(A900) A Comprehensive Review of Cross-Cultural Adaptation of Multilingual Patient Related Outcome Measures for Pediatric Dysphonia

Introduction: Patient Reported Outcome Measures (PROMs) are an important part of comprehensive voice assessment for children with dysphonia. Availability of multilingual PROMs enhances care for diverse populations. This review compares available PROMs for pediatric dysphonia in languages other than English.

Methods: PubMed, ScienceDirect and Web of Science were searched for PROMs assessing pediatric dysphonia. References were also queried. Cross-cultural adaptation, study group characteristics and validity and reliability assessments were compared across PROMs available in at least one language other than English. Beaton et al.’s six-stage cross-cultural adaptation guidelines were used to assess the translation process.

Results: Of the five PROMs evaluating pediatric dysphonia, four were available in at least one language other than English, and one, the Pediatric Voice Handicap Index (pVHI) was available in more than five languages. The pVHI was translated into 14 languages and for 16 cultural contexts. Mandarin Chinese (n = 3), Arabic (n = 3), and Turkish (n = 3) were the most widely available languages. Females represented 30.6% of dysphonic subjects, and 46.1% of control subjects. Only one translation (3.8%) satisfied all of Beaton et al.’s stages for cross-cultural adaptation, 57.7% completed at least four stages. Clinical validity of PROM translations was demonstrated with significantly higher scores in dysphonic children to at least p=0.001 by Mann-Whitney U test. There was high average internal consistency (M=0.918, SD=0.054) and high average test-retest reliability (M=0.879, SD=0.106).

Conclusions: Multilingual PROMs for pediatric dysphonia are available in several languages, but many widely spoken languages remain unavailable. Existing translations demonstrate excellent validity and reliability, but few studies strictly adhered to cross-cultural adaptation standards. Additional translations with strict adherence to cross-cultural adaptation standards could promote inclusion of marginalized patient populations.