Minimal Important Difference in Voice Handicap Index-10

Abstract

Importance: The minimal important difference (MID) on patient-reported outcome measures can indicate how much of a change on that scale is meaningful.

Objective: To use an anchor-based approach to estimate MID in the Voice Handicap Index-10 (VHI-10) total score.

Design, setting, and participants: In this cohort study, a volunteer sample of adult patients visiting the voice clinic at the University of Minnesota from April 7, 2013, through July 3, 2016, completed the VHI-10 (range, 0-40, with higher scores indicating greater voice-related handicap) at baseline and 2 weeks later in conjunction with a global rating of change. An anchor-based approach was used to identify an MID. The association between the global change score and change in VHI-10 score was analyzed using Pearson rank correlation. A distribution-based method was used to corroborate the findings.

Main outcome and measures: Global rating of change on the VHI-10.

Results: Of the 273 participants, 183 (67.0%) were women and 90 (33.0%) were men (mean [SD] age, 54.3 [15.6] years); 259 (94.9%) were white. Participants had a variety of voice disorders, most commonly muscle tension dysphonia, irritable larynx, benign vocal fold lesions, and motion abnormalities. Among patients reporting no change on the global change score, the mean (SD) change in VHI-10 score was 1 (5). Among those reporting a small change, the mean (SD) change in VHI-10 was also 1 (5). Among those reporting a moderate change in voice symptoms, the mean (SD) change in VHI-10 score was 6 (8). Among those with a large change, the mean (SD) change in VHI-10 score was 9 (13). The correlation between the global change score and the change in VHI-10 score was 0.32 (95% CI, 0.12-0.49). Distribution-based analyses identified effect sizes comparable to those of the anchor-based categories.

Conclusions and relevance: These findings suggest that a difference of 6 on the VHI-10 may represent an MID. This difference was associated with a moderate change on the global rating scale, and the small-change and no-change categories were indistinguishable. Given the lack of differentiation between small and no change and the modest correlation between the global change score and change in the VHI-10 score, additional studies are needed.

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure.. Box Plot of Voice Handicap Index–10 (VHI-10) Δ at 14-Day Follow-up

The whiskers illustrate the minimum and maximum reported within each group; the lower and upper borders of the box, the first and third quartiles, respectively; the line in the box, the median; and the diamond, the mean change in VHI-10 score within each group. Greater global change scores were associated with greater mean changes.