Impact of Cultural-Linguistic Differences on Vocal Fatigue Perception: A Systematic Review and Meta-Analysis

The perception of a clinical condition or disorder can vary across patients from different cultural-linguistic backgrounds. There is insufficient evidence to inspect this potential impact on the perception of vocal fatigue (VF) as a common condition perceived by patients with voice disorders. In order to more comprehensively explore this phenomenon, a systematic review was carried out to investigate the differences in perceived VF in a variety of cultural-linguistic contexts, based on a standard self-assessment instrument-the Vocal Fatigue Index (VFI), as translated in different languages. A thorough search was done in MEDLINE, CENTRAL, Web of Science, and Google Scholar by March 2024. Cross-sectional studies investigating the accuracy of the VFI to detect perceived VF in all available languages were considered. The VFI has three distinct parts or factors assessing: (a) tiredness of voice, (b) physical discomfort associated with voicing, and (c) improvement of symptoms with rest. The cutoff points and sensitivity and specificity of each factor were submitted to meta-analysis, and the summary receiver operating characteristic curves were used to determine pooled sensitivity and specificity of each factor of the VFI. Eight papers that examined the diagnostic accuracy of the VFI in English, Malayalam, Turkish, German, Mandarin Chinese, Polish, Cantonese, and Finnish languages were identified as being eligible for this meta-analysis. The pooled sensitivity and specificity along with their confidence intervals (CIs) were as follows: 0.91 CI [0.80, 0.96] and 0.88 CI [0.78, 0.94] for Factor 1, 0.83 CI [0.69, 0.91] and 0.84 CI [0.76, 0.89] for Factor 2, and 0.75 CI [0.67, 0.82] and 0.77 CI [0.59, 0.89] for Factor 3. The present research demonstrates medium to high but heterogeneous accuracy of the VFI for detecting perceived VF across cultural-linguistic contexts. Given the promising results, future studies should focus on (a) further investigating the underlying factors for the observed heterogeneity in diagnostic accuracy and (b) adapting and validating the VFI in more languages toward establishing its validity as a cross-linguistic diagnostic tool for the perception of VF. https://doi.org/10.23641/asha.26397106.