The VHI-10 and VHI Item Reduction Translations-Are we all Speaking the Same Language?

Objectives. The Vocal Handicap Index-10 (VHI-10) was designed as an item reduction of the original VHI to provide a quick, reliable, and quantifiable measure of patients' own vocal handicap perception. Many translations of the VHI-10 have been produced, but methodologies of translation vary between articles and do not always mirror that of the English VHI-10. This discrepancy leads to confusion about normative values and the applicability of published data in non-English-speaking cultures. This article examines the various item reductions of the VHI-10 from the VHI and the differing methodologies of translation of the VHI-10. Study Design. This is an invited review article. Methods. Published item reductions and translations of the VHI-10 were reviewed. Normative values for each translation, where available, were calculated. The World Health Organization recommendations for the translation of instruments are reviewed. Results/Conclusions. There are substantial differences between the original VHI-10 (created and published in American English) and many of the translations of the VHI-10 and other proposed item reductions, both in the actual questions used and the order of the questions. We have to conclude that for a number of the non-English VHI-10/VHI reductions, the instruments are not equivalent, meaning the results from different languages are not comparable. Our recommendation for future patient-reported instrument translations is to translate and validate the instrument according to the World Health Organization protocol while maintaining item consistency and order, allowing studies to be better focused and decrease unnecessary replication of well-performed studies, as well as allowing metadata to be combined from different countries and cultures.