Psychometric analysis of an ecological vocal effort scale in individuals with and without vocal hyperfunction during activities of daily living

Katherine L. Marks, Alessandra Verdi, Laura E. Toles, Kaila L. Stipancic, Andrew J. Ortiz, Robert E. Hillman, Daryush D. Mehta

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: The purpose of this study was to examine the psychometric properties of an ecological vocal effort scale linked to a voicing task. Method: Thirty-eight patients with nodules, 18 patients with muscle tension dysphonia, and 45 vocally healthy control individuals participated in a week of ambulatory voice monitoring. A global vocal status question was asked hourly throughout the day. Participants produced a vowel–consonant– vowel syllable string and rated the vocal effort needed to produce the task on a visual analog scale. Test–retest reliability was calculated for a subset using the intraclass correlation coefficient, ICC(A, 1). Construct validity was assessed by (a) comparing the weeklong vocal effort ratings between the patient and control groups and (b) comparing weeklong vocal effort ratings before and after voice rehabilitation in a subset of 25 patients. Cohen’s d, the standard error of measurement (SEM), and the minimal detectable change (MDC) assessed sensitivity. The minimal clinically important difference (MCID) assessed responsiveness. Results: Test–retest reliability was excellent, ICC(A, 1) = .96. Weeklong mean effort was statistically higher in the patients than in controls (d = 1.62) and lower after voice rehabilitation (d = 1.75), supporting construct validity and sensitivity. SEM was 4.14, MDC was 11.47, and MCID was 9.74. Since the MCID was within the error of the measure, we must rely upon the MDC to detect real changes in ecological vocal effort. Conclusion: The ecological vocal effort scale offers a reliable, valid, and sensitive method of monitoring vocal effort changes during the daily life of individuals with and without vocal hyperfunction.

Original languageEnglish (US)
Pages (from-to)2589-2604
Number of pages16
JournalAmerican Journal of Speech-Language Pathology
Issue number6
StatePublished - Nov 2021
Externally publishedYes

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Developmental and Educational Psychology
  • Linguistics and Language
  • Speech and Hearing


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