First report on the reliability and validity of speech handicap index in ...

patients within the first six months of initial treatment and those over 80 years of age
were also excluded from the study.
Questionnaires
The development of the Dutch version of the Speech Handicap Index (SHI) was largely
based on the widely used and popular voice-specific scale the ‘Voice Handicap Index’
(VHI) 32 by Rinkel et al. 2 Consequently, our English version of SHI (Appendix) is on the
same lines. 32 It has 30 well-constructed questions to evaluate the patient’s speech and
psycho-social functions. These questions were adapted from the original manuscript of
the development and validation of the Dutch version of the SHI. Here the questions were
translated and then back-translated by expert professional translators to ensure that words
and nuances are correctly matched as was confirmed by the Dutch group. Our English
version of the SHI is based on a Likert five- point scale with response categories as never
(0); almost never (1); sometimes (2); almost always (3) and always (4). Total SHI score is
calculated by adding all the response numbers and can range from 0-120; higher scores
indicate more severe speech-related problems. In addition to these 30 questions, there is a
global question which rates the patient’s overall speech quality. Here there are four
response categories: excellent; good; average and bad which are scored as 0, 30, 70 and
100. Higher scores again indicate a greater speech problem.
For the purpose of validity, we have utilized the UWQOL V.04 as a comparative QOL
scale. This is a validated, widely-used, self-administered head and neck cancer-specific
questionnaire with 12 domains for evaluation, speech being one of them. Other domains
included are pain, appearance, activity, recreation, swallowing, chewing, shoulder
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