1
|
Cordier R, Joosten AV, Heijnen BJ, Speyer R. A Psychometric Evaluation of the Dysphagia Handicap Index Using Rasch Analysis. J Clin Med 2024; 13:2331. [PMID: 38673604 PMCID: PMC11050868 DOI: 10.3390/jcm13082331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. Methods: Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure's response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. Results: The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. Conclusions: The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred.
Collapse
Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE1 8ST, UK;
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | | | - Bas J. Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
| | - Renée Speyer
- Curtin School of Allied Health, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands;
- Department Special Needs Education, University of Oslo, NO-0371 Oslo, Norway
- MILO Foundation, Centre for Augmentative and Alternative Communication, 5482 JH Schijndel, The Netherlands
| |
Collapse
|
2
|
Manduchi B, Che Z, Ringash JG, Fitch MI, Howell D, Martino R. Patient-reported outcome measures for dysphagia in head and neck cancer: A systematic review and appraisal of content validity and internal structure. Head Neck 2024; 46:951-972. [PMID: 38356437 DOI: 10.1002/hed.27693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
Dysphagia is a major head and neck cancer (HNC) issue. Dysphagia-related patient-reported outcome measures (PROMs) are critical for patient-centred assessment and intervention tailoring. This systematic review aimed to derive a comprehensive inventory of HNC dysphagia PROMs and appraise their content validity and internal structure. Six electronic databases were searched to February 2023 for studies detailing PROM content validity or internal structure. Eligible PROMs were those developed or validated for HNC, with ≥20% of items related to swallowing. Two independent raters screened citations and full-text articles. Critical appraisal followed COSMIN guidelines. Overall, 114 studies were included, yielding 39 PROMs (17 dysphagia-specific and 22 generic). Of included studies, 33 addressed PROM content validity and 78 internal structure. Of all PROMs, only the SOAL met COSMIN standards for both sufficient content validity and internal structure. Notably, the development of 18 PROMs predated the publication of COSMIN standards. In conclusion, this review identified 39 PROMs addressing dysphagia in HNC, of which only one met COSMIN quality criteria. Given that half of PROMs were developed prior to COSMIN guidelines, future application of current standards is needed to establish their psychometric quality.
Collapse
Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Zhiyao Che
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- The Swallowing Lab, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Li D, Huang Y, Wu F, Huang Q, Liu Y, Yao J, Shen N, Wang Y, Yu L, Yuan C, Zhang W. Simplified Chinese version of the PROMIS Pediatric-25 profile: A validation study among cancer children. J Pediatr Nurs 2024; 75:e1-e9. [PMID: 38212174 DOI: 10.1016/j.pedn.2023.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/26/2023] [Accepted: 11/26/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE Pediatric cancer is a significant health concern in China, and evaluating the impact of cancer and its treatment on the well-being of young patients is essential for both clinical care and research purposes. This study aimed to psychometrically validate the Patient-reported Outcomes Measurement Information System Pediatric-25 Profile (PROMIS-Pediatric-25) among Chinese children with cancer. DESIGN AND METHODS We enrolled a group of 114 children living with cancer between the ages of 8 and 17. Each participant completed questionnaires that covered sociodemographic and clinical information and the PROMIS-Pediatric-25. The floor and ceiling effect was examined. Cronbach's alpha and split-half coefficient were examined to determine the reliability. Factor structure was explored by factor analysis. Three assumptions of Rasch model-based item response theory (IRT) were assessed. Differential item functioning (DIF) was investigated concerning factors of gender, diagnosis, and treatment stage. RESULTS The floor or ceiling effects were detected for six domains. The reliability was found to be excellent. Furthermore, the factor structure of these six domains was validated. Our analysis confirmed that the assumptions required for IRT were met with acceptable unidimensionality, local independence, and good monotonicity. Additionally, we observed measurement equivalence, with outstanding levels of DIF across factors such as gender, diagnosis, and treatment stage. CONCLUSION PROMIS-Pediatric 25 is a highly reliable and valid instrument for evaluating key domains of health-related quality of life in Chinese pediatric cancer patients. PRACTICE IMPLICATION Nursing practice could engage the PROMIS-Pediatric 25 for accurate and quick children symptom and function assessment.
Collapse
Affiliation(s)
- Danyu Li
- School of Nursing, Fudan University, Shanghai, China
| | - Yueshi Huang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fulei Wu
- School of Nursing, Fudan University, Shanghai, China
| | - Qingmei Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Yang Liu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Yao
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Nanping Shen
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingwen Wang
- Children's Hospital of Fudan University, Shanghai, China
| | - Ling Yu
- Children's Hospital of Fudan University, Shanghai, China
| | | | - Wen Zhang
- School of Nursing, Fudan University, Shanghai, China.
| |
Collapse
|
4
|
Dantas RO, Alves LMT, Silva ACV, Cassiani RA, Alves DC, Nascimento WV. Eating Assessment Tool (EAT-10) Scores to Detect Self-Reported Dysphagia in Brazilians. Dysphagia 2023; 38:1609-1614. [PMID: 37272949 DOI: 10.1007/s00455-023-10588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
The Eating Assessment Tool (EAT-10) detects swallowing impairments (dysphagia) self-reported by patients according to their perception. This noninvasive, inexpensive, self-administered instrument is quickly and easily filled out. The objective of this investigation was to evaluate the scores, sensitivity, and specificity of the method to define self-reported dysphagia in Brazilians. EAT-10 scores were evaluated in 443 healthy individuals (273 women and 170 men), aged 20 to 84 years, with no swallowing difficulties or diseases, and 72 patients with diseases that cause dysphagia (35 women and 37 men), aged 29 to 88 years. Each of the 10 instrument items has a 0-4 rating scale, in which 0 indicates no problem and 4, a severe problem; total results range from 0 to 40. The median EAT-10 score of healthy subjects was 0 (range: 0-20), and that of patients was 14.5 (range: 1-40). Considering a ≥ 3 cutoff score to define dysphagia risk, it was self-reported by 97.2% of patients with dysphagia and 9.5% of no-disease individuals (97.2% sensitivity and 90.7% specificity). The positive predictive value of the test was 63% and the negative predictive value was 99.5%. Healthy women had higher scores (median 0, range: 0-20) than healthy men (median 0, range: 0-8, p < 0.01) and more results indicative of self-reported dysphagia (11.7%) than healthy men (5.9%). The EAT-10 cutoff score to detect self-reported dysphagia in Brazilians should be 3, as previously considered. Healthy women complain more of self-reported dysphagia than healthy men. The test has high sensitivity and specificity.
Collapse
Affiliation(s)
- Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
- , Ribeirão Preto, Brazil.
| | | | | | | | | | - Weslania Viviane Nascimento
- Laboratory of Gastrointestinal Physiology, Department of Surgery, Hospital of Mataró, Universitat Autonoma de Barcelona, Mataró, Spain
| |
Collapse
|
5
|
Kim GY, Cho YS, An JH, Kim JW, Moon IJ. Rasch Analysis of the Korean Version of the Tinnitus Handicap Inventory. J Clin Med 2023; 12:5785. [PMID: 37762724 PMCID: PMC10531739 DOI: 10.3390/jcm12185785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Tinnitus is the perception of abnormal sounds in the ears or head without external auditory stimulation. While classical test theory is often used in tinnitus questionnaire development, it has limitations in assessing item characteristics. Item response theory (IRT) offers more precise individual ability estimations and identifies key and less important items, making it superior for reliable measurement tools. This study investigated the suitability of the Korean version of the Tinnitus Handicap Inventory (K-THI) as a patient-reported outcome measure (PROM) for clinical trials. Using Rasch analysis based on IRT, we evaluated K-THI's measurement of tinnitus-related disability in 545 patients (40.4% men, 59.6% women). Five items (2, 7, 8, 19, and 24) did not fit the Rasch model, yet a unidimensional scale and good fit for person and item data emerged (person: 0.89; item: 0.98). The three-point rating scale in K-THI proved suitable. IRT allowed precise evaluation of K-THI's properties, vital for reliable PROMs in patient-centered care. Our findings highlight IRT's role in questionnaire development, contributing to the advancement of PROMs.
Collapse
Affiliation(s)
- Ga-Young Kim
- Hearing Research Laboratory, Samsung Medical Center, Seoul 06351, Republic of Korea; (G.-Y.K.); (Y.S.C.)
- Medical Research Institute, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Young Sang Cho
- Hearing Research Laboratory, Samsung Medical Center, Seoul 06351, Republic of Korea; (G.-Y.K.); (Y.S.C.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Ji Hyun An
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea;
| | - Jung-Wan Kim
- Department of Speech and Language Pathology, College of Rehabilitation Sciences, Daegu University, Gyeongsan 38453, Republic of Korea;
| | - Il Joon Moon
- Hearing Research Laboratory, Samsung Medical Center, Seoul 06351, Republic of Korea; (G.-Y.K.); (Y.S.C.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea
| |
Collapse
|
6
|
Li D, Zong X, Huang Q, Wu F, Huang Y, Ge Y, Zhang W, Yuan C. Validation of the simplified Chinese version of PROMIS Parent Proxy-25 Profile in parents of children with cancer. J Pediatr Nurs 2023; 72:e19-e26. [PMID: 37331836 DOI: 10.1016/j.pedn.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE To determine the psychometric properties of the Patient-reported Outcomes Measurement Information System Parent Proxy-25 Profile (PROMIS-25) in a sample of Chinese parents of children with cancer. DESIGN AND METHODS A cross-sectional sample (N = 148) of parents with children aged 5-17 years living with cancer was recruited. Each participant completed sociodemographic and clinical questionnaires and PROMIS-25. The flooring and ceiling effects were calculated. Reliability was determined by the Cronbach's alpha and split-half coefficient. Factor structure was examined by factor analysis. Model fit and graphical plots were assessed to test the assumptions of Rasch model-based item response theory (IRT). Differential item functioning (DIF) was assessed in terms of gender, age, and treatment stage. RESULTS PROMIS-25 demonstrated some flooring and ceiling effect, excellent reliability (Cronbach's α > 0.7 for all six domains), and the six-domain factor structure was supported. The IRT assumptions were met in terms of unidimensionality, local independence, monotonicity, and measurement equivalence with acceptable DIF in terms of gender, age, diagnosis, and treatment stage. CONCLUSION PROMIS-25 is a highly reliable and valid instrument for evaluating children with cancer that assesses important health-related quality of life domains of child cancer. PRACTICE IMPLICATION Chinese parents of children with cancer and healthcare providers could use PROMIS-25 to assess the symptoms of children.
Collapse
Affiliation(s)
- Danyu Li
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China; School of Nursing, Fudan University, Shanghai, China
| | - Xuqian Zong
- School of Nursing, Fudan University, Shanghai, China
| | - Qingmei Huang
- School of Nursing, Fudan University, Shanghai, China
| | - Fulei Wu
- School of Nursing, Fudan University, Shanghai, China
| | - Yueshi Huang
- Department of Nursing, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Youhong Ge
- Department of Hematology, Children's Hospital of Fudan University, Shanghai, China
| | - Wen Zhang
- School of Nursing, Fudan University, Shanghai, China.
| | | |
Collapse
|
7
|
Jackson R, Jordan JT. Reliable change in developmental outcomes of Brain Balance ® participants stratified by baseline severity. Front Psychol 2023; 14:1171936. [PMID: 37674742 PMCID: PMC10478577 DOI: 10.3389/fpsyg.2023.1171936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023] Open
Abstract
The effects of comprehensive multimodal programs on developmental outcomes have not been well-studied. Emerging evidence suggests a possible role for the Brain Balance® (BB) program, a multimodal training program, in serving as a nonpharmacologic approach to addressing cognitive, attentional, and emotional issues in youth. In this analysis, we examined the effects of 3 months of participation in the BB program on the outcomes of children and adolescents with developmental difficulties (N = 4,041; aged 4-18 years; 69.7% male). Parent-rated scores on the Brain Balance-Multidomain Developmental Survey (BB-MDS) were used to assess six areas at baseline and post-program: (1) negative emotionality; (2) reading/writing difficulties; (3) hyperactive/disruptive behavior; (4) academic disengagement; (5) motor/coordination problems; and (6) social communication problems. To estimate change from pre- to post-program, we calculated effect size (Cohen's d) and the Reliable Change Index (RCI) for groups stratified by baseline severity. There was a very large effect size for the moderate/high severity (d = 1.63) and extreme severity (d = 2.08) groups, and a large effect size for the mild severity group (d = 0.87). The average percentage of participants who observed reliable change over all BB-MDS domains was 60.1% (RCICTT) for extreme severity, 46.6% (RCICTT) for moderate/high severity, and 21.1% (RCICTT) for baseline mild severity. In additional assessments of primitive reflexes and sensory motor activity, students demonstrated significantly diminished primitive reflexes from pre- to post-participation and significant improvements in sensory motor skills including fine motor skills, gait and aerobic ability, proprioception, rhythm and timing, and eye-gaze stability. Overall, these results demonstrate improvements in primitive reflex integration and sensory motor skills, as well as statistically significant reliable change in emotionality, reading/writing, behavior, academic engagement, motor skills, and social communication in BB participants from pre- to post-program, with the probability and degree of change increasing as the participants' baseline severity increases. These results contribute to the growing literature on the need for evidence-based nonpharmacologic approaches to addressing developmental issues. Future research with well-controlled designs, longitudinal follow-up, implementation across settings, and participant groups in which diagnoses are known, will help to more fully characterize the effects of the BB program.
Collapse
Affiliation(s)
- Rebecca Jackson
- Brain Balance Achievement Centers, Naperville, IL, United States
| | - Joshua T. Jordan
- Department of Psychology, Dominican University of California, San Rafael, CA, United States
| |
Collapse
|
8
|
Selvaraj JL, Venkatesh L, Varadharajan V, Chandrasekar K, Srinivas S, John C. Development and Evaluation of the Psychometric Properties of the Tamil Version of Eating Assessment Tool - 10 (EAT-10): Preliminary Findings from Persons with Head and Neck Cancer. Indian J Otolaryngol Head Neck Surg 2023; 75:632-640. [PMID: 37275015 PMCID: PMC10234939 DOI: 10.1007/s12070-022-03376-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Aims: This study aimed to develop and evaluate the psychometric properties of the Tamil version of the Eating Assessment Tool (EAT-10). Setting & Study Design: Prospective cross-sectional study on persons with Head and Neck Cancer (HNC) during their follow-up for oncological and swallowing consultation at a tertiary care hospital and healthy individuals recruited from the community. Methods: The study was conducted in two phases: (1) translation and development of the Tamil version of EAT-10 and (2) administration of Tamil EAT-10 to assess internal consistency reliability, test-retest reliability and known-group validity. 92 participants with HNC in the clinical group and 149 healthy adults in the control group completed the Tamil EAT-10. In addition, a subgroup of 20 participants with HNC repeated the questionnaire within a week to assess test-retest reliability. Results: The Cronbach alpha for the 10 items was 0.96 indicating high internal consistency reliability. The test-retest reliability of the individual items and the total scores (r = 0.98) of the Tamil version of EAT-10 were high. The total EAT-10 scores for the HNC group (14.4 ± 11.5) were significantly higher (p < 0.001) than the scores for healthy adults (0.72 ± 2.0). Conclusion: The Tamil version of the EAT-10 developed in this study is a reliable and valid self-administered tool for identifying concerns related to swallowing among persons treated for HNC and healthy adults. This tool can be implemented for clinical practice and research in dysphagia among a Tamil-speaking population. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03376-8.
Collapse
Affiliation(s)
- Jasmine Lydia Selvaraj
- Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), 600116 Porur, Chennai, India
| | - Lakshmi Venkatesh
- Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), 600116 Porur, Chennai, India
| | - Vasudharany Varadharajan
- Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), 600116 Porur, Chennai, India
| | - Kavyashree Chandrasekar
- Sri Ramachandra Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), 600116 Porur, Chennai, India
| | - Satish Srinivas
- Department of Radiation Oncology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| | - Christopher John
- Department of Radiation Oncology, Sri Ramachandra Medical College & Research Institute, Sri Ramachandra Institute of Higher Education & Research, Porur, Chennai, India
| |
Collapse
|
9
|
Kashima K, Watanabe K, Sato T, Katori Y. Analysis of Dysphagia and Cough Strength in Patients with Unilateral Vocal Fold Paralysis. Dysphagia 2023; 38:510-516. [PMID: 33728514 DOI: 10.1007/s00455-021-10274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
The association between swallowing function and cough strength in patients with unilateral vocal fold paralysis (UVFP) is unknown. We evaluated the relationship between voluntary cough strength and dysphagia among patients with UVFP (UVFP group) by comparing their data with that of corresponding healthy participants (healthy control [HC] group) in a prospective observational study. From February 1st, 2018 to March 30th, 2019, we recruited patients with a voice disorder due to UVFP, who were referred to our university hospital. Patients with a history of laryngeal surgery, vagal nerve paralysis, or cardiac and respiratory failure were excluded. Descriptive and clinical data regarding swallowing, voice, and cough peak flow (CPF) were collected as a measure of cough strength. The UVFP group comprised six women and seven men (median age, 68.0 years), and the HC group comprised six women and eight men (median age 65.5 years). The groups differed significantly in the Eating Assessment Tool (EAT)-10 scores and CPF rates (P < 0.001). Among patients with UVFP, 84.6% had an abnormal EAT-10 score of ≥ 3. Additionally, 16.7% of the patients exhibited liquid aspiration with contrast medium on a videofluorographic swallowing study (VFSS). There was no correlation between the CPF values, EAT-10 scores, or the VFSS results. Therefore, patients with severe UVFP, whose condition had been fixed, had difficulties when swallowing (85% of cases), and some even presented with aspiration on VFSS (20% of cases), while receiving a regular diet.
Collapse
Affiliation(s)
- Kazutaka Kashima
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Kenichi Watanabe
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takeshi Sato
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| |
Collapse
|
10
|
Analysis of electrophysiological and mechanical dimensions of swallowing by non-invasive biosignals. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
11
|
Rivelsrud MC, Hartelius L, Bergström L, Løvstad M, Speyer R. Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses. Dysphagia 2023; 38:76-121. [PMID: 35639156 PMCID: PMC9873728 DOI: 10.1007/s00455-022-10465-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/29/2022] [Indexed: 01/28/2023]
Abstract
Oropharyngeal dysphagia (OD) is prevalent in the elderly and persons with complex medical conditions, resulting in considerable medical and psychosocial consequences and reduced quality of life. Many prevalence studies regard OD in relation to age or diagnosis. Knowledge on the prevalence of OD in different healthcare settings is lacking. This systematic review aimed to estimate the prevalence of OD in adults admitted to hospitals, rehabilitation facilities, nursing homes, and palliative care facilities through meta-analyses. A systematic literature search was completed including all dates up to March 30, 2021. The methodology and reporting were based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Forty-four out of 1,956 screened articles were deemed eligible. Considerable heterogeneity in definitions of OD and type and quality of selected outcome measures were observed. Overall within-group pooled prevalence estimates for OD determined by meta-analysis were 36.5% (95% CI 29.9 - 43.6) in the hospital setting, 42.5% (95% CI 35.8 - 49.5) in the rehabilitation setting, and 50.2% (95% CI 33.3-67.2) in nursing homes. No OD prevalence data were identified for palliative care facilities. Results for between-group analyses of OD prevalence estimates in the hospital setting were non-significant for type of assessment method, diagnostic group, and type of hospital ward, but indicated significantly higher prevalence estimates in nursing homes when using screening compared to patient-report. Future research should provide OD prevalence data for palliative care, achieve consensus in OD-related terminology when performing prevalence studies, and use screening and assessments with optimal diagnostic performance and psychometric properties.
Collapse
Affiliation(s)
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Liza Bergström
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Speech Pathology, Division of Neurology, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
- REMEO Stockholm, Stockholm, Sweden
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, the Netherlands
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| |
Collapse
|
12
|
Moloney J, Regan J, Walshe M. Patient Reported Outcome Measures in Dysphagia Research Following Stroke: A Scoping Review and Qualitative Analysis. Dysphagia 2023; 38:181-190. [PMID: 35467246 PMCID: PMC9873730 DOI: 10.1007/s00455-022-10448-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/28/2022] [Indexed: 01/28/2023]
Abstract
Patient reported outcome measures (PROMs) are commonly used to evaluate the impact of a health condition on quality of life (QOL). This study aimed to identify the range of PROMs that are currently in common use in clinical trials in dysphagia following stroke and to qualitatively analyse these PROMs by mapping the content to both the International Classification of Functioning and Disability Framework (ICF) and the Core Outcome Measures in Effectiveness Trials (COMET) Taxonomy for outcome classification. With consideration for the PRISMA-ScR checklist, a scoping review was conducted to identify commonly used PROMs in randomised controlled trials reported in persons with dysphagia stroke. A search of five databases was conducted. Studies were excluded if they included pediatric participants i.e. < 18 years of age, or if the text was not available in the English language. 110 papers met the inclusionary criteria. Twelve of these 110 papers included a dysphagia PROM. Two PROMs were identified as being in common use-the SWAL-QOL and the EAT-10. These two tools consisted of 47 items and 78 meaningful concepts, which were subsequently mapped to the ICF and the COMET Taxonomy. Mapping to the ICF showed that neither tool directly assessed the impact of 'Environmental Factors' on the experience of dysphagia. Mapping to the COMET Taxonomy showed that neither tool considered the impact of 'Role Functioning' on the person's experience of dysphagia. The development of a suitable and appropriate patient-reported assessment tool for use in those with dysphagia following stroke is warranted.
Collapse
Affiliation(s)
- Jennifer Moloney
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
| |
Collapse
|
13
|
Zhang PP, Yuan Y, Lu DZ, Li TT, Zhang H, Wang HY, Wang XW. Diagnostic Accuracy of the Eating Assessment Tool-10 (EAT-10) in Screening Dysphagia: A Systematic Review and Meta-Analysis. Dysphagia 2023; 38:145-158. [PMID: 35849209 PMCID: PMC9873714 DOI: 10.1007/s00455-022-10486-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023]
Abstract
The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82-0.93), 0.59 (95% CI 0.39-0.77), 2.17 (95% CI 1.38-3.42), 0.19 (95% CI 0.13-0.29), and 11.49 (95% CI 5.86-22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68-0.94), 0.82 (95% CI 0.65-0.92), 4.84 (95% CI 1.72-13.50), 0.18 (95% CI 0.07-0.46), and 26.24 (95% CI 5.06-135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82-0.93) and 0.903 (95% CI 0.88-0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.
Collapse
Affiliation(s)
- Ping-Ping Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Ying Yuan
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - De-Zhi Lu
- School of Medical, Shanghai University, 99 Shangda Road, Shanghai, China
| | - Ting-Ting Li
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hui Zhang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Hong-Ying Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China
| | - Xiao-Wen Wang
- School of Rehabilitation Medicine, Weifang Medical University, 7166 Baotong West Street, Weifang, Shandong, China.
- Rehabilitation Department, Affiliated Hospital of Weifang Medical College, 518 Fuyuan Street, Weifang, Shandong, China.
| |
Collapse
|
14
|
Fedecostante M, Dell'Aquila G, Cherubini A. Editorial: Screening for Dysphagia: Time Is Now! J Nutr Health Aging 2023; 27:593-594. [PMID: 37702328 DOI: 10.1007/s12603-023-1960-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 09/14/2023]
Affiliation(s)
- M Fedecostante
- Antonio Cherubini, Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento. IRCCS INRCA, Ancona, Italy,
| | | | | |
Collapse
|
15
|
Schindler A, de Fátima Lago Alvite M, Robles-Rodriguez WG, Barcons N, Clavé P. History and Science behind the Eating Assessment Tool-10 (Eat-10): Lessons Learned. J Nutr Health Aging 2023; 27:597-606. [PMID: 37702330 DOI: 10.1007/s12603-023-1950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/31/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is an underdiagnosed medical condition with a high prevalence in populations such as patients with frailty, neurological disease, or head and neck pathology. Potential barriers to its diagnosis include lack of (or low) awareness of the existence and severity of the condition, the hidden nature of the condition within the 'normal ageing' process, clinical limitations, and socioeconomic reasons. Consequently, an effective treatment is not systematically offered in a timely manner, and complications, such as dehydration and respiratory infections or aspiration pneumonia, can arise. To overcome this issue, the early use of screening questionnaires to identify people at risk of swallowing disorders represents the cornerstone of preventive medicine. Several screening tools have been created but few are widely used in clinical practice. The Eating Assessment Tool-10 (EAT-10) was developed as a quick, easy-to-understand, and self-administered screening tool for OD. METHODS A literature review was conducted in five databases with no restrictions on the language, date of publication, or design of the study to identify aspects of the validation, applicability, and usefulness of EAT-10. RESULTS AND CONCLUSIONS Transcultural adaptation and translation studies, as well as studies involving various types of patients with dysphagia in different settings have shown the validity and reliability of EAT-10 in relation to the gold standard and other validation tools. The use of this standardised screening tool could be used as a primary screening instrument of dysphagia in routine clinical practice across a wide range of diseases and settings and thereby increase the likelihood of early diagnosis and management of a condition that lead to serious complications and impaired quality of life.
Collapse
Affiliation(s)
- A Schindler
- William Gildardo Robles-Rodriguez FUCS: Fundacion Universitaria de Ciencias de la Salud, Colombia,
| | | | | | | | | |
Collapse
|
16
|
Ghelichi L, Hashemian M, Nakhostin Ansari N, Tarameshlu M. Cross-cultural Adaption, Validation and Factor Analysis of the Persian Version of the Eating Assessment Tool: EAT-10. Dysphagia 2022; 37:1511-1518. [PMID: 35132473 DOI: 10.1007/s00455-021-10405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/28/2021] [Indexed: 02/05/2023]
Abstract
The eating assessment tool (EAT-10) is a self-reported questionnaire to assess the patient's perception of swallowing difficulties. The aim of this study was to cross-culturally adapt and determine validity and reliability of the Persian version of the EAT-10 (P-EAT-10) in patients with oropharyngeal dysphagia. The EAT-10 was translated into Persian language and cross-culturally adapted. One hundred patients with dysphagia (mean age ± SD = 44.44 ± 14.69 years) participated. The test-retest reliability (time interval = 7 days) was assessed in 50 patients. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and smallest detectable change (SDC) were analyzed. The Persian version of functional oral intake scale (FOIS-P) was also recorded to assess construct validity. One hundred healthy subjects completed the P-EAT-10 for clinical validity. Factor analysis was performed to determine the P-EAT-10 structure. There were no missing responses and floor or ceiling effects. Internal consistency was high (Cronbach's α 0.91). Item-total correlations exceeded acceptable standard of 0.3 for the all items (0.62-0.83). The test-retest reliability was excellent [(ICC)agreement 0.96]. The SEM and SDC were 2.61 and 7.23, respectively. Construct validity was confirmed by a significant correlation between the P-EAT-10 and FOIS-P scores (r = 0.84). Clinical validity was supported by a significant discrimination between patients and healthy subjects (t = 29.97, P < 0.001). Factor analysis indicated 2 components for the P-EAT-10. The P-EAT-10 is a valid and reliable tool and can be used in clinic and research for the assessment of oropharyngeal dysphagia in Persian-speaking patients.
Collapse
Affiliation(s)
- Leila Ghelichi
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Hashemian
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tarameshlu
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
17
|
Donohue C, Tabor Gray L, Anderson A, DiBiase L, Chapin J, Wymer JP, Plowman EK. Discriminant Ability of the Eating Assessment Tool-10 to Detect Swallowing Safety and Efficiency Impairments. Laryngoscope 2022; 132:2319-2326. [PMID: 35137963 DOI: 10.1002/lary.30043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/07/2022] [Accepted: 01/21/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS Quick, sensitive dysphagia screening tools are necessary to identify high-risk patients for further evaluation in busy multidisciplinary amyotrophic lateral sclerosis (ALS) clinics. We examined the relationship between self-perceived dysphagia using the validated Eating Assessment Tool-10 (EAT-10) and videofluoroscopic analysis of swallowing safety and efficiency. STUDY DESIGN Prospective, observational, longitudinal study. METHODS Individuals with ALS completed the EAT-10 and a videofluoroscopic swallowing study. Duplicate, independent, blinded analyses of the validated Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale were performed to index swallowing safety and efficiency (mild dysphagia: DIGEST ≥ 1, moderate dysphagia: DIGEST ≥ 2). A between-groups analysis of variance with Games-Howell test for post-hoc pairwise comparisons was performed to examine EAT-10 scores across dysphagia severity levels. Receiver operator characteristic curve analysis, area under the curve (AUC), sensitivity, specificity, positive-negative predictive values (PPV, NPV), and odds ratios (OR) were derived. RESULTS Four hundred and thirty five paired EAT-10 and DIGEST scores were analyzed. Mean EAT-10 score was 8.48 (95% confidence interval [CI]: 7.63-9.33). Individuals with dysphagia demonstrated higher EAT-10 scores (mild: 4.1 vs. 11.3, moderate: 6.0 vs. 17.5, P < .001). Mean EAT-10 scores increased across DIGEST levels (D0: 4.1, D1: 7.9, D2: 15.1, D3: 20.4, D4: 39.0). For mild dysphagia, an EAT-10 cut score of 3 was optimal: AUC 0.74 (95% CI: 0.69-0.78; sensitivity: 77%; specificity: 53%; PPV: 71%; NPV: 60%; OR: 3.5). An EAT-10 cut score of 7 optimized detection of moderate dysphagia: AUC 0.83 (95% CI: 0.78-0.87; sensitivity: 81%; specificity: 66%; PPV: 39%; NPV: 93%; OR: 8.1). CONCLUSION The EAT-10 is an easy-to-administer dysphagia screening tool with good discriminant ability for use in ALS clinics. LEVEL OF EVIDENCE 2 Laryngoscope, 132:2319-2326, 2022.
Collapse
Affiliation(s)
- Cara Donohue
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A.,Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida, U.S.A
| | - Lauren Tabor Gray
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A.,Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida, U.S.A
| | - Amber Anderson
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A
| | - Lauren DiBiase
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A
| | - Jennifer Chapin
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A
| | - James P Wymer
- Department of Neurology, University of Florida, Gainesville, Florida, U.S.A
| | - Emily K Plowman
- Aerodigestive Research Core Laboratory, University of Florida, Gainesville, Florida, U.S.A.,Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida, U.S.A.,Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida, U.S.A.,Department of Neurology, University of Florida, Gainesville, Florida, U.S.A.,Department of Surgery, University of Florida, Gainesville, Florida, U.S.A
| |
Collapse
|
18
|
Slovak Translation and Cross-Cultural Validation of the Eating Assessment Tool (EAT10 ®). J Clin Med 2022; 11:jcm11195966. [PMID: 36233831 PMCID: PMC9570619 DOI: 10.3390/jcm11195966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: The objective of the study was the language adaptation and verification of psychometric properties of the Slovak version of the EAT10® questionnaire. Methods: The original English version of the questionnaire was translated into the Slovak language. The research group included 136 control participants and 51 dysphagic patients. Test−retest reliability, item analysis, internal consistency, construct and clinical validity, and Receiver Operating Characteristic (ROC) analysis were performed to verify the psychometric properties of the Slovak EAT10®. Results: The internal consistency assessed with Cronbach’s alpha is excellent (α = 0.94). Statistical analysis of the Slovak version of EAT10® showed excellent reliability (0.91, p < 0.001) in the test−retest. Through item-to-total correlation, we found out that all items significantly correlated with the overall score in EAT10®. Factor analysis proved a high construct validity. The EAT10® questionnaire was able to reveal a latent variable: a swallowing disorder, which was affecting a group of patients. The clinical validity results confirmed statistically significant differences in the mean scores of the control and dysphagic groups (z = −10.30; p < 0.001). By dividing the dysphagic group into four subgroups (Head and Neck Cancer, Extraesophageal Reflux, Iatrogenic, and Neurological) there were nonsignificant differences in the mean scores of the subgroups. The cut-off value for the Slovak EAT10® is three points. Conclusion: The Slovak EAT10® is a valid and reliable tool designed for the subjective assessment of oropharyngeal dysphagia in patients.
Collapse
|
19
|
Rech RS, de Goulart BNG, Dos Santos KW, Marcolino MAZ, Hilgert JB. Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis. Aging Clin Exp Res 2022; 34:2945-2961. [PMID: 36207669 DOI: 10.1007/s40520-022-02258-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. METHODS The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). RESULTS The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). CONCLUSION One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.
Collapse
Affiliation(s)
- Rafaela Soares Rech
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Karoline Weber Dos Santos
- Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Miriam Allein Zago Marcolino
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Graduate Studies Program in Epidemiology, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil. .,Graduate Studies Program in Dentistry, Faculty of Dentistry, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil. .,Department of Preventive and Social Dentistry, Faculty of Dentistry, Universidade Federal Do Rio Grande Do Sul, Brazil, Rio Grande do Sul, Porto Alegre, Santa Cecília, Ramiro Barcelos, 2492.
| |
Collapse
|
20
|
Papini NM, Jung M, Cook A, Lopez NV, Ptomey LT, Herrmann SD, Kang M. Psychometric properties of the 26-item eating attitudes test (EAT-26): an application of rasch analysis. J Eat Disord 2022; 10:62. [PMID: 35509106 PMCID: PMC9069796 DOI: 10.1186/s40337-022-00580-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/15/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The 26-item Eating Attitudes Test (EAT-26) is a commonly used tool to assess eating disorder risk. The purpose of this study was to examine the psychometric properties of the EAT-26 with a combined sample: (1) of adults with overweight and obesity enrolled in a behavioral weight loss program and (2) general adult sample (n = 469; age = 36.17 ± 17.83 years; female = 72.5%; white = 66.3%; obese BMI category = 58%). METHODS Rasch modeling was used to assess model-data fit, create an item-person map to evaluate relative distribution items and persons, item difficulty, and person's eating disorder (ED) risk level of the EAT-26. Differential item functioning (DIF) and rating scale functioning of the EAT-26 were also evaluated using Rasch analysis. RESULTS A total of 7 misfit items were removed from the final analysis due to unacceptable Infit and Outfit mean square residual values. The item-person map showed that the items were biased toward participants with moderate to high levels of ED risk and did not cover those who had low risk for having an ED (< - 1 logits). The DIF analyses results showed that none of the items functioned differently across sex, but 5 items were flagged based on obesity status. The six-category Likert-type rating scale did not function well indicating a different response format may be needed. CONCLUSION Several concerns were identified with the psychometric evaluation of the EAT-26 that may question its utility in assessing ED risk in individuals at low risk for ED, within samples of people who have overweight and obesity seeking weight loss treatment. The 26-item Eating Attitudes Test is a self-rated measure of eating attitudes that measures symptoms and concerns of eating disorders (ED). Very little is known about how this instrument performs differently based on individual factors like body mass index (BMI) and sex (male/female). We used an advanced measurement theory (i.e., Rasch analysis) to determine if the EAT-26 is an adequate measure to detect disordered eating in men and women of different BMIs. Results indicated that the EAT-26 was biased toward participants with moderate to high levels of disordered eating risk and did not adequately detect individuals at low risk for disordered eating. The EAT-26 did not function differently based on sex (male/female). However, five questions did function differently based on obesity status (those without obesity/ those with obesity). Finally, we observed the six-category rating scale did not function appropriately and that a new response format may be warranted. In sum, there were several issues (e.g., poor rating scale and different item functioning) with the EAT-26 and future work should develop screening tools that detect low risk of disordered eating as well as function well in adults with overweight and obesity.
Collapse
Affiliation(s)
- Natalie M Papini
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA.
| | - Myungjin Jung
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
| | - Amanda Cook
- Volunteer Behavioral Health Care System, Murfreesboro, TN, USA
| | - Nanette V Lopez
- Department of Health Sciences, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86001, USA
| | - Lauren T Ptomey
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, The University of Mississippi, University, MS, USA
| |
Collapse
|
21
|
Is There a Correlation Between NRS-2002 and EAT-10 Score? TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Lee EH, Lee YW, Kang HJ. Psychometric properties of the revised Diabetes Knowledge Test using Rasch analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:851-857. [PMID: 34284912 DOI: 10.1016/j.pec.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The revised Diabetes Knowledge Test (DKT2) is the instrument that is the most widely used for measuring diabetes knowledge; nevertheless, its structural validity has never been evaluated. This study aimed to determine the psychometric properties of the DKT2. METHODS This study performed a secondary data analysis of people with diabetes recruited at university hospitals. Rasch analysis was used. RESULTS One item in the 14-item DKT2 measuring general diabetes knowledge exhibited a poor-fit, and so it was eliminated. The person-item map showed that items of greater difficulty need to be added to the instrument. The principal-components analysis of residuals revealed a unidimensional structure. The person reliability was 0.50, with a person separation index of 1.01. Measurement invariance was not satisfied for items 11 and 2 according to gender and age. CONCLUSIONS The unidimensional structure of the 13-item DKT2 demonstrated poor person reliability and a low person separation index. Females and elderly persons found it more difficult to respond to items 11 and 2, respectively. PRACTICE IMPLICATIONS Careful consideration is necessary when using the 13-item DKT2 in practice and research. It is recommended for future studies to add items of greater difficulty to the instrument.
Collapse
Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea.
| | - Young Whee Lee
- Department of Nursing, Inha University, Incheon, Republic of Korea.
| | - Hyun-Jung Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea.
| |
Collapse
|
23
|
Magalhães Junior HV, Pernambuco LDA, Cavalcanti RVA, Silva RGD, Lima KC, Ferreira MAF. Accuracy of an epidemiological oropharyngeal dysphagia screening for older adults. Gerodontology 2021; 39:418-424. [PMID: 34913514 DOI: 10.1111/ger.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the accuracy of an epidemiological screening questionnaire for oropharyngeal dysphagia in older people. BACKGROUND Determining the cut-off point and the accuracy of the self-reported epidemiological questionnaire for screening oropharyngeal dysphagia in older adults is important for mass screening, which may estimate the prevalence of oropharyngeal dysphagia. MATERIALS AND METHODS This was a cross-sectional diagnostic study with a convenience sample of 70 older adults over 60 years of age of both sexes, aged between 60 and 90 years (mean age 69.2; SD, 7.6). It used a screening questionnaire with nine ordered items response options resulted in a score ranging from 0 to 18. The criterion test was the fiberoptic endoscopic evaluation of swallowing, with analysis of the receiver operating characteristic (ROC), with a 5% significance level. RESULTS Oropharyngeal dysphagia frequency by the criterion test was 73%, with no significant difference between age and sex. The area under the ROC curve was 0.88 (95% confidence interval: 0.79-0.98) above the cut-off point 3. This screening questionnaire showed good parameters of sensitivity (80%), specificity (89%), positive predictive value (95%), negative predictive value (63%), positive likelihood ratio (7.64), negative likelihood ratio (0.22) and accuracy (83%). CONCLUSIONS This questionnaire may be a satisfactory screening tool for estimating the prevalence of oropharyngeal dysphagia in older adults.
Collapse
Affiliation(s)
| | | | | | - Roberta Gonçalves da Silva
- Department of Speech, Language and Hearing Sciences, São Paulo State University (Unesp), School of Philosophy and Sciences, Marília Universtiy of São Paulo, Marília, Brazil
| | - Kenio Costa Lima
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande of Norte (UFRN), Natal, Brazil
| | - Maria Angela Fernandes Ferreira
- Department of Dentistry, Postgraduate Public Health Program (PPGSCol-UFRN), Federal University of Rio Grande of Norte (UFRN), Natal, Brazil
| |
Collapse
|
24
|
Yang L, Zhang Z, Gao H, Wu Y, Wei H, Kong J, Wang R, Cheng J, Tian J. Cultural Adaptation and Validation of Questionnaires for Evaluation of Health-Related Quality of Life with Dysphagia in Different Countries: A Systematic Review. Dysphagia 2021; 37:812-823. [PMID: 34181064 DOI: 10.1007/s00455-021-10330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
Dysphagia can have devastating and long-lasting effects on the patient's health-related quality of life (HRQoL). In recent years, a number of questionnaires for the evaluation of the HRQoL of patients with dysphagia have been developed and have been adapted for use in different countries and cultures. However, problems may arise in the process of cultural adaptation and validation, which can affect the quality of the questionnaires and their measurements. This study was conducted to systematically summarize the cultural adaptation and validation of questionnaires for the evaluation of dysphagia-related HRQoL in different countries, assessing the varieties, measurement properties, and qualities of these questionnaires, with the aim of identifying the status of their adaptation and validation and ways in which they might be improved. Four databases were searched, and relevant articles were screened, with data from eligible reports extracted and reviewed. The methodological quality of the included articles was evaluated using the QualSyst critical appraisal tool. The HRQoL questionnaires for patients with dysphagia were assessed using the quality criteria for the measurement properties of health status questionnaires proposed by Terwee et al. and Timmerman et al. 29 studies published between 2008 and 2020 were included. The questionnaires described in these 29 studies were translated into 19 languages and culturally adapted to 21 countries. The adapted questionnaires were based on the Swallowing quality of life questionnaire (SWAL-QOL) by Mchorney et al., the Dysphagia Handicap Index (DHI) by Silbergleit et al., the M.D. Anderson Dysphagia Inventory (MDADI) by Chen et al., and the Eating Assessment Tool-10 (EAT-10) by Belafsky et al. It was found that the questionnaires were reliable and valid instruments for the assessment of dysphagia-related HRQoL, but the quality criteria for cultural adaptation and validation were not strictly followed, especially in the categories of criterion validity, agreement, responsiveness, and interpretability. In conclusion, although the questionnaires were found to be both reliable and valid, the quality criteria should be considered and strictly followed in the cultural adaptation and validation process in the future.
Collapse
Affiliation(s)
- Lin Yang
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Zhigang Zhang
- The First Hospital of Lanzhou University, Lanzhou, China.
- School of Nursing, Lanzhou University, Lanzhou, China.
| | - Huiya Gao
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuchen Wu
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Huaping Wei
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Jiajia Kong
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Rui Wang
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jie Cheng
- The First Hospital of Lanzhou University, Lanzhou, China
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
| |
Collapse
|
25
|
White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults. Dysphagia 2021; 37:333-349. [PMID: 33787994 PMCID: PMC8009935 DOI: 10.1007/s00455-021-10283-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
Collapse
|
26
|
Duncan DR, DiFilippo C, Kane M, Lurie M, McSweeney ME, Rosen RL. Overlapping Symptoms of Gastroesophageal Reflux and Aspiration Highlight the Limitations of Validated Questionnaires. J Pediatr Gastroenterol Nutr 2021; 72:372-377. [PMID: 33264182 PMCID: PMC9765758 DOI: 10.1097/mpg.0000000000002987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Infants frequently present with feeding difficulties and respiratory symptoms, which are often attributed to gastroesophageal reflux but may be because of oropharyngeal dysphagia with aspiration. The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is a clinical measure of gastroesophageal reflux disease but now there is greater understanding of dysphagia as a reflux mimic. We aimed to determine the degree of overlap between I-GERQ-R and evidence of dysphagia, measured by Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) and videofluoroscopic swallow study (VFSS). METHODS We performed a prospective study of subjects <18 months old with feeding difficulties. All parents completed Pedi-EAT-10 and I-GERQ-R as a quality initiative to address parental feeding concerns. I-GERQ-R results were compared with Pedi-EAT-10 and, whenever available, results of prior VFSS. Pearson correlation coefficients were calculated to determine the relationship between scores. Groups were compared with 1-way ANOVA and Fisher exact test. ROC analysis was completed to compare scores with VFSS results. RESULTS One hundred eight subjects with mean age 7.1 ± 0.5 months were included. Pedi-EAT-10 and I-GERQ-R were correlated (r = 0.218, P = 0.023) in all subjects and highly correlated in the 77 subjects who had prior VFSS (r = 0.369, P = 0.001). The blue spell questions on I-GERQ-R had relative risk 1.148 (95% confidence interval [CI] 1.043-1.264, P = 0.142) for predicting aspiration/penetration on VFSS, with 100% specificity. Scores on the question regarding crying during/after feedings were also higher in subjects with abnormal VFSS (1.1 ± 0.15 vs 0.53 ± 0.22, P = 0.04). CONCLUSIONS I-GERQ-R and the Pedi-EAT-10 are highly correlated. I-GERQ-R results may actually reflect oropharyngeal dysphagia and not just gastroesophageal reflux disease in infants.
Collapse
Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Courtney DiFilippo
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Madeline Kane
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Margot Lurie
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Maireade E. McSweeney
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| |
Collapse
|
27
|
Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
Collapse
Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| |
Collapse
|
28
|
Speyer R, Cordier R, Bouix C, Gallois Y, Woisard V. Using Classical Test Theory to Determine the Psychometric Properties of the Deglutition Handicap Index. Dysphagia 2021; 37:65-73. [PMID: 33515311 PMCID: PMC8844159 DOI: 10.1007/s00455-021-10250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/13/2021] [Indexed: 11/06/2022]
Abstract
The Deglutition Handicap Index (DHI) is a self-report measure for patients at risk of oropharyngeal dysphagia on deglutition-related aspects of functional health status (FHS) and health-related quality of life (HR-QoL). The DHI consists of 30 items which are subsumed within the Symptom, Functional and Emotional subscales. The purpose of this study was to evaluate the psychometric properties of the DHI using Classic Test Theory according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. A total of 453 patients with dysphagia with different aetiologies were recruited concurrently at two academic hospitals. Dysphagia was confirmed by fiberoptic endoscopic and/or videofluoroscopic evaluation of swallowing. In addition, a healthy control group of 132 participants were recruited. Structural validity was determined using exploratory and confirmatory factor analyses and internal consistency by calculating Cronbach’s alpha coefficients. Hypothesis testing was evaluated using Mann–Whitney U-tests, linear regression analysis and correlations analysis. Diagnostic performance and receiver operating characteristic curves analysis were calculated. Factor analyses indicated that the DHI is a unidimensional measure. The DHI has good internal consistency with some indication of item redundancy, weak to moderate structural validity and strong hypothesis testing for construct validity. The DHI shows high diagnostic performance as part of criterion validity. These findings support that the DHI is an appropriate choice as a patient self-report measure to evaluate FHS and HR-QoL in dysphagia. Ongoing validation to assess the measure for possible item redundancy and to examine the dimensionality of the DHI using item response theory is recommended.
Collapse
Affiliation(s)
- Renée Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway. .,School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia. .,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Reinie Cordier
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Australia.,Department Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Clara Bouix
- Logopedics Training Center, Medical Department, Paul Sabatier University Toulouse III, Toulouse, France
| | - Yohan Gallois
- Department of Otoneurology and Pediatric ENT, Pierre Paul Riquet Hospital, University Hospital of Toulouse, Toulouse, France
| | - Virginie Woisard
- Logopedics Training Center, Medical Department, Paul Sabatier University Toulouse III, Toulouse, France.,Voice and Deglutition Unit, Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, Toulouse, France.,Oncorehabilitation Unit, Toulouse Universitary Cancer Institute, Oncopole Hospital, Toulouse, France
| |
Collapse
|
29
|
Is Dysphagia Under Diagnosed or is Normal Swallowing More Variable than We Think? Reported Swallowing Problems in People Aged 18-65 Years. Dysphagia 2020; 36:910-918. [PMID: 33226473 PMCID: PMC7680995 DOI: 10.1007/s00455-020-10213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Purpose Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18–65 years. Methods The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were e-mailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann–Whitney U) and Spearman’s rho correlation. Results From March 2014 to October 2017: 2054 responses (32 reported ages outside of 18–65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18–65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0–36, mean 1.57, SD 3.49). EAT-10 score ≥ 3 (337) median 5 (range 3–36, mean 7.02 SD 5.91). Median age 36 (range 19–65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p = 0.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale = 1648, Nmale = 364) = 275,420.000, z = − 2.677, p = 0.007. Age and EAT-10 score were not associated: females rs = − 0.043, p = 0.079, N = 1648, males rs = − 0.003, p = 0.952, N = 364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10 = 17). Conclusion Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.
Collapse
|
30
|
Optimal Examination Sites for Periodontal Disease Evaluation: Applying the Item Response Theory Graded Response Model. J Clin Med 2020; 9:jcm9113754. [PMID: 33233427 PMCID: PMC7700480 DOI: 10.3390/jcm9113754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023] Open
Abstract
Periodontal examination data have a complex structure. For epidemiological studies, mass screenings, and public health use, a simple index that represents the periodontal condition is necessary. Periodontal indices for partial examination of selected teeth have been developed. However, the selected teeth vary between indices, and a justification for the selection of examination teeth has not been presented. We applied a graded response model based on the item response theory to select optimal examination teeth and sites that represent periodontal conditions. Data were obtained from 254 patients who participated in a multicenter follow-up study. Baseline data were obtained from initial follow-up. Optimal examination sites were selected using item information calculated by graded response modeling. Twelve sites—maxillary 2nd premolar (palatal-medial), 1st premolar (palatal-distal), canine (palatal-medial), lateral incisor (palatal-central), central incisor (palatal-distal) and mandibular 1st premolar (lingual, medial)—were selected. Mean values for clinical attachment level, probing pocket depth, and bleeding on probing by full mouth examinations were used for objective variables. Measuring the clinical parameters of these sites can predict the results of full mouth examination. For calculating the periodontal index by partial oral examination, a justification for the selection of examination sites is essential. This study presents an evidence-based partial examination methodology and its modeling.
Collapse
|
31
|
Bofill-Soler N, Guillen-Sola A, Marco E, Nieto-Cadalso S, Barrera MC, Pera-Cegarra O, Membrive I, Duran X, Foro P. Is EAT-10 Useful to Assess Swallowing during the Chemo-Radiotherapy Phase in Patients with Head and Neck Cancer? A Pilot Study. Ann Otol Rhinol Laryngol 2020; 130:689-698. [PMID: 33094639 DOI: 10.1177/0003489420966625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/HYPOTHESIS The 10-item Eating-Assessment Tool (EAT-10) is a dysphagia screening test. In HNC patients, screening and diagnosis of dysphagia are not well-established. To determine the metrological properties of the EAT-10 compared with videofluoroscopy in non-surgical HNC-patients and to assess the relationship between EAT-10 scores and patients' self-reported symptoms. STUDY DESIGN Prospective cohort study. METHODS Forty-six HNC-patients recently diagnosed and referred to chemoradiotherapy (CRT). Main outcome was evidence of dysphagia according to EAT-10 score, self-perception on a Visual Analog Scale (VAS) of impaired swallowing, severity on the Penetration-Aspiration Scale (PAS), and the Functional Oral Intake Scale (FOIS). Patients were assessed at baseline, before-CRT, after-CRT, and at 3-month follow-up. RESULTS A strong baseline correlation between EAT-10, VAS, and FOIS was observed. All 3 values decreased in weeks 6 to 9 after CRT initiation; a poor correlation of EAT-10 with VAS was observed at 3-month follow-up. A receiver operating characteristic curve determined new cut-off points (sensitivity/specificity) for safe swallowing: baseline 3 (86%, 77%); post-CRT, 15 (62.5%, 80%); and 3-month follow-up, 4 (83%, 75%). CONCLUSIONS New safe-swallow EAT-10-points are suggested for this population during screening and the oncological follow-up. A poor correlation between EAT10-score and patient self-reported symptoms was observed at the end-RT and at 3-month follow-up, highlighting the need for an objective evaluation instrument.
Collapse
Affiliation(s)
- Neus Bofill-Soler
- Physical Medicine and Rehabilitation Department, Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
| | - Anna Guillen-Sola
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar, Barcelona, Catalunya, Spain.,Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalunya, Spain.,Hospital de l'Esperança, Barcelona, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar, Barcelona, Catalunya, Spain.,Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalunya, Spain
| | - Sonia Nieto-Cadalso
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar, Barcelona, Catalunya, Spain
| | | | - Oscar Pera-Cegarra
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Catalunya, Spain
| | - Ismael Membrive
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Catalunya, Spain
| | - Xavier Duran
- Assessoria metodològica i Bioestadística, IMIM - Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Catalunya, Spain
| | - Palmira Foro
- Radiation Oncology Department, Hospital del Mar, Parc de Salut Mar, Barcelona, Catalunya, Spain
| |
Collapse
|
32
|
Systematic Dysphagia Screening of Elderly Persons in the Emergency Department-A Feasibility Study. Geriatrics (Basel) 2020; 5:geriatrics5040075. [PMID: 33053743 PMCID: PMC7709572 DOI: 10.3390/geriatrics5040075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 01/01/2023] Open
Abstract
Identification of elderly patients in risk of dysphagia as early as possible upon hospital admission seems warranted due to the risk of aspiration pneumonia, dehydration, length of stay, and increased mortality. This study aimed to evaluate the feasibility and outcome of dysphagia screening of elderly persons admitted to the emergency department (ED). Inclusion criteria were age ≥ 60 years. A nurse applied the Simple Water Swallow test within one hour of admission. Subsequent assessment was performed by an occupational therapist (OT) using Volume Viscosity Swallow Test and Minimal Eating Observation Form. Of 113 eligible participants (median age 78 years), 75 (66%) were screened in the ED by the nurse, and among those, 12 (16%) were detected with dysphagia. Twenty of the patients not screened in the ED due to critical illness were tested by the OT in the ward after clinical stabilization and 15 patients (75%) were identified with dysphagia. This study demonstrated that it is feasible to perform dysphagia screening of elderly persons by a nurse in the ED, but there are severe limitations according to screening patients with critical illness and patients fasting before surgery in the ED. These patients have a high prevalence of dysphagia and should be screened as early as possible after hospitalization, as it will rarely be possible in the ED.
Collapse
|
33
|
Schlickewei O, Nienstedt JC, Frank U, Fründt O, Pötter-Nerger M, Gerloff C, Buhmann C, Müller F, Lezius S, Koseki JC, Pflug C. The ability of the eating assessment tool-10 to detect penetration and aspiration in Parkinson's disease. Eur Arch Otorhinolaryngol 2020; 278:1661-1668. [PMID: 32978686 DOI: 10.1007/s00405-020-06377-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Dysphagia is common in patients with Parkinson's disease (PD) and often leads to pneumonia, malnutrition, and reduced quality of life. This study investigates the ability of the Eating Assessment Tool-10 (EAT-10), an established, easy self-administered screening tool, to detect aspiration in PD patients. This study aims to validate the ability of the EAT-10 to detect FEES-proven aspiration in patients with PD. METHODS In a controlled prospective cross-sectional study, a total of 50 PD patients completed the EAT-10 and, subsequently, were examined by Flexible Endoscopic Evaluation of Swallowing (FEES) to determine the swallowing status. The results were rated through the Penetration-Aspiration Scale (PAS) and data were analyzed retrospectively. RESULTS PAS and EAT-10 did not correlate significantly. Selected items of the EAT-10 could not predict aspiration or residues. 19 (38%) out of 50 patients with either penetration or aspiration were not detected by the EAT-10. The diagnostic accuracy was established at only a sufficient level (AUC 0.65). An optimal cut-off value of ≥ 6 presented a sensitivity of 58% and specificity of 82%. CONCLUSIONS The EAT-10 is not suited for the detection of penetration and aspiration in PD patients. Therefore, it cannot be used as a screening method in this patient population. There is still a need for a valid, simple, and efficient screening tool to assist physicians in their daily diagnostics and to avoid clinical complications.
Collapse
Affiliation(s)
- Ole Schlickewei
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Ulrike Frank
- Department of Linguistics, Swallowing Research Lab, University of Potsdam, Potsdam, Germany
| | - Odette Fründt
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Frank Müller
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
34
|
Garcia-Casado J, Prats-Boluda G, Ye-Lin Y, Restrepo-Agudelo S, Perez-Giraldo E, Orozco-Duque A. Evaluation of Swallowing Related Muscle Activity by Means of Concentric Ring Electrodes. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20185267. [PMID: 32942616 PMCID: PMC7570555 DOI: 10.3390/s20185267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Surface electromyography (sEMG) can be helpful for evaluating swallowing related muscle activity. Conventional recordings with disc electrodes suffer from significant crosstalk from adjacent muscles and electrode-to-muscle fiber orientation problems, while concentric ring electrodes (CREs) offer enhanced spatial selectivity and axial isotropy. The aim of this work was to evaluate CRE performance in sEMG recordings of the swallowing muscles. Bipolar recordings were taken from 21 healthy young volunteers when swallowing saliva, water and yogurt, first with a conventional disc and then with a CRE. The signals were characterized by the root-mean-square amplitude, signal-to-noise ratio, myopulse, zero-crossings, median frequency, bandwidth and bilateral muscle cross-correlations. The results showed that CREs have advantages in the sEMG analysis of swallowing muscles, including enhanced spatial selectivity and the associated reduction in crosstalk, the ability to pick up a wider range of EMG frequency components and easier electrode placement thanks to its radial symmetry. However, technical changes are recommended in the future to ensure that the lower CRE signal amplitude does not significantly affect its quality. CREs show great potential for improving the clinical monitoring and evaluation of swallowing muscle activity. Future work on pathological subjects will assess the possible advantages of CREs in dysphagia monitoring and diagnosis.
Collapse
Affiliation(s)
- Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (G.P.-B.); (Y.Y.-L.)
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (G.P.-B.); (Y.Y.-L.)
| | - Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (G.P.-B.); (Y.Y.-L.)
| | - Sebastián Restrepo-Agudelo
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050012, Colombia; (S.R.-A.); (E.P.-G.); (A.O.-D.)
| | - Estefanía Perez-Giraldo
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050012, Colombia; (S.R.-A.); (E.P.-G.); (A.O.-D.)
| | - Andrés Orozco-Duque
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050012, Colombia; (S.R.-A.); (E.P.-G.); (A.O.-D.)
| |
Collapse
|
35
|
Romero-Gangonells E, Virgili-Casas MN, Dominguez-Rubio R, Povedano M, Pérez-Saborit N, Calvo-Malvar N, Barceló MA. Evaluation of Dysphagia in Motor Neuron Disease. Review of Available Diagnostic Tools and New Perspectives. Dysphagia 2020; 36:558-573. [PMID: 32797289 DOI: 10.1007/s00455-020-10170-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
Oropharyngeal dysphagia (OD) is highly prevalent (up to 80%) in patients with motor neuron disease (MND), influencing the prognosis of the disease. The clinical assessment of dysphagia is complex. There are assessment scales and screening questionnaires, but they have not been tested in patients with MND. In a sample of 46 patients with MND, the sensitivity and specificity of the EAT-10 and SwalQoL questionnaires, as well as the ALS-SS and FOIS scales, were tested and compared to the gold standard technique (videofluoroscopy, VFS). The patients were stratified using the DOSSc variable according to the video fluoroscopic examination with (n = 37) or without (n = 8) signs of dysphagia, and the results were compared with the scores obtained in the dysphagia questionnaires. None of the studied questionnaires was more sensitive than the others, but one stood out for its high specificity (= 1): the SwalQoL revised FS. The symptom frequency section of the SwalQoL questionnaire with some modifications, (SwalQoL revised FS) may be a useful tool in the clinical assessment of dysphagia because it's capable to detect the patients that really don't have dysphagia. The ALS-SS showed the greatest validity as a severity scale of dysphagia among the sample studied. A specific questionnaire for screening for dysphagia in MND needs to be developed. Until that time, the proposal is to use a combination of the existing questionnaires for other pathologies (EAT-10 and SwalQoL) and the specific scale for MND, the ALS-SS, to make an accurately clinical assessment of OD in MND patients before to perform a videofluoroscopy.
Collapse
Affiliation(s)
- Elisabet Romero-Gangonells
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
- Department of Endocrinology and Clinical Nutrition, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - M Núria Virgili-Casas
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
- Department of Endocrinology and Clinical Nutrition, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Raúl Dominguez-Rubio
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
| | - Mònica Povedano
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL (Institut D'Investigació Biomèdica de Bellvitge), L'Hospitalet de Llobregat, Spain
| | - Núria Pérez-Saborit
- Department of Image Diagnosis and Nuclear Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Nahum Calvo-Malvar
- Department of Image Diagnosis and Nuclear Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Maria A Barceló
- Functional Motor Neuron Unit (UFMN), Department of Neurology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain.
- Research Group On Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, Campus de Montilivi, 17003, Girona, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| |
Collapse
|
36
|
A prospective study for evaluation of structural and clinical validity of the Eating Assessment Tool. BMC Geriatr 2020; 20:269. [PMID: 32758137 PMCID: PMC7405447 DOI: 10.1186/s12877-020-01654-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Eating Assessment Tool is a self-rating questionnaire developed to assess symptom severity and treatment efficacy in swallowing disorders. The aim of this study was to investigate the structural validity of the Eating Assessment Tool and whether individual item scores differed between dysphagia secondary to neurological and structural/esophageal disorders, respectively. METHODS This is a prospective cross-sectional questionnaire study. In total, 200 community-dwelling adults with suspected dysphagia referred for fiberoptic endoscopic examination of swallowing at Karolinska University Hospital, Stockholm, Sweden, completed the S-EAT-10. Patients' medical charts were reviewed in order to establish the type of dysphagia. Principal axis factoring was conducted to examine structural validity, and Mann-Whitney U tests were used to study differences in the S-EAT-10 score patterns between different types of dysphagia. RESULTS One single factor explained 54% of the total variance in EAT-10 item scores. All ten items loaded substantially or strongly on this factor, supporting the single-factor solution (Cronbach's alpha = 0.90). Structural/esophageal dysphagia was associated with higher scores on six items and with a higher total EAT-10 score. CONCLUSIONS The EAT-10 yields a unidimensional index of symptom severity in patients with dysphagia. Individual item scores reflect typical symptoms in neurogenic and structural/esophageal dysphagia, supporting its clinical relevance.
Collapse
|
37
|
de Sire A, Giachero A, DE Santi S, Inglese K, Solaro C. Screening dysphagia risk in 534 older patients undergoing rehabilitation after total joint replacement: a cross-sectional study. Eur J Phys Rehabil Med 2020; 57:131-136. [PMID: 32594668 DOI: 10.23736/s1973-9087.20.06321-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this postacute phase, they might suffer from other symptoms, including dysphagia, defined as a dysfunction of the digestive system, characterized by an objective difficulty or a sensation of difficulty in swallowing. It is considered as a very challenging problem in older people and early detection is fundamental for a prompt and effective management. However, up to date, there is a lack of data on dysphagia risk screening in orthopedic rehabilitation inpatients. AIM The aim of this study was to evaluate dysphagia risk through Eating Assessment Tool (EAT-10) in older people undergoing rehabilitation after total hip or knee arthroplasty. DESIGN Cross-sectional study. SETTING Rehabilitation Unit. POPULATION All consecutive patients undergone total hip or knee arthroplasty, aged ≥65 years, referring to Orthopedics Rehabilitation Unit "Mons. Luigi Novarese" Hospital, Moncrivello, Italy, for a 24-month period (from 1st January 2018 to 31st December 2019). We excluded patients with: 1) diagnosis of neurological diseases; 2) pharyngeal or esophageal cancer; 3) maxillofacial cancer; 4) tracheotomy. METHODS Dysphagia risk was assessed through EAT-10. The cohort was divided into two groups, according to water swallowing test (WST), in order to evaluate differences in terms of different EAT-10 scores. Furthermore, based on pathological WST, we have stratified study participants by the American Speech-Language-Hearing Association (ASHA)'s National Outcomes Measurement System (NOMS) swallowing scale in order to evaluate differences in terms of the different EAT-10 scores. RESULTS We included 534 participants (180 men, 357 women), mean aged 74.8±5.6 years. Thirty-one patients (5.8%) had pathological WST and 34 (6.4%) reported EAT-10 ≥3. There were significant differences (P<0.001) between groups (pathological WST vs. normal WST) in terms of all EAT-10 total scores. EAT-10 reported a high specificity (96.8% if ≥3 and 98.4% if ≥4), but a low sensitivity (58.1% if ≥3 and 54.8% if ≥4). CONCLUSIONS EAT-10 might be considered as useful screening tools for dysphagia in older people, considering the high specificity of EAT-10≥4. CLINICAL REHABILITATION IMPACT Screening dysphagia risk should be recommended also in patients undergoing rehabilitation in order to set up an early diagnosis and management.
Collapse
Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy -
| | - Alice Giachero
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Shara DE Santi
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Katia Inglese
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Claudio Solaro
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| |
Collapse
|
38
|
Pizzorni N, Pirola F, Ciammola A, Schindler A. Management of dysphagia in Huntington's disease: a descriptive review. Neurol Sci 2020; 41:1405-1417. [PMID: 31989345 DOI: 10.1007/s10072-020-04265-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/18/2020] [Indexed: 12/19/2022]
Abstract
Huntington's disease (HD) is a rare neurodegenerative disorder of the central nervous system characterized by involuntary choreatic movements, cognitive, behavioral, and psychiatric disturbances. Most HD suffer from dysphagia and aspiration pneumonia is the leading cause of death. However, little is known about dysphagia management in HD. A revision of the literature was conducted to depict the state of the art on the assessment and treatment of dysphagia in HD. Literature search of the last 10 years was performed using PubMed and EMBASE. Twenty-four studies were included: 16 cross-sectional studies, 2 case reports, 2 case series, 2 open-label trials, 1 pre-post study, and 1 randomized controlled trial. Based on the studies retrieved, dysphagia should be assessed from the early stage of the disease, especially when specific clinical markers occur. Timing for dysphagia re-assessment should be based on the recommendation of the swallowing experts on the individual case. Instrumental assessment of swallowing by videofluoroscopy or videoendoscopy is feasible and recommended to diagnose dysphagia in patients with HD. Clinical assessment tools and patient-reported outcome measures may be used to complete the swallowing examination, but not to replace instrumental assessment. The impact of pharmacological and rehabilitative treatments on dysphagia in HD has been little studied in literature. While the effect of tetrabenazine on swallowing is still controversial, compensatory strategies seem to be applicable and efficacious. To date, there are no well-proven rehabilitative strategies to improve swallowing function in patients with HD. The topic of dysphagia in HD remains poorly studied compared with its clinical relevance.
Collapse
Affiliation(s)
- Nicole Pizzorni
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20157, Milan, Italy.
| | - Francesca Pirola
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20157, Milan, Italy
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20145, Milan, Italy
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Via GB Grassi 74, 20157, Milan, Italy
| |
Collapse
|
39
|
Hansen T, Kjaersgaard A. Item analysis of the Eating Assessment Tool (EAT-10) by the Rasch model: a secondary analysis of cross-sectional survey data obtained among community-dwelling elders. Health Qual Life Outcomes 2020; 18:139. [PMID: 32404203 PMCID: PMC7222581 DOI: 10.1186/s12955-020-01384-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/28/2020] [Indexed: 01/19/2023] Open
Abstract
Background The Eating Assessment Tool (EAT-10) is increasingly used to screen for self-perceived oropharyngeal dysphagia (OD) in community-dwelling elders. A summated EAT-10 total score ranges from 0 to 40, with a score ≥ 3 indicative of OD. When using cut-points of a summated score, important requirements for the measurements are specific objectivity, validity, and reliability. Analysis by the Rasch model allows investigation of whether scales like EAT-10 satisfy these requirements. Currently, a few studies have found that EAT-10 responses from clinical populations with OD do not adequately fit the Rasch model. Purpose The aim of this study was to determine whether measurements by EAT-10 fit the Rasch model when applied in screening self-perceived OD in non-clinical populations. Methods Secondary analysis was conducted on data from a cross-sectional survey of community-dwelling elders living in a municipal district of Tokyo, Japan, in which 1875 respondents completed the Japanese version of EAT-10 (J-EAT-10). Data were cleaned and recoded for the purpose of the analysis in this study, which resulted in inclusion of J-EAT-10 responses from 1144 respondents. Data were analyzed using RUMM2030 and included overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning, local item dependency, and targeting. Results The analysis identified that the response categories from zero to four were not used as intended and did not display monotonicity, which necessitated reducing the five categories to three. Considerable floor effect was demonstrated and there was an inappropriate match between items’ and respondents’ estimates. The person separation reliability (PSI = 0.65) was inadequate, indicating that it is not possible to differentiate between different levels of OD. Several items displayed misfit with the Rasch model, and there were local item dependency and several redundant items. Conclusions J-EAT-10 performed less than optimally and exhibited substantial floor effect, low reliability, a rating scale not working as intended, and several redundant items. Different improvement strategies failed to resolve the identified problems. Use of J-EAT-10 in population-based surveys cannot therefore be recommended. For such purpose, alternative screening tools of self-perceived OD should be chosen or a new one should be developed and validated.
Collapse
Affiliation(s)
- Tina Hansen
- Division of Occupational Therapy, Faculty of Health and Technology, Copenhagen University College, Sigurdsgade 26, 2200, N Copenhagen, Denmark.
| | - Annette Kjaersgaard
- Department for Education, Hammel Neurorehabilitation Centre and University Research Clinic, Voldbyvej 15, 8450, Hammel, Denmark
| |
Collapse
|
40
|
Krishnamurthy R, Balasubramanium RK, Hegde PS. Evaluating the Psychometric Properties of the Kannada Version of EAT 10. Dysphagia 2020; 35:962-967. [PMID: 32036548 DOI: 10.1007/s00455-020-10094-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/01/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Eating Assessment Tool 10 is a symptom survey and has several advantages over other existing questionnaires. The instrument has also proven to be useful in establishing initial dysphagia symptom severity and to aid in measuring treatment outcomes. Due to its wide applicability, the instrument has been translated into several languages. The aim of the present study was to translate and validate the Kannada version of Eating Assessment Tool 10. METHOD 88 individuals with dysphagia and equal number of healthy individuals filled the Kannada version of Eating Assessment Tool. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was also established by comparing the scores of dysphagia patients and healthy controls. RESULTS The overall Cronbach's α for the tool was 0.9 indicating a good internal consistency. The internal consistency of each of the items was also high, and ranged 0.88 to 0.9. Twenty patients filled the questionnaire after a span of 48 h, and the ICC coefficient was found to be 0.89 indicating a high reliability. The control group has significantly lower scores for all scales when compared to the dysphagia group [t(174) = 78.41, p < 0.001]. CONCLUSION The present study demonstrates that the Kannada version of EAT 10 has good internal consistency, test retest reliability, and concurrent validity. The results of the study also reveal that it is a reliable and valid tool for screening dysphagia population.
Collapse
Affiliation(s)
- Rahul Krishnamurthy
- Department of Audiology and Speech Language Pathology, Kastruba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kastruba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | | |
Collapse
|
41
|
Krishnamurthy R, Balasubramanium RK. Translation and Validation of Kannada Version of the Dysphagia Handicap Index. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:255-262. [PMID: 31940224 DOI: 10.1044/2019_ajslp-19-00122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background The Dysphagia Handicap Index (DHI) is a 25-item questionnaire that assesses the quality of life among individuals with dysphagia. The aim of this study was to translate and validate the Kannada version of DHI (DHI-K). Method Eighty-eight individuals with dysphagia and an equal number of healthy individuals filled out the DHI-K. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI-K scores of patients with dysphagia and healthy controls. Results The overall Cronbach's α for DHI-K was .81, indicating good internal consistency. Cohen's κ agreement for test-retest reliability of self-perceived severity was found to be .9. Correlation between subscales of DHI and self-perceived severity was analyzed using Spearman correlation coefficient and was found to very high. The control group has significantly lower scores for all scales when compared to the dysphagia group (physical: t(174) = 31.74, p < .001; functional: t(174) = 32.65, p < .001; emotional: t(174) = 36.3, p < .001; total: t(174) = 34.08, p < .001). Conclusions This study demonstrates that DHI-K has good internal consistency, test-retest reliability, and concurrent validity. The results of the study also reveal that it is a reliable and valid tool for assessment of handicap in Kannada-speaking dysphagia population.
Collapse
Affiliation(s)
- Rahul Krishnamurthy
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, Karnataka, India
- Manipal Academy of Higher Education, Karnataka, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech-Language Pathology, Kasturba Medical College, Mangalore, Karnataka, India
- Manipal Academy of Higher Education, Karnataka, India
| |
Collapse
|
42
|
Focht Garand KL, Hill EG, Armeson K, Martin-Harris B. Aging Effects on Eating Assessment Tool-10 (EAT-10) Total Scores in Healthy, Community-Dwelling Adults. CANADIAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY : CJSLPA = REVUE CANADIENNE D'ORTHOPHONIE ET D'AUDIOLOGIE : RCOA 2020; 44:1-8. [PMID: 33708276 PMCID: PMC7946383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to examine how aging and sex impacted scores on the Eating Assessment Tool-10 in a large sample of healthy, non-dysphagic adults. Differences in Eating Assessment Tool-10 total normal (< 3) and abnormal (≥ 3) scores were examined across four age categories (21-39 years, 40-59 years, 60-79 years, 80 years and older) and between sexes. The mean (± SD) Eating Assessment Tool-10 total score for this healthy cohort of 167 individuals was 0.6 (± 1.6), with the majority of participants (75%) earning a score of zero. No significant differences were found in Eating Assessment Tool-10 total scores across age categories (p = .53) or between sexes (p = .79). Post-hoc analyses further explored relationships between Eating Assessment Tool-10 total scores and swallow performance measures as observed during videofluoroscopy. All participants (n = 15) scoring 3 and greater on the Eating Assessment Tool-10 passed an aspiration screen (i.e., 3-ounce water swallow challenge). Nine participants scoring less than 3 and failing the aspiration screen were not observed to have airway invasion as measured by the Penetration-Aspiration Scale during videofluoroscopy. A significant relationship was not observed between Eating Assessment Tool-10 total scores and highest Penetration-Aspiration Scale score. Eating Assessment Tool-10 total scores reported in the current study for patients with gastroesophageal reflux disease were significantly lower (p < .001) than total scores reported in the Eating Assessment Tool-10 validation study by Belafsky et al. (2008). In summary, aging or sex effects did not appear to impact self-report of dysphagia-related symptoms as measured by the Eating Assessment Tool-10. The Eating Assessment Tool-10, therefore, may not demonstrate the sensitivity needed to capture sub-clinical changes of the aging swallowing mechanism.
Collapse
Affiliation(s)
| | | | - Kent Armeson
- Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
43
|
Heijnen BJ, Böhringer S, Speyer R. Prediction of aspiration in dysphagia using logistic regression: oral intake and self-evaluation. Eur Arch Otorhinolaryngol 2020; 277:197-205. [PMID: 31630245 PMCID: PMC6942603 DOI: 10.1007/s00405-019-05687-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Oropharyngeal dysphagia (OD) has a major influence on health in general and health-related quality of life (HR-QoL) in particular. The gold standard assessments for OD, especially for aspiration in OD, are fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy (VFSS), but not all patients have access to such procedures. Therefore, the current study built a prediction model to forecast aspiration in patients with OD on the basis of common self-evaluation questionnaires and oral intake status. METHODS A consecutive series of 111 patients with confirmed diagnosis of OD was measured according to a standardised protocol using the following tools: the Swallowing Quality of Life Questionnaire (SWAL-QOL), the Dysphagia Handicap Index (DHI), two self-report visual analogue scales which measure the Severity and the Impairment of the swallowing problem on everyday social life as experienced by the patient, the Eating Assessment Tool 10 (EAT-10), the Functional Oral Intake Scale (FOIS) and subsequently FEES (the gold standard). Penalised logistic regression was carried out to predict aspiration. The performance of the resulting models was evaluated by constructing receiver operating characteristics (ROC) curves and computing areas under the curve (AUC). RESULTS The final model showed an AUC of 0.92, indicating excellent performance. CONCLUSION This study shows that it may be possible to accurately predict aspiration in oropharyngeal dysphagia by a non-invasive and non-instrumental assessment protocol including oral intake status and self-report questionnaires on functional health status and HR-QoL.
Collapse
Affiliation(s)
- Bas J Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Zone H2-Q, PO Box 9600, 2300, Leiden, RC, The Netherlands.
| | - Stefan Böhringer
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Renée Speyer
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Zone H2-Q, PO Box 9600, 2300, Leiden, RC, The Netherlands
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia
| |
Collapse
|
44
|
Rivelsrud MC, Kirmess M, Hartelius L. Cultural adaptation and validation of the Norwegian version of the swallowing quality of life questionnaire (SWAL-QOL). Health Qual Life Outcomes 2019; 17:179. [PMID: 31805954 PMCID: PMC6896756 DOI: 10.1186/s12955-019-1248-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 11/21/2019] [Indexed: 12/28/2022] Open
Abstract
Introduction Oropharyngeal dysphagia (OD) is a disorder that can have devastating and long lasting effects on a person’s medical, mental and psychosocial well-being, thus negatively impacting quality of life. There is currently no validated dysphagia-specific quality of life instrument in Norway. This project aims to evaluate the psychometric properties of the culturally adapted Norwegian version of SWAL-QOL (Nor-SWAL-QOL). Methods The original SWAL-QOL was translated into Norwegian according the international translation guidelines. A group of 102 persons with OD and a group of 123 healthy controls were recruited to assess the validity and reliability of the Nor-SWAL-QOL. Correlation analysis of the Nor-SWAL-QOL and the Short Form 36 (SF-36) and correlation analysis of OD group and control group Nor-SWAL-QOL subscale scores were computed to determine convergent, discriminant, and known-groups validity which help comprise construct validity. Internal consistency, test-retest reliability and intraclass correlation coefficient (ICC) were computed for reliability. Results Convergent and discriminant validity was demonstrated between Nor-SWAL-QOL subscales and SF-36 domains, and distinguished between persons with and those without oropharyngeal dysphagia on all subscales and on the symptom frequency battery (p < 0.001). Additionally, the Nor-SWAL-QOL differentiated between symptom severity levels within the OD group; those requiring food and liquid modifications and those who are tube fed and not tube fed. Nor-SWAL-QOL showed good reliability with adequate internal consistency (Cronbach’s α ≥0.70), test-retest reliability (Spearman’s rho values 0.68–0.90) and ICC values (0.67–0.89) for all subscales and for the symptom frequency battery. Conclusion Access to valid and reliable dysphagia-specific QoL outcome measures for health care practitioners, dysphagia clinicians and researchers is necessary for comprehensive assessment and treatment outcome measures. The Nor-SWAL-QOL exhibits sufficient psychometric properties for implementation in the Norwegian population.
Collapse
Affiliation(s)
- Maribeth Caya Rivelsrud
- University of Gothenburg, Gothenburg, Sweden. .,Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453, Bjørnemyr, Norway.
| | - Melanie Kirmess
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453, Bjørnemyr, Norway.,Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Lena Hartelius
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyrveien 11, 1453, Bjørnemyr, Norway.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
45
|
Dysphagia Prevalence, Attitudes, and Related Quality of Life in Patients with Multiple Sclerosis. Dysphagia 2019; 35:677-684. [DOI: 10.1007/s00455-019-10075-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
|
46
|
Parra-Anguita L, Moreno-Cámara S, López-Franco MD, Pancorbo-Hidalgo PL. Validation of the Spanish Version of the Dementia Knowledge Assessment Tool 2. J Alzheimers Dis 2019; 65:1175-1183. [PMID: 30124445 DOI: 10.3233/jad-180290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are currently no questionnaires to measure the knowledge of nurses about dementia or Alzheimer's disease care in the Spanish language. OBJECTIVE To validate the Spanish version of the Dementia Knowledge Assessment Tool 2 (DKAT2-Sp). METHODS The DKAT2 was translated into Spanish and then back-translated. The new Spanish version was validated in a sample of 361 members of the nursing staff from 24 nursing homes and a sample of 297 nursing students in Spain. Psychometric properties were assessed through an item analysis, a Rasch analysis, differential item functioning analysis, construct validity (known groups), and internal consistency (Cronbach's alpha). RESULTS The 21 items of the DKAT2-Sp fit the model well, showing a wide range of difficulty. Four items have differential items functioning between nursing professionals and students. The DKAT2-Sp shows acceptable internal consistency (Cronbach's alpha = 0.76 for nursing professionals and 0.83 for students). Scores obtained in the known groups test were as hypothesized (Nursing home staff mean = 15.57 versus Nursing student mean = 12.85; p < 0.0001 for mean difference), supporting construct validity. CONCLUSION The DKAT2-Sp is a reliable and valid questionnaire to measure knowledge about dementia in both nursing professionals and nursing students in Spanish-speaking contexts.
Collapse
Affiliation(s)
- Laura Parra-Anguita
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Sara Moreno-Cámara
- Department of Nursing, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | | | | |
Collapse
|
47
|
Cordier R, Munro N, Wilkes-Gillan S, Speyer R, Parsons L, Joosten A. Applying Item Response Theory (IRT) Modeling to an Observational Measure of Childhood Pragmatics: The Pragmatics Observational Measure-2. Front Psychol 2019; 10:408. [PMID: 30873094 PMCID: PMC6403159 DOI: 10.3389/fpsyg.2019.00408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 02/11/2019] [Indexed: 12/02/2022] Open
Abstract
Assessment of pragmatic language abilities of children is important across a number of childhood developmental disorders including ADHD, language impairment and Autism Spectrum Disorder. The Pragmatics Observational Measure (POM) was developed to investigate children's pragmatic skills during play in a peer-peer interaction. To date, classic test theory methodology has reported good psychometric properties for this measure, but the POM has yet to be evaluated using item response theory. The aim of this study was to evaluate the POM using Rasch analysis. Person and item fit statistics, response scale, dimensionality of the scale and differential item functioning were investigated. Participants included 342 children aged 5-11 years from New Zealand; 108 children with ADHD were playing with 108 typically developing peers and 126 typically developing age, sex and ethnic matched peers played in dyads in the control group. Video footage of this interaction was recorded and later analyzed by an independent rater unknown to the children using the POM. Rasch analysis revealed that the rating scale was ordered and used appropriately. The overall person (0.97) and item (0.99) reliability was excellent. Fit statistics for four individual items were outside acceptable parameters and were removed. The dimensionality of the measure showed two distinct elements (verbal and non-verbal pragmatic language) of a unidimensional construct. These findings have led to a revision of the first edition of POM, now called the POM-2. Further empirical work investigating the responsiveness of the POM-2 and its utility in identifying pragmatic language impairments in other childhood developmental disorders is recommended.
Collapse
Affiliation(s)
- Reinie Cordier
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Natalie Munro
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Wilkes-Gillan
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Renée Speyer
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Lauren Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Annette Joosten
- School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| |
Collapse
|
48
|
Shapira-Galitz Y, Yousovich R, Halperin D, Wolf M, Lahav Y, Drendel M. Does the Hebrew Eating Assessment Tool-10 Correlate with Pharyngeal Residue, Penetration and Aspiration on Fiberoptic Endoscopic Examination of Swallowing? Dysphagia 2019; 34:372-381. [DOI: 10.1007/s00455-018-9964-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 11/14/2018] [Indexed: 12/12/2022]
|
49
|
Mañas-Martínez AB, Bucar-Barjud M, Campos-Fernández J, Gimeno-Orna JA, Pérez-Calvo J, Ocón-Bretón J. Association of positive screening for dysphagia with nutritional status and long-term mortality in hospitalized elderly patients. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2018. [DOI: 10.1016/j.endien.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
50
|
Shapira-Galitz Y, Drendel M, Yousovich-Ulriech R, Shtreiffler-Moskovich L, Wolf M, Lahav Y. Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients. Dysphagia 2018; 34:63-72. [PMID: 29882103 DOI: 10.1007/s00455-018-9914-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
Abstract
The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects of dysphagia patients' quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1-7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test-retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach's alpha = 0.96), as was the test-retest reproducibility (Spearman's correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI's total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18-56 for dysphagia patients compared to 0, IQR 0-2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman's correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson's correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients' QoL.
Collapse
Affiliation(s)
- Yael Shapira-Galitz
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel.
| | - Michael Drendel
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Ruth Yousovich-Ulriech
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Liat Shtreiffler-Moskovich
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel
| | - Michael Wolf
- The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel
| | - Yonatan Lahav
- The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel
| |
Collapse
|