Adaptedness and coping in dysphagic students

Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia

BACKGROUND & AIMS

The aim of this study was to develop and evaluate the validity and reliability of a self-report inventory to measure symptomatic severity of oral-pharyngeal dysphagia.

METHODS

Test-retest reliability and face, content, and construct validity of a prototype visual analogue scale inventory were assessed in 45 patients who had stable, neuromyogenic dysphagia.

RESULTS

Normalized scores varied over time by -0.5% +/- 17.6% (95% confidence interval, -9.2% to 8.2%). Factor analysis identified a single factor (dysphagia), to which 18 of 19 questions contributed significantly, that accounted for 56% of total variance (P < 0.0001). After deletion of 2 questions with poor face validity and patient compliance, this proportion increased to 59%; mean test-retest change was -2% (95% confidence interval, -11% to 7%); and total score correlated highly with an independent global assessment severity score (r = 0.7; P < 0.0001). A mean 70% reduction in score (P < 0.0001) was observed after surgery in patients with Zenker's diverticulum (discriminant validity).

CONCLUSIONS

Applied to patients with neuromyogenic dysphagia, the 17-question inventory shows strong test-retest reliability over 2 weeks as well as face, content, and construct validity. Discriminant validity (responsiveness) has been demonstrated in a population with a correctable, structural cricopharyngeal disorder. Responsiveness of the instrument to treatment in neuromyogenic dysphagia remains to be quantified.

The experiential meaning of eating, handicap, adaptedness, and confirmation in living with esophageal dysphagia

This article is mainly based on interview studies of pensioners' (n = 62), patients' (n = 19), and students' (n = 87) experiences of living with longstanding esophageal dysphagia. The aim is to describe the experiential meaning of dysphagic patients' lives by interpreting their experiences, problems, and emotions and by specifying these into scales according to the model of goal-directed action by Pörn [43-49]. The experiential meaning will be articulated in terms of attainment or nonattainment of goals in relation to eating, handicap, adaptedness, and confirmation. In the experiential meaning of eating, the emphasis is on the attainment of nourishing goals or goals attained by means of food with desired hedonistic qualities and linked with feelings of hope or no hope of a shared life. The experiential meaning of handicap is interpreted as the dysphagic individual's experiences of an actual nonattainment of eating goals due to swallowing disabilities and with experiences of nonattainment of other important goals and related emotions; for example, shame for human incompetence. The experiential meaning of adaptedness is understood as the dysphagic individual's experiences of actual capacity for goal attainments interpreted as a sense of control in the daily living with dysphagia and linked with security, or in the negative case, reduced self-esteem and feelings of panic or fear. The experiential meaning of confirmation is interpreted as the dysphagic individual's experiences of actual or potential repertoire for goal attainment, i.e., self-assessment strengthened by evidence obtained in relationships linked with emotions of hope of self-realization. In conclusion, a specific model for understanding the dysphagic patient's concealment of dysphagia in the medical encounter has been developed.