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Brazilian-Portuguese Linguistic Validation of the Velopharyngeal Insufficiency Effects on Life Outcome Instrument

Denadai, Rafael MD*; Raposo-Amaral, Cassio Eduardo MD, PhD*; Sabbag, Anelise SLP, Msc*; Ribeiro, Rafael Andrade CP, Msc*; Buzzo, Celso Luiz MD, Msc*; Raposo-Amaral, Cesar Augusto MD*; Hung, Man PhD†,‡; Skirko, Jonathan R. MD, MPH§

doi: 10.1097/SCS.0000000000005679
Original Articles

Background: The purpose of this study was to conduct a linguistic validation of the velopharyngeal insufficiency (VPI) Effects on Life Outcome (VELO) instrument for use in Brazilian-Portuguese patients with VPI.

Methods: The original English version of the VELO instrument was translated into Brazilian-Portuguese, back-translated, and adapted among the Brazilian patients (n = 21) with VPI and their parents, based on the standardized guidelines for the cross-culture adaption process. Discrepancies in the forward and backward translation steps were computed. Comprehension rates were captured for each debriefing interview. The content validity index (CVI) per item (I-CVI) and of the scale (S-CVI universal agreement [S-CVI/UA] and averaging [S-CVI/Ave]) were calculated.

Results: Reconciliation of the 2 forward translations and the comparison between the back translation and the original VELO version resulted in some item wordings with discrepancies which were reviewed by the research team (translators, expert committee, and original developers of instrument). Three rounds of cognitive interviews also led to some revisions of wording. Comprehension rates of patients and their parents were 60% to 100%, 80% to 100%, and 100% in the first, second, and third rounds of cognitive interviews, respectively. The I-CVI, S-CVI/AU, and SCI/Ave for the Brazilian-Portuguese VELO version were 0.83 (or higher), 0.83 (or higher), and 0.97, respectively.

Conclusions: The linguistic validation process of the VELO instrument created a cross-culturally equivalent Brazilian-Portuguese version for use in Brazilian-Portuguese speaking patients with VPI.

*Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, Brazil

College of Dental Medicine, Roseman University of Health Sciences, South Jordan

Department of Orthopaedic Surgery Operations, University of Utah

§Division of Pediatric Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT.

Address correspondence and reprint requests to Rafael Denadai, MD, Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Av. Adolpho Lutz, 100, Caixa Postal: 6028, Campinas, São Paulo CEP: 13084-880, Brazil; E-mail:

Received 25 February, 2019

Accepted 22 April, 2019

The authors have no funding and conflicts of interests to disclose.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 by Mutaz B. Habal, MD.