The reliability and validity of patient self-rating of their own voice quality

Objectives: To provide preliminary data on the reliability and validity of dysphonic patients rating their own voice quality. Design: Prospective reliability/validity assessment of voice ratings in dysphonic patients. Setting: The Royal Free Hampstead NHS Primary Care Trust. Participants: Thirty‐five adult dysphonia patients recruited from ENT referrals to a speech and language therapy department. Exclusion criteria were (i) a hearing impairment which may affect auditory discrimination and (ii) a diagnosis of cognitive impairment which may affect task comprehension. Main outcome measures: Patient intra‐rater reliability was assessed by test–retest ratings, using G (Grade), R (Rough), B (Breathy), A (Asthenic), S (Strained) (GRBAS). Validity was assessed by comparing (i) patient–clinician inter‐rater reliability, (ii) patients’ GRBAS ratings with their Vocal Performance Questionnaire (VPQ) responses. Result: (i) Patients had lower intrarater reliability than clinicians (for G of GRBAS, kappa = 0.51 versus 0.74); (ii) patients consistently rated their voices more severely than clinicians (for G of GRBAS, mean rating = 1.4 versus 1.0); (iii) clinician–patient inter‐rater agreement was no better than chance (paired t‐test, all P 0.4, P