perceived Control Over Voice in the Present using Item Response Theory



      this study aims to verify the stages of evidence of validity of the voice-adapted present perceived control scale (V-APPCS) in its translated and cross-culturally adapted version for the Brazilian Portuguese “Voice-Adapted Present Perceived Control Scale” and to estimate the psychometric measurements of the properties of its items based on the item response theory (IRT).


      the instrument underwent a process of translation and cross-cultural adaptation for the Brazilian Portuguese, the process was carried out by two qualified translators, native in the destination language, and fluent in the language and culture of origin. The first translated version of the protocol was forwarded to a back-translation, performed by a third bilingual Brazilian translator. The translations were analyzed and compared by a committee composed of five speech therapists who are specialists in voice and with proficiency in the English language. The empirical study used data from 168 individuals, 127 had voice problems and 41 vocally healthy ones. For the stages of validity evidence, the following analyses were performed: Cronbach's alpha, exploratory factor analysis, confirmatory factor analysis and IRT.


      The stages of translation and cross-cultural adaptation allowed linguistic adjustments to be made so that the items were understandable and suitable for use in Brazil. The adequacy, structure, and application of the items were confirmed through the application of the final version of the scale in twenty individuals in a real context. The instrument in its Brazilian version presented good internal consistency, with bifactorial structure the exploratory factor analysis, besides presenting satisfactory values in the adjustment indexes of the model, confirming the structure of the confirmatory factor Analysis. The IT was applied to evaluate the parameters discrimination (a) and difficulty (b) of the items of the instrument; item 5 “I have control over my day-to-day reactions to the voice problem.” Presented itself as a more discriminative item and item 8 “My reaction to the voice problem is not under my control.” As an item of greater difficulty.


      The V-APPCS, translated, cross-culturally adapted, and validated, is robust and adequate to represent the construct in the Brazilian versions.

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        • Behlau M
        The 2016 G. paul moore lecture: lessons in voice rehabilitation: journal of voice and clinical practice.
        J Voice. 2019; 33(5): 669-681
        • Almeida LN
        • Nascimento JA
        • et al.
        Validation process of voice self-assessment instruments in Brazil.
        Audiol Comm Res. 2021; 26: e2364
        • Kasama ST
        • Brasolotto AG.
        Percepção vocal e qualidade de vida.
        Pro Fono. 2007; 19: 19-28
        • Ugulino AC
        • Oliveira G
        • Behlau M.
        Perceived dysphonia by the clinician's and patient's viewpoint.
        J Soc Bras Fonoaudiol. 2012; 24: 113-118
        • Costa DB da
        • Lopes LW
        • et al.
        Fatores de risco e emocionais na voz de professores com e sem queixas vocais.
        Revista CEFAC. 2013; 15: 1001-1010
        • Behlau M
        • Oliveira G
        • dos Santos LM de A
        • et al.
        Validação no Brasil de protocolos de auto-avaliação do impacto de uma disfonia.
        Pro-Fono. 2009; 21: 326-332
      1. World Health Organization. Division of Mental Health and Prevention of Substance Abuse. (‎1997)‎. WHOQOL : measuring quality of life. World Health Organization. Available from:

        • Paoliello K
        • Oliveira G
        • Behlau M
        Singing voice handicap mapped by different self-assessment instruments.
        Codas. 2013; 25: 463-468
        • Leite APD
        • Carnevale LB
        • Rocha
        • et al.
        Relação entre autoavaliação vocal e dados da avaliação clínica em indivíduos disfônicos.
        Revista CEFAC. 2015; 17: 44-51
        • 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
        • Moreti F
        • Zambon F
        • Oliveira G
        • et al.
        Cross-cultural adaptation, validation, and cutoff values of the Brazilian version of the voice symptom scale—VoiSS.
        J Voice. 2014; 28: 458-468
        • Misono S
        • Meredith L
        • Peterson CB
        • et al.
        New perspective on psychosocial distress in patients with dysphonia: the moderating role of perceived control.
        J Voice. 2016; 30: 172-176
        • Frazier P
        • Keenan N
        • Anders S
        • et al.
        Perceived past, present, and future control and adjustment to stressful life events.
        J Pers Soc Psychol. 2011; 100: 749-765
        • Bandura Albert.
        Social cognitive theory: an agentic perspective.
        Asian J Soc Psychol. 1999; 2: 1-26
        • Vinney LA
        • Turkstra LS.
        The role of self-regulation in voice therapy.
        J Voice. 2013; 27: 390.e1-390.e11
      2. Barbosa IK, Behlau M, Lima-Silva MF, et al. Voice symptoms, perceived voice control, and common mental disorders in elementary school teachers. J Voice. 2019;35:158.e1–158.e7. Published online.

        • Hunter EJ
        • Cantor-Cutiva LC
        • van Leer E
        • et al.
        Toward a consensus description of vocal effort, vocal load, vocal loading, and vocal fatigue.
        J Speech, Language, and Hearing Res. 2020; 63: 509-532
      3. Barbosa IKL, Behlau M, Lopes LW, et al. Voice and self-regulation: integrating review of the literature. J Voice. 2020;36:499–506. Published online.

        • Nguyen-Feng VN
        • Frazier PA
        • Stockness A
        • et al.
        Web-based perceived present control intervention for voice disorders: a pilot study.
        J Voice. 2020; 34: 300.e1-300.e9
        • Branski RC
        • Cukier-Blaj S
        • Pusic A
        • 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
        • Andrade JM de
        • Laros JA
        • Gouveia VV
        O uso da teoria de resposta ao item em avaliações educacionais: diretrizes para pesquisadores.
        Aval Psicol. 2010; 9: 421-435
        • Araujo EAC de
        • Andrade DF de
        • Bortolotti SLV
        Teoria da resposta ao item.
        Rev Escola Enfermagem USP. 2009; 43: 1000-1008
        • Pasquali L.
        Teoria de Resposta Ao Item: Teoria, Procedimentos e Aplicações.
        1st ed. Curitiba: Appris, 2018
        • Castro SM de J
        • Trentini C
        • Riboldi J
        Teoria da resposta ao item aplicada ao Inventário de Depressão Beck.
        Rev Brasil Epidemiol. 2010; 13: 487-501
        • Bechger TM
        • Maris G
        • Verstralen HHFM
        • et al.
        Using classical test theory in combination with item response theory.
        Appl Psychol Meas. 2003; 27: 319-334
        • Sartes LMA
        • Souza-Formigoni MLO
        Avanços na psicometria: da teoria clássica dos testes à teoria de resposta ao item.
        Psicol Reflex Crit. 2013; 26: 241-250
        • Alencar SAL de
        Análise Fatorial e Aplicação Da Teoria de Resposta Ao Item Na Escala Do Desconforto Do Trato Vocal Em Pacientes Com Disfonia [master’s thesis].
        João Pessoa: Universidade Federal da Paraíba, 2019
        • Aguiar AC de
        • Almeida LN
        • Pernambuco L
        • et al.
        Stages of readiness in patients with dysphonia: a proposal based on factor analysis using the URICA-V scale.
        J Voice. 2018;34:547–558;
        • Pasquali L.
        Psicometria: Teoria e Aplicações.
        Brasília: UNB, 1997
        • Aguiar AC de
        • Almeida LN
        • Pernambuco L
        • et al.
        Stages of readiness in patients with dysphonia: a proposal based on factor analysis using the URICA-V scale.
        J Voice. 2020; 34: 547-558
        • Moreti F
        • Zambon F
        • Behlau M.
        Voice symptoms and vocal deviation self-assessment in different types of dysphonia.
        Codas. 2014; 26: 331-333
        • Deary IJ
        • Wilson JA
        • Carding PN
        • et al.
        VoiSS: a patient-derived Voice Symptom Scale.
        J Psychosom Res. 2003; 54: 483-489
        • Behlau M
        • Moreti F
        • Zambon F
        • et al.
        Referente a: Escala de Sintomas Vocais-ESV: forma de aplicação e cálculos do instrumento.
        Rev CEFAC. 2016; 18: 323-325
        • Hair JF
        • Black WC
        • Babin BJ
        et al. 6th ed. Análise Multivariada de Dados. Porto Alegre:Bookman, 2009
        • Filho DBF
        • Júnior JADS.
        Desvendando os mistérios do coeficiente de correlação de Pearson (r).
        Rev Pol Hoje. 2009; 18: 115-146
        • Dziuban CD
        • Shirkey EC.
        When is a correlation matrix appropriate for factor analysis? Some decision rules.
        Psychol Bull. 1974; 81: 358-361
        • Damásio BF.
        Contribuições da Análise Fatorial Confirmatória Multigrupo (AFCMG) na avaliação de invariância de instrumentos psicométricos.
        Psico-USF. 2013; 18: 211-220
        • Hair J
        • Anderson R
        • Babin B
        Multivariate Data Analysis. 6th ed. Pearson Prentice Hall, Upper Saddle River2006
      4. Ramos N dos S Validação Do Índice de Desvantagem Vocal Com Base Na Teoria de Resposta Ao Item [master’s thesis]. João Pessoa:Universidade Federal da Paraíba; 2020.

        • Figueiredo Filho DB
        • Silva Jr., JA.
        Visão além do alcance: uma introdução à análise fatorial.
        Opin Publ. 2010; 16: 160-185
        • Daniel WW
        • Cross CL
        Biostatistics: A Foundation for Analysis in the Health Sciences. 10 th ed. NY. John Wiley e Sons, 2013
        • Albuquerque AS
        • Tróccoli BT.
        Desenvolvimento de uma escala de bem-estar subjetivo.
        Psicol Teoria Pesquisa. 2004; 20: 153-164
        • Baker FB
        • Kim SH.
        The Basics of Item Response Theory.
        Eric Clearinghouse on Assessment and Evaluation. MD: University of Maryland, College Park, 2001
        • Boone DR
        • Mcfarlane SC
        • Berg
        • et al.
        The voice and voice therapy.
        J Commun Disord. 1972; 5: 295-298
        • Almeida AA
        • Behlau M.
        Relations between self-regulation behavior and vocal symptoms.
        J Voice. 2017; 31: 455-461
        • Colton RH
        • Casper JK
        • Leonard R.
        Understanding Voice Problems: A Physiological Perspective for Diagnosis and Treatment.
        Baltimore MD: Williams and Wilkins, 1996
        • Turiano NA
        • Chapman BP
        • Agrigoroaei S
        • et al.
        Perceived control reduces mortality risk at low, not high, education levels.
        Health Psychol. 2014; 33: 883-890
        • Pernambuco L
        • Espelt A
        • Magalhães HV
        • et al.
        Recommendations for elaboration, transcultural adaptation, and validation process of tests in Speech, Hearing and Language Pathology.
        Codas. 2017; 29:e20160217
        • Deary IJ
        • Wilson JA
        • Carding PN
        • et al.
        From dysphonia to dysphoria: mokken scaling shows a strong, reliable hierarchy of voice symptoms in the Voice Symptom Scale questionnaire.
        J Psychosom Res. 2010; 68: 67-71
        • Souza AC de
        • Alexandre NMC
        • Guirardello E de B
        Propriedades psicométricas na avaliação de instrumentos: avaliação da confiabilidade e da validade.
        Epidemiol Serv Saude. 2017; 26: 649-659
        • Frazier P
        • Merians A
        • Misono S
        Perceived control and voice handicap in patients with voice disorders.
        Health Psychol. 2017; 36: 1105-1108
        • Nguyen-Feng VN
        • Frazier PA
        • Roy N
        • et al.
        Perceived control, voice handicap, and barriers to voice therapy.
        J Voice. 2019;
        • Misono S
        • Peterson CB
        • Meredith L
        • et al.
        Psychosocial distress in patients presenting with voice concerns.
        J Voice. 2014; 28: 753-761
        • Nunes CHDS
        • Sancineto Primi R
        • et al.
        Teoria de Resposta ao Item para otimização de escalas tipo likert- um exemplo de aplicação.
        Rev Iberoamer Diagn Eval Psicol. 2008; 1: 51-79
        • Alexandre NMC
        • Coluci MZO.
        Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas.
        Cienc Saude Colet. 2011; 16: 3061-3068
        • Behlau M
        • Madazio G.
        Measuring quality of life in dysphonic patients: a systematic review of content development in patient-reported outcomes measures.
        J Voice. 2010; 24: 193-198