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| |  Likert Superior to Visual Analogue Scale for Speech Assessment in Laryngeal Cancer Patients: Presented at AAO-HNSF By Kristina Rebelo SAN DIEGO -- October 9, 2009 -- When assessing rehabilitation needs for laryngeal cancer patients in areas of voice and speech, the Likert scale was found to be superior to the visual analogue scale (VAS) because VAS may produce instability in response patterns, according to a study presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting 2009. The ongoing study’s protocol called for the administration of VAS and Likert scales to 71 patients between 1998 and 2005 after treatment for stage 0 to IV laryngeal cancer. Investigators sought to determine whether the scales were different in terms of measuring changes after voice and speech issues were treated. Three aspects were investigated: speech intelligibility, voice quality, and speech acceptability. “We did not find any statistically significant differences, but the Likert scale was more stable. VAS seems to produce an instability in response patterns, which, in practice, does not necessarily imply a true change,” said Mia Johansson, MD, Sahlgrenska University Hospital, Gothenburg, Sweden, on October 7. A large deterioration in the median results was detected between pretreatment 1 (baseline) and 2 (visit to the speech language pathologist) in speech intelligibility in test and retest analyses with VAS, said Dr. Johansson. Because tumour growth would be too small to affect voice or speech, these deteriorations are difficult to detect clinically. Baseline questionnaires were distributed before treatment and 12 weeks after patients received their diagnosis. A follow-up assessment was made 12 months after treatment was initiated. Additional data were used from 21 of the patients for test-retest analyses. Nonparametric statistical methods were used. From baseline to follow-up, both Likert scores and VAS were reliable and detected significant improvements; however, the researchers found that for some of the Likert scores, the associated VAS values varied across a wide range at all assessments and for score changes. At baseline, the interscale concordance showed more disordered pairs than at follow-up. At both time points, older patients produced more disordered pairs. According to Dr. Johansson, one limitation of the study was that the scales were not administered randomly; the patients first had the Likert scale and then the VAS, with an instrument in between. Dr. Johansson also noted that some patients may have tried to match one scale to the other to be viewed as having consistent results. “However, this was contradictory to our results,” she said. “In fact, that would have given the opposite results from the wide range of VAS values associated with each Likert score.”
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