Screening for Voice Disorders in Older Adults (RAVI)—Part III: Cutoff Score and Clinical Consistency

Leandro Pernambuco, Albert Espelt, Kenio Costa de Lima

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)


© 2017 The Voice Foundation Aim The aim of the study was to determine the cutoff score and clinical consistency of “Screening for Voice Disorders in Older Adults” (RAVI—Rastreamento de Alterações Vocais em Idosos). Study Design This is a prospective, nonrandomized, cross-sectional diagnostic study. Methods A sample of 301 subjects, including both sexes, aged 60 and more, and all of whom were living in either a community or an institution, was studied. To determine which subjects had or did not have voice problems, we used a composite reference standard (auditory-perceptual analysis of sustained vowel phonation, auditory-perceptual analysis of connected speech, and vocal self-assessment). The best cutoff score was identified using the receiver operating characteristic (ROC) curve analysis. The clinical consistency indicators were co-positivity, co-negativity, positive and negative predictive values, positive and negative likelihood ratio, and test efficiency. The significance level was 5%. Results The area under the ROC curve was 0.763 (95% confidence interval: 0.706–0.821), and the best cutoff score for determining which older adults had or did not have a voice disorder was 2. All clinical consistency indicators were satisfactory: co-positivity (79%), co-negativity (60%), predictive positive value (51%), negative predictive value (84%), positive likelihood ratio (2.01), negative likelihood ratio (0.34), and test efficiency (69%). Conclusions RAVI has satisfactory indicators of clinical consistency and is able to determine which older adults have voice disorders by a cutoff score of 2. The use of RAVI as a screening tool is recommended to help determine the prevalence of voice disorders in older adults.
Original languageEnglish
Pages (from-to)117.e17-117.e22
JournalJournal of Voice
Issue number1
Publication statusPublished - 1 Jan 2017


  • aging
  • diagnostic studies
  • epidemiology
  • validation studies
  • voice disorders


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