Evidence of response process validity of a spectrographic voice analysis protocol

Silva, Allan Carlos França da; Diniz, Emmanuel Gustavo Rodrigues; Paiva, Maxsuel Avelino Alves de; Silva, Itacely Marinho da; Silva, Saulo Iordan do Nascimento; Lima Filho, Luiz Medeiros Araujo; Lopes, Leonardo Wanderley

doi:10.1590/2317-6431-2023-2826pt

Brasil

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Original Article • Audiol., Commun. Res. 29 • 2024 • https://doi.org/10.1590/2317-6431-2023-2826en linkcopy

Evidence of response process validity of a spectrographic voice analysis protocol

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose To develop the validity step based on the response processes of the Spectrographic Analysis Protocol (SAP).

Methods 10 speech therapists and 10 undergraduate students of the Speech Therapy course were recruited, who applied the SAP in 10 spectrograms, performed the evaluation of the PAE items, and participated in a cognitive interview (CI). The SAP was reanalyzed to reformulate or exclude items based on the responses. The chi-square test and the accuracy values were used to analyze the answers to the questionnaires and qualitative analysis of the CI data.

Results the participants achieved accuracy > 70% in most items of the SAP. Only seven items achieved accuracy ≤ 70%. There was a difference between presence vs. absence of difficulty in identifying items in the spectrogram. Most participants had no problem identifying the SAP items. In the CI, only six items did not correctly identify the intention, verified in the qualitative analysis. In addition, participants suggested excluding five items.

Conclusion After the validation step based on the response processes, the SAP is reformulated. Seven items were deleted, and two items were reformulated. Thus, the final version of the SAP after this stage was reduced from 25 to 18 items, distributed in the five domains.

Keywords: Voice; Voice disorders; Speech acoustics; Voice quality; Validation study

FEHRING CRITERIA	SCORE	ADAPTED CRITERIA	ADAPTED SCORE
Master of nursing.	4	Bachelor’s degree in speech-language-hearing sciences (mandatory criterion)	0
Master of nursing - dissertation with relevant content in the clinical area.	1	Master’s degree with a dissertation on voice	2
Research - published articles on diagnostics.	2	Research - published articles on voice	2
Article on diagnostics published in a reference journal.	2	Article on voice published in a journal ≥ B1	2
Doctor of diagnostics.	2	Doctoral degree with thesis on voice	2
At least 1 year of clinical experience in internal medicine nursing.	1	At least 2 years of clinical practice in voice and experience in narrowband spectrographic analysis	3
Certified in internal medicine with proven clinical experience.	2	Specialization/specialist in voice	3
Maximum score	14	Maximum score	14

SAP ITEM	SPECTROGRAM
	PRESENT		ABSENT		p-value	Accu	Sens	Spec
	n	%	n	%	p-value	Accu	Sens	Spec
Item 1 - Presence of noise at the beginning of the emission					<0.001^* * Significant values (p < 0.05) - Chi-square test	90.0%	86.3%	94.4%
Present	19	95%	3	15%
Absent	1	5%	17	85%
Item 2 - Presence of dark well-defined vertical striations at the beginning of the emission					0.491	62.5%	64.7%	60.8%
Present	11	55%	6	30%		62.5%
Absent	9	45%	14	70%
Item 3 - High number of irregular harmonics at the beginning of the emission					0.011*	50.0%	50.0%	50.0%
Present	14	70%	14	70%
Absent	6	30%	6	30%
Item 4 - No irregularity or observable noise at the beginning of the trace					0.002*	60.0%	70.0%	56.6%
Present	7	35%	3	15%
Absent	13	65%	17	85%
Item 5 - Presence of irregularities in the trace					<0.001*	94.7%	95.0%	94.0%
Present	19	95%	1	15%
Absent	1	5%	17	85%
Item 6 - Gradual loss of trace definition/energy					0.027*	100%	100%	100%
Present	20	100%	7	35%
Absent	0	0	13	65%
Item 7 - Presence of abrupt interruptions in the trace					<0.001*	92.5%	90.4%	94.3%
Present	19	95%	2	20%
Absent	1	5%	18	90%
Item 8 - Presence of regular spectrographic trace					<0.001*	87.5%	85.7%	89.4%
Present	18	90%	3	15%
Absent	2	10%	17	85%
Item 9 - Presence of harmonics with little brightness					0.039*	80.0%	83.3%	77.2%
Present	15	75%	3	15%
Absent	5	25%	17	85%
Item 10 - Decreased energy and number of harmonics above 4000 Hz					<0.001*	100%	100%	100%
Present	20	100%	2	10%
Absent	0	0	18	90%
Item 11 - Presence of harmonics above 4000 Hz					0.039*	90.0%	90.0%	90.0%
Present	18	90%	2	10%
Absent	2	10%	18	90%
Item 12 - Decreased energy or number of harmonics up to 4000 Hz					<0.001*	72.5%	68.0%	80.0%
Present	17	85%	8	40%
Absent	3	15%	12	60%
Item 13 - Increased energy between 1000 and 3000 Hz					<0.001*	85.0%	79.1%	93.7%
Present	19	95%	5	25%
Absent	1	5%	15	75%
Item 14 - Predominance of F0 trace rather than that of other harmonics					0.002*	55.0%	53.3%	60.0%
Present	16	80%	14	70%
Absent	4	20%	6	30%
Item 15 - Decreased energy level in the whole frequency band throughout the trace					0.012*	90.0%	90.0%	90.0%
Present	18	90%	2	10%
Absent	2	10%	18	90%
Item 16 - Increased energy level in the whole frequency band throughout the trace					<0.001*	90.0%	90.0%	90.0%
Present	18	90%	1	5%
Absent	2	10%	19	95%
Item 17 - Series rich in regular harmonics up to 4000 Hz					0.058	85.0%	100%	76.9%
Present	14	70%	0	0
Absent	6	30%	20	100%
Item 18 - Presence of irregular horizontal striations between harmonics					0.012*	66.6%	70.0%	62.5%
Present	14	70%	10	50%
Absent	6	30%	10	50%
Item 19 - Presence of undefined or sketched harmonics					0.004*	57.5%	55.1%	63.63%
Present	16	80%	13	65%
Absent	4	20%	7	35%
Item 20 - Predominant presence of low-amplitude harmonics					<0.001*	57.1%	55.0%	59.1%
Present	11	55%	7	35%
Absent	9	45%	13	65%
Item 21 - Presence of irregular harmonics					<0.001*	86.0%	80.9%	89.6%
Present	17	85%	4	20%
Absent	3	15%	26	80%
Item 22 - Presence of noise between harmonics below 4000 Hz					0.042*	80.0%	77.2%	83.3%
Present	17	85%	5	25%
Absent	3	15%	15	75%
Item 23 - Presence of additional diffuse noise above 4000 Hz					<0.001*	87.5%	85.7%	89.4%
Present	18	90%	3	15%
Absent	2	10%	17	85%
Item 24 - Harmonics replaced with noise in the spectrographic trace					<0.001*	85.0%	79.1%	93.7%
Present	19	95%	5	25%
Absent	1	5%	15	75%
Item 25 - Spectrographic trace with discrete or no noise between harmonics below 4000 Hz					0.039*	77.5%	73.9%	82.3%
Present	17	85%	6	30%
Absent	3	15%	14	70%

SAP ITEM	USAGE DIFFICULTIES				p-value
	PRESENT		ABSENT
	n	%	n	%
Item 1 - Presence of noise at the beginning of the emission	1	2.63%	18	97.37%	<0.001^* * Significant values (p < 0.05) - Chi-square test
Item 2 - Presence of dark well-defined vertical striations at the beginning of the emission	5	13.15%	14	86.85%	0.002*
Item 3 - High number of irregular harmonics at the beginning of the emission	4	10.52%	15	89.48%	<0.001*
Item 4 - No irregularity or observable noise at the beginning of the trace	5	13.15%	14	86.85%	<0.001*
Item 5 - Presence of irregularities in the trace	0	0.00%	19	100%	<0.001*
Item 6 - Gradual loss of trace definition/energy	1	2.63%	18	97.37%	0.002*
Item 7 - Presence of abrupt interruptions in the trace	0	0.00%	19	100%	<0.001*
Item 8 - Presence of regular spectrographic trace	3	7.89%	16	92.11%	<0.001*
Item 9 - Presence of harmonics with little brightness	4	10.52%	15	89.48%	0.025*
Item 10 - Decreased energy and number of harmonics above 4000 Hz	2	5.26%	17	94.74%	<0.001*
Item 11 - Presence of harmonics above 4000 Hz	1	2.63%	18	97.37%	<0.001*
Item 12 - Decreased energy or number of harmonics up to 4000 Hz	2	5.26%	17	94.74%	<0.001*
Item 13 - Increased energy between 1000 and 3000 Hz	1	2.63%	18	97.37%	0.007*
Item 14 - Predominance of F0 trace rather than that of other harmonics	3	7.89%	16	92.11%	0.002*
Item 15 - Decreased energy level in the whole frequency band throughout the trace	3	7.89%	16	92.11%	<0.001*
Item 16 - Increased energy level in the whole frequency band throughout the trace	1	2.63%	18	97.37%	<0.001*
Item 17 - Series rich in regular harmonics up to 4000 Hz	1	2.63%	18	97.37%	0.007*
Item 18 - Presence of irregular horizontal striations between harmonics	6	15.78%	13	84.22%	<0.001*
Item 19 - Presence of undefined or sketched harmonics	0	0.00%	19	100%	<0.001*
Item 20 - Predominant presence of low-amplitude harmonics	7	18.41%	12	81.59%	0.002*
Item 21 - Presence of irregular harmonics	2	5.26%	17	94.74%	0.025*
Item 22 - Presence of noise between harmonics below 4000 Hz	1	2.63%	18	97.37%	<0.001*
Item 23 - Presence of additional diffuse noise above 4000 Hz	2	5.26%	17	94.74%	<0.001*
Item 24 - Harmonics replaced with noise in the spectrographic trace	1	2.63%	18	97.37%	<0.001*
Item 25 - Spectrographic trace with discrete or no noise between harmonics below 4000 Hz	5	13.15%	14	86.85%	<0.001*

Item	Domain	Decision	Criteria
(2) Presence of dark well-defined vertical striations at the beginning of the emission	Beginning of the emission	Excluding the item	Accuracy ≤ 70%
	Beginning of the emission	Excluding the item	Difficulties identifying the intention of the item
(3) High number of irregular harmonics at the beginning of the emission	Beginning of the emission	Excluding the item	Accuracy ≤ 70%
	Beginning of the emission	Excluding the item	Suggested in the cognitive interview
(4) No irregularity or observable noise at the beginning of the trace	Beginning of the emission	Excluding the item	Accuracy ≤ 70%
	Beginning of the emission	Excluding the item	Suggested in the cognitive interview
(5) Presence of irregularities in the trace	Temporal aspects of the emission	Reformulating the item as follows: “Changes in the spectrographic trace configuration in the time domain”	Difficulties identifying the intention of the item
(8) Presence of regular spectrographic trace	Temporal aspects of the emission	Excluding the item	Suggested in the cognitive interview
(14) Predominance of F0 trace rather than that of other harmonics	Energy distribution in the trace	Excluding the item	Accuracy ≤ 70%
	Energy distribution in the trace	Excluding the item	Difficulties identifying the intention of the item
(15) Decreased energy level in the whole frequency band throughout the trace	Energy distribution in the trace	Maintaining the item unchanged	Difficulties identifying the intention of the item
(17) Series rich in regular harmonics up to 4000 Hz	Energy distribution in the trace	Excluding the item	Suggested in the cognitive interview
(18) Presence of irregular horizontal striations between harmonics	Description of the harmonics	Maintaining the item unchanged	Accuracy ≤ 70%
(19) Presence of undefined or sketched harmonics	Description of the harmonics	Maintaining the item unchanged	Accuracy ≤ 70%
(19) Presence of undefined or sketched harmonics	Description of the harmonics	Maintaining the item unchanged	Difficulties identifying the intention of the item
(20) Predominant presence of low-amplitude harmonics	Description of the harmonics	Maintaining the item unchanged	Accuracy ≤ 70%
(20) Predominant presence of low-amplitude harmonics	Description of the harmonics	Maintaining the item unchanged	Difficulties identifying the intention of the item
(21) Presence of irregular harmonics	Description of the harmonics	Reformulating the item as follows: “Presence of harmonics with irregular trajectory and morphology (non-rectilinear)”	Suggested in the cognitive interview
(25) Spectrographic trace with discrete or no noise between harmonics below 4000 Hz	Distribution of noise in the trace	Excluding the item	Suggested in the cognitive interview

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Academia Brasileira de Audiologia Rua Itapeva, 202, conjunto 61, CEP 01332-000, Tel.: (11) 3253-8711 - São Paulo - SP - Brazil
E-mail: revista@audiologiabrasil.org.br

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[1] Subtitle: ≥ = greater than or equal to; B1 = Qualis evaluation