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Mata S, Blánquez B, Serrano F. The Oropharyngeal Dysphagia Screening Test for Patients and Professionals: Validation in Cognitive Impairment and in Severe Mental Illness. Dysphagia 2024:10.1007/s00455-024-10707-0. [PMID: 38872057 DOI: 10.1007/s00455-024-10707-0] [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: 12/19/2023] [Accepted: 04/08/2024] [Indexed: 06/15/2024]
Abstract
Dysphagia is a symptom that appears with high prevalence in persons diagnosed with dementia, intellectual disability, or severe mental illness. Risk of aspiration pneumonia or even death is very high in these populations. However, screening for dysphagia risk in these patients is complicated by the fact that most of them suffer from cognitive impairments and behavioral manifestations that hinder the assessment process using the existing screening tests. The aim of this study was to validate the Oropharyngeal Dysphagia Screening Test for Patients and Professionals, in patients with cognitive impairment (dementia/intellectual disability) or with severe mental illness (schizophrenia and other psychotic disorders, bipolar disorder, or major depressive disorder). For this purpose, 148 institutionalized patients were evaluated by professionals responsible for their food intake. The Oropharyngeal Dysphagia Screening Test for Patients and Professionals was used to assess its validity in screening for oropharyngeal dysphagia in patients with cognitive impairments and in patients with severe mental illness. Also, the Eating Assessment Tool-10 and the Swallowing Disturbance Questionnaire were used for convergent reliability procedures. Four comparison groups were established: patients with cognitive impairment with and without oropharyngeal dysphagia, and patients with severe mental illness with and without oropharyngeal dysphagia. Results from the Oropharyngeal Dysphagia Screening Test for Patients and Professionals adequately distinguished between groups with and without dysphagia, in addition to presenting adequate levels of convergent validity and reliability. These results were obtained from other-reports (professionals responsible for patients' food intake), using a simple, quickly applied test that does not require the use of food in patients with an altered cognitive state or with severe mental illness. With this study we expand the validity of the Oropharyngeal Dysphagia Screening Test for Patients and Professionals in populations with severe cognitive deficits and mental illness in which there is a great deficiency of oropharyngeal dysphagia screening instruments.
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Affiliation(s)
- Sara Mata
- The Mind, Brain and Behavior Research Center, University of Granada (CIMCYC-UGR), University of Granada, Granada, Spain
| | - Blas Blánquez
- Benito Menni Mental Health Care complex, SantBoi de Llobregat, Barcelona, Spain
| | - Francisca Serrano
- The Mind, Brain and Behavior Research Center, University of Granada (CIMCYC-UGR), University of Granada, Granada, Spain.
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Georgiou R, Voniati L, Papaleontiou A, Gryparis A, Ziavra N, Tafiadis D. Exploring the diagnostic accuracy and applicability of the Gugging Swallowing Screen in children with feeding and/or swallowing disorders. Neurogastroenterol Motil 2024; 36:e14790. [PMID: 38545701 DOI: 10.1111/nmo.14790] [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: 10/02/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The Gugging Swallowing Screen (GUSS) is a bedside dysphagia screening tool that has been designed to determine the risk of aspiration in acute stroke patients. There is no evidence in the literature for the GUSS for the pediatric population. The present study aimed to determine the diagnostic accuracy of GUSS as a screening tool in the Greek language for children with dysphagia. METHODS Eighty-Greek-Cypriot children aged 3-12 years who had dysphagia participated in this retrospective study. The translated into Greek GUSS was administered twice (pre- and post-therapy) to each patient throughout 24 sessions of dysphagia therapy. KEY RESULTS The GUSS showed a high internal consistency (Cronbach's α = 0.826), good test-retest reliability (rs = 0.767), convergent validity compared to the Greek Pediatric Eating Assessment tool-10 (PEDI-EAT-10) total score (rs = -0.365), and inter-rater reliability (κ = 0.863). A total cutoff points equal to 13.00 was also calculated. Aspiration was identified by the GUSS with low sensitivity and high specificity (PPV 100%, NPV 57%, LR+ NA, LR- 0.79); dysphagia/penetration was identified with high sensitivity and low specificity (PPV 33%, NPV 100%, LR+ 0.102, LR- NA). CONCLUSIONS & INFERENCES The pediatric version of GUSS has been found to be a valuable tool in identifying the risk of aspiration as that of adults. It proved to be used as a good screening guide for selecting and confirming the existence of dysphagia from instrumental assessments. This is the first study of the pediatric version of GUSS, and future studies on this topic are needed.
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Affiliation(s)
- Rafaella Georgiou
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Health Sciences, Speech and Language Therapy, European University, Nicosia, Cyprus
| | - Louiza Voniati
- Department of Health Sciences, Speech and Language Therapy, European University, Nicosia, Cyprus
| | - Andri Papaleontiou
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandros Gryparis
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nafsika Ziavra
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dionysios Tafiadis
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Health Sciences, Speech and Language Therapy, European University, Nicosia, Cyprus
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Umay E, Cankurtaran D, Tezel N, Uz C, Tombak Y, Karaahmet O, Aykin Yigman Z, Celik G, Unlu Akyuz E. Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy. Clin Pediatr (Phila) 2024:99228241241901. [PMID: 38591868 DOI: 10.1177/00099228241241901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.
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Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Nihal Tezel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Cuma Uz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Yasemin Tombak
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Ozgur Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Gulnur Celik
- Physical Medicine and Rehabilitation Clinic, Mamak State Hospital, Ankara, Turkey
| | - Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
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Porter K, Smart S, Hennessey N, Cocks N. Chewing skills in two and three year old children: Gender and age comparisons on an adapted version of the test of mastication and swallowing (TOMASS-C). INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:38-44. [PMID: 36511843 DOI: 10.1080/17549507.2022.2152867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Few assessment tools objectively measure chewing skills in the paediatric population. There is a need for assessment tools that use consistent foods so comparisons can be made between typically developing children and children with paediatric feeding disorders, and to measure the efficacy of treatment. The Test of Masticating and Swallowing Solids for adults (TOMASS) and children (TOMASS-C) are assessments that use a cracker as a consistent measure to assess chewing skills. Normative data exist for children over 4 years, however, no data are available for younger children. This study investigated age and gender-related differences in mastication skills in typically developing children aged 2-3 years when eating a cracker. METHOD Thirty participants aged 2;0-3;10 were assessed using an adapted version of the TOMASS-C. Participants were required to eat a single Arnott's Salada cracker, and the number of bites, masticatory cycles, swallows, and duration of time to finish the cracker were measured. RESULT Two-year-old children used more masticatory cycles and took longer to finish the cracker than 3-year-old children. There were no significant effects of age on the number of swallows and number of bites, and no significant differences between boys and girls. CONCLUSION This study provides preliminary normative data for chewing skills in children aged 2 and 3 years and confirms that the TOMASS-C is sensitive to developmental changes in mastication within this younger age range. These results expand our understanding of oral motor and chewing development in children.
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Affiliation(s)
- Katelin Porter
- Curtin School of Allied Health, Curtin University, Bentley, Australia
| | - Sharon Smart
- Curtin School of Allied Health, Curtin University, Bentley, Australia
| | - Neville Hennessey
- Curtin School of Allied Health, Curtin University, Bentley, Australia
| | - Naomi Cocks
- Curtin School of Allied Health, Curtin University, Bentley, Australia
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Alex A, Lindh MG, Palmcrantz S. Assessing eating and swallowing in adults born with intellectual and motor disabilities: Face and content validity of a Swedish translation of the Dysphagia Assessment Package. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:1174-1189. [PMID: 37531152 DOI: 10.1111/jir.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Adults born with intellectual disabilities (ID) and motor disabilities (MD) have higher risk of dysphagia and should be assessed to decrease risk of severe complications. However, standardised assessment tools in Swedish are lacking. METHODS The Dysphagia Assessment Package (DAP) was cross-culturally translated from English to Swedish (DAP-SE) and tested for content validity by an expert group. Face validity was assessed by five speech and language therapist (SLT) during meal observations (n = 10), and the clinical relevance was reported in a study-specific questionnaire. RESULTS The DAP-SE was culturally adapted within the process of translation and was found to contain clinically relevant aspects to assess and suggest further interventions for adults with ID and MD. Face and content validity was confirmed by the expert group. CONCLUSION This study, in which the DAP-SE was tested in a small sample size, provides the first indications of the instrument's validity with respect to evaluating mealtimes, swallowing function and swallowing safety in adults born with ID and MD. The study adds to the knowledge on how to translate and culturally adapt an assessment tool to clinically assess dysphagia on a complex and vulnerable patient group.
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Affiliation(s)
- A Alex
- Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - M G Lindh
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Department of Neuroscience, Speech and Language Pathology, Uppsala University, Uppsala, Sweden
| | - S Palmcrantz
- Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Marshall J, Gosa MM, Dodrill P. Patient-Reported Outcome Measures That Describe the Feeding Skills Domain for Pediatric Feeding Disorder: A Clinimetric Review. J Pediatr Gastroenterol Nutr 2023; 77:137-145. [PMID: 37084340 DOI: 10.1097/mpg.0000000000003798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVES Pediatric feeding disorder (PFD) is defined as "impaired oral intake that is not age-appropriate, and is associated with medical, nutritional, feeding skill, and/or psychosocial dysfunction." Patient-reported outcome measures (PROMs) are tools that complement clinical assessment, but many have limited clinimetric data. This review aimed to assess PROMs that reported on the feeding skills domain for PFD in children. METHODS A search strategy across 4 databases was conducted (July 2022). PROMs were included in the review if they described elements of the feeding skills domain of PFD, had criterion/norm-referenced data and/or a standardized assessment procedure, description, or scoring system available, and were applicable to children ≥6 months. PROMs were mapped to the PFD diagnostic domains and aspects of the International Classification of Function (ICF) model. Quality assessment was completed using the COnsensus-based Standards to the selection of health Measurement Instruments methodology. RESULTS Overall, 14 PROMs across 22 papers met inclusion criteria. There was variable methodological quality across the tools, with those more recently developed often receiving better scores, particularly where a more rigorous process for tool development and content validity was reported. Most tools captured ICF aspects of impairment (n = 11, eg, biting/chewing) or activity (n = 13, eg, eating a meal), rather than social participation (n = 3, eg, going to a restaurant). CONCLUSIONS Using PROMs with strong content validity, and including some measure of social participation, is recommended as part of an assessment battery for PFD. Consideration of the caregiver/child perspective is an essential component of family-centered care.
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Affiliation(s)
- Jeanne Marshall
- From the Speech Pathology Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Memorie M Gosa
- the Department of Communicative Disorders, The University of Alabama, Tuscaloosa, AL
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Rabaey PA, Barlow K, Jama H, Lehr V. Investigation of Assessment Tools in the Area of Pediatric Feeding Evaluation: A Mixed-Methods Study. Am J Occup Ther 2023; 77:7704205110. [PMID: 37498961 DOI: 10.5014/ajot.2023.050040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
IMPORTANCE The new diagnostic code for pediatric feeding disorder (PFD) in the International Classification of Diseases, 10th edition, Clinical Modification, requires that occupational therapists and speech-language pathologists (SLPs) use valid and reliable assessment tools that capture the complexity of PFD. OBJECTIVE To determine current assessment tools that clinicians are using across the four domains of PFD: (1) medical factors, (2) nutrition factors, (3) feeding skill factors, and (4) psychosocial factors. A secondary objective was to obtain clinicians' perceptions of the assessment tools. DESIGN A mixed-methods study using survey research and focus groups. SETTING Online survey and virtual focus groups. PARTICIPANTS Occupational therapists and SLPs who identified as clinicians who treat PFDs. RESULTS The survey revealed that 65% of the clinicians (N = 445) used a nonstandardized assessment tool across the four domains of PFD. The focus groups (n = 26) revealed four resulting themes that expanded the survey results: (1) no one assessment tool works, (2) clinicians rely on self-created assessments, (3) it takes a team and collaboration, and (4) there are many issues with the current assessment of PFD. CONCLUSIONS AND RELEVANCE This study reveals the need for clinicians working with children with PFD to use feeding assessment tools with sound psychometric properties. The requirement for occupational therapists and SLPs to evaluate and treat dysphagia and disorders of feeding indicates the need to provide entry-level education on reliable and valid assessment tools that thoroughly evaluate all the domains of PFD. What This Article Adds: This article highlights current assessment tools used by occupational therapists and SLPs treating PFD and the need for more standardized procedures and tools to evaluate children across the four domains of PFD.
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Affiliation(s)
- Paula A Rabaey
- Paula A. Rabaey, PhD, MPH, OTR/L, is Associate Professor, Occupational Therapy, University of Minnesota, Minneapolis;
| | - Kate Barlow
- Kate Barlow, OTD, MS, OTR/L, is Associate Professor, Occupational Therapy, American International College, Springfield, MA
| | - Hibak Jama
- Hibak Jama, is Student, St. Catherine University, St. Paul, MN
| | - Victoria Lehr
- Victoria Lehr, OTD, MS, OTR/L, is Occupational Therapist and Vocational Director, Cutchins Programs for Children and Families, Northhampton, MA
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Khamis A, Badawi N, Morgan C, Novak I. Baby Intensive Early Active Treatment (babiEAT): A Pilot Randomised Controlled Trial of Feeding Therapy for Infants with Cerebral Palsy and Oropharyngeal Dysphagia. J Clin Med 2023; 12:jcm12072677. [PMID: 37048760 PMCID: PMC10095351 DOI: 10.3390/jcm12072677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/09/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
Cerebral palsy (CP), results in impairment of muscle function including the face, mouth, and throat, leading to oropharyngeal dysphagia (OPD), which affects 85% of children with CP. OPD increases risk of deficiencies in growth, neurological development, and aspiration pneumonia, a leading cause of death in CP. This pilot randomised controlled trial aimed to (i) assess feasibility and acceptability of a novel neuroplasticity and motor-learning feeding intervention program, Baby Intensive Early Active Treatment (babiEAT), and standard care, and (ii) explore preliminary efficacy of babiEAT on health and caregiver feeding-related quality of life (QoL). A total of 14 infants with both CP and OPD were randomly allocated to 12 weeks of babiEAT or standard care. Results indicate that babiEAT and standard care are equally feasible, and acceptable. Parents in the babiEAT group thought recommendations were significantly more effective than standard care parents, were more likely to recommend the program to a friend and reported higher QoL. babiEAT infants showed significantly greater efficiency in fluid intake, fewer compensatory strategies with cup drinking, consumption of more advanced food textures, and shorter mealtimes without impacting intake, aspiration risk, or weight. This small pilot study shows promise for babiEAT in infants with CP and OPD. Further research is needed to determine strength of its effects.
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Affiliation(s)
- Amanda Khamis
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
- The Children’s Hospital at Westmead, The Sydney Children’s Hospitals Network, Sydney, NSW 2145, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia
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Cerchiari A, Tofani M, Giordani C, Franceschetti S, Capuano E, Pizza F, Della Bella G, Raponi M, Biondo G. Development and Pilot Study of a Pediatric Screening for Feeding and Swallowing Disorders in Infants and Children: The Pediatric Screening–Priority Evaluation Dysphagia (PS–PED). CHILDREN 2023; 10:children10040638. [PMID: 37189887 DOI: 10.3390/children10040638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
Feeding and swallowing disorders (FSD) are common during childhood, with a prevalence of 85% in children with neurodevelopmental disorders. A comprehensive screening is essential to identify FSD and improve health outcomes in a clinical setting. This study aims to develop a new Pediatric Screening tool capable of identifying FSD. This screening tool was developed in three steps: selecting variables based on clinical experience, searching the literature and finding agreement between experts with a two-round Delphi study. This process, which reached 97% of agreement between experts, led to the development of the Pediatric Screening–Priority Evaluation Dysphagia (PS–PED). PS–PED comprises 14 items divided into three main domains: clinical history, health status and feeding condition. We also carried out a pilot test for measuring internal consistency, as measured with Cronbach Coefficient alpha. Concurrent validity, as measured with Pearson correlation coefficient, was tested using a videofluoroscopy swallow study (VFSS) classified with the Penetration Aspiration Scale (PAS). The pilot test was conducted on 59 children with different health conditions. Our findings showed good internal consistency (alpha = 0.731), and a strong linear correlation with PAS (Pearson 0.824). Furthermore, comparing PS–PED and PAS scores, we find preliminary strong discriminant validity to identify children with FSD (p < 0.01). Our results provide evidence on using the 14-item PS–PED as a screening tool for FSD in a clinical sample of children with heterogeneous disease.
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O'Leary L, Maine A, Ring N, Reid J, Speirs L, Allan L, Truesdale M, Taggart L. A scoping review of the evidence for the use of screening tools in people with intellectual disabilities with dysphagia. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:429-447. [PMID: 36797039 DOI: 10.1111/jar.13076] [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: 02/24/2022] [Revised: 12/11/2022] [Accepted: 01/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Dysphagia can have serious health implications including choking and respiratory infection leading to poorer quality of life. People with intellectual disabilities are at higher risk of dysphagia related health complications and early death. Robust dysphagia screening tools are vital for this population. METHOD A scoping review and appraisal of the evidence for dysphagia and feeding screening tools for use with people with intellectual disabilities was undertaken. RESULTS Seven studies (using six screening tools) met the review inclusion criteria. Mostly studies were limited by no defined dysphagia criteria, no verification of tools with a gold reference standard (e.g., videofluoroscopic examination) and lack of participant diversity (small samples, narrow age range, severity of intellectual disability or limited settings). CONCLUSIONS There is urgent need for development and rigorous appraisal of existing dysphagia screening tools to meet the needs of a wider range of people with intellectual disabilities (particularly mild-to-moderate severity) and in wider settings.
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Affiliation(s)
- Lisa O'Leary
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Andrew Maine
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nicola Ring
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - James Reid
- NHS Forth Valley, Community Hospital, Stirling, UK
| | | | - Louise Allan
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Maria Truesdale
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Cordier R, Speyer R, Martinez M, Parsons L. Reliability and Validity of Non-Instrumental Clinical Assessments for Adults with Oropharyngeal Dysphagia: A Systematic Review. J Clin Med 2023; 12:jcm12020721. [PMID: 36675650 PMCID: PMC9861493 DOI: 10.3390/jcm12020721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/12/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
This systematic review on non-instrumental clinical assessment in adult oropharyngeal dysphagia (OD) provides an overview of published measures with reported reliability and validity. In alignment with PRISMA, four databases (CINAHL, Embase, PsycINFO, and PubMed) were searched, resulting in a total of 16 measures and 32 psychometric studies included. The included measures assessed any aspect of swallowing, consisted of at least one specific subscale relating to swallowing, were developed by clinical observation, targeted adults, and were developed in English. The included psychometric studies focused on adults, reported on measures for OD-related conditions, described non-instrumental clinical assessments, reported on validity or reliability, and were published in English. Methodological quality was assessed using the standard quality assessment QualSyst. Most measures targeted only restricted subdomains within the conceptual framework of non-instrumental clinical assessments. Across the 16 measures, hypothesis testing and reliability were the most reported psychometrics, whilst structural validity and content validity were the least reported. Overall, data on the reliability and validity of the included measures proved incomplete and frequently did not meet current psychometric standards. Future research should focus on the development of comprehensive non-instrumental clinical assessments for adults with OD using contemporary psychometric research methods.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
| | - Renée Speyer
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 XA Leiden, The Netherlands
- Correspondence:
| | - Matthew Martinez
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
| | - Lauren Parsons
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
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12
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Umay E, Eyigor S, Giray E, Karadag Saygi E, Karadag B, Durmus Kocaaslan N, Yuksel D, Demir AM, Tutar E, Tikiz C, Gurcay E, Unlu Z, Celik P, Unlu Akyuz E, Mengu G, Bengisu S, Alicura S, Unver N, Yekteusaklari N, Uz C, Cikili Uytun M, Bagcier F, Tarihci E, Akaltun MS, Ayranci Sucakli I, Cankurtaran D, Aykın Z, Aydın R, Nazli F. Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts. World J Pediatr 2022; 18:715-724. [PMID: 35821340 DOI: 10.1007/s12519-022-00584-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. METHODS This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). RESULTS In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. CONCLUSIONS This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.
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Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey.
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospıtal, Istanbul, Turkey
| | - Evrim Karadag Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Nihal Durmus Kocaaslan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University, Istanbul, Turkey
| | - Deniz Yuksel
- Department of Pediatric Neurology, University of Health Sciences, Ankara Dr Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Engin Tutar
- Department of Pediatric Gastroenterology, Marmara University, Ankara, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Eda Gurcay
- University of Health Sciences Turkey, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Pelin Celik
- Department of Developmental Pediatric, Ankara City Hospital, Ankara, Turkey
| | - Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Guven Mengu
- Department of Western Languages and Literatures, Ankara Haci Bayram Veli University, English Language and Literature Division, Ankara, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Necati Unver
- Department of Otolaryngology, Head and Neck Surgery, Marmara University, Istanbul, Turkey
| | - Nida Yekteusaklari
- Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Cuma Uz
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Merve Cikili Uytun
- Department of Child and Adolescent Psychiatry, Ankara University, Ankara, Turkey
| | - Fatih Bagcier
- Department of Physical Medicine and Rehabilitation, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Elif Tarihci
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Iclal Ayranci Sucakli
- University of Health Sciences Turkey, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Aykın
- Ministry of Health, Mamak Public Hospital, Ankara, Turkey
| | - Resa Aydın
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Fatma Nazli
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
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Pitarch Castellano I, Cabrera-Serrano M, Calvo Medina R, Cattinari MG, Espinosa García S, Fernández-Ramos JA, García Campos O, Gómez-Andrés D, Grimalt Calatayud MA, Gutiérrez Martínez AJ, Ibáñez Albert E, Kapetanovic García S, Madruga-Garrido M, Martínez-Moreno M, Medina Cantillo J, Melián Suárez AI, Moreno Escribano A, Munell F, Nascimento Osorio A, Pascual-Pascual SI, Povedano M, Santana Casiano IM, Vázquez-Costa JF. Delphi consensus on recommendations for the treatment of spinal muscular atrophy in Spain (RET-AME consensus). Neurologia 2022; 37:216-228. [PMID: 35241415 DOI: 10.1016/j.nrleng.2021.07.002] [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: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) is a neurodegenerative disease caused by a biallelic mutation of the SMN1 gene, located on the long arm of chromosome 5, and predominantly affects the motor neurons of the anterior horn of the spinal cord, causing progressive muscle weakness and atrophy. The development of disease-modifying treatments is significantly changing the natural history of SMA, but uncertainty remains about which patients can benefit from these treatments and how that benefit should be measured. METHODOLOGY A group of experts specialised in neurology, neuropediatrics, and rehabilitation and representatives of the Spanish association of patients with SMA followed the Delphi method to reach a consensus on 5 issues related to the use of these new treatments: general aspects, treatment objectives, outcome assessment tools, requirements of the treating centres, and regulation of their use. Consensus was considered to be achieved when a response received at least 80% of votes. RESULTS Treatment protocols are useful for regulating the use of high-impact medications and should guide treatment, but should be updated regularly to take into account the most recent evidence available, and their implementation should be assessed on an individual basis. Age, baseline functional status, and, in the case of children, the type of SMA and the number of copies of SMN2 are characteristics that should be considered when establishing therapeutic objectives, assessment tools, and the use of such treatments. The cost-effectiveness of these treatments in paediatric patients is mainly influenced by early treatment onset; therefore, the implementation of neonatal screening is recommended. CONCLUSIONS The RET-AME consensus recommendations provide a frame of reference for the appropriate use of disease-modifying treatments in patients with SMA.
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Affiliation(s)
- I Pitarch Castellano
- Sección de Neurología Pediátrica, Unidad de Enfermedades Neuromusculares, Servicio de Pediatría, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | - M Cabrera-Serrano
- Servicio de Neurología y Neurofisiología, Hospital Virgen del Rocío, Sevilla, Spain
| | - R Calvo Medina
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Materno-Infantil Regional Universitario de Málaga, Spain
| | - M G Cattinari
- Fundación Atrofia Muscular Espinal (FundAME), Madrid, Spain
| | - S Espinosa García
- Sección de Rehabilitación Infantil, Hospital Universitario La Paz, Madrid, Spain
| | - J A Fernández-Ramos
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - O García Campos
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Universitario de Toledo, Spain
| | - D Gómez-Andrés
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - M A Grimalt Calatayud
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - A J Gutiérrez Martínez
- Servicio de Neurología, Complejo Hospitalario Universitario Insular, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - E Ibáñez Albert
- Sección de Rehabilitación Infantil, Servicio de Medicina Física y Rehabilitación, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - S Kapetanovic García
- Unidad de ELA y Enfermedades Neuromusculares, Servicio de Neurología, Hospital Universitario Basurto, OSI Bilbao-Basurto, Bilbao, Vizcaya, Spain
| | - M Madruga-Garrido
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Viamed Santa Ángela de la Cruz, Sevilla, Spain
| | - M Martínez-Moreno
- Sección de Rehabilitación Infantil, Servicio de Medicina Física y Rehabilitación, Hospital Universitario La Paz, Madrid, Spain
| | - J Medina Cantillo
- Servicio de Medicina Física y Rehabilitación, Hospital Sant Joan de Déu, Barcelona, Spain
| | - A I Melián Suárez
- Sección de Rehabilitación Infantil, Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - A Moreno Escribano
- Servicio de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - F Munell
- Sección de Neurología Pediátrica, Servicio de Pediatría, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - A Nascimento Osorio
- Unidad de Patología Neuromuscular, Servicio de Neurología, CIBERER, Hospital Sant Joan de Déu, Barcelona, Spain
| | - S I Pascual-Pascual
- Servicio de Neurologia Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | - M Povedano
- Unidad Funcional de Motoneurona (UFMN), Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - I M Santana Casiano
- Sección de Rehabilitación Infantil, Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - J F Vázquez-Costa
- Servicio de Neurologia, Unidad de Enfermedades Neuromusculares, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Pitarch Castellano I, Cabrera-Serrano M, Calvo Medina R, Cattinari M, Espinosa García S, Fernández-Ramos J, García Campos O, Gómez-Andrés D, Grimalt Calatayud M, Gutiérrez Martínez A, Ibáñez Albert E, Kapetanovic García S, Madruga-Garrido M, Martínez-Moreno M, Medina Cantillo J, Melián Suárez A, Moreno Escribano A, Munell F, Nascimento Osorio A, Pascual-Pascual S, Povedano M, Santana Casiano I, Vázquez-Costa J. Consenso Delphi de las recomendaciones para el tratamiento de los pacientes con atrofia muscular espinal en España (consenso RET-AME). Neurologia 2022. [DOI: 10.1016/j.nrl.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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15
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Fiori S, Moretti E, Amador C, Martinelli A, Scaramuzzo RT, Controzzi T, Battini R, Filippi L, Guzzetta A, Gargani L. Lung ultrasound in young children with neurological impairment: A proposed integrative clinical tool for deaeration-detection related to feeding. Front Pediatr 2022; 10:932409. [PMID: 35967558 PMCID: PMC9363586 DOI: 10.3389/fped.2022.932409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Infants and children with neurological impairment, such as cerebral palsy (CP), often experience abnormal ingestion functions, including oropharyngeal dysphagia and gastroesophageal reflux disease, which led to aspiration-related respiratory complications, morbidity, hospitalization, or death. There is a lack of evidence-based, repeatable, infant-friendly instrumental procedures to assess aspiration-risk in infants with CP or other neurological disorders, with also a lack of clinical assessment measures to support the use of more invasive diagnostic techniques. To this purpose, in the current study we explore the feasibility of lung ultrasound (LUS), to assess lung deaeration possibly related to aspiration during meal, in a cohort of 35 subjects affected by CP or other encephalopathies, and 10 controls in the same age-range. We coupled LUS procedure with meal caregiver administration for each child. Our results support the feasibility of this innovative approach in the clinical setting. Exploratory findings revealed a number of lung abnormalities likely related to abnormal ingestion function in subjects. Subgroup analyses revealed possible differences in LUS abnormalities between CP and other encephalopathies, possibly related to different mechanism of disease or dysfunction. Also, some evidences arose about the possible relationship between such LUS abnormalities and feeding and swallowing abilities in CP or other encephalopathies. LUS showed preliminarily feasibility and effectiveness in detecting meal-related LUS abnormalities in a dynamic manner in the clinical setting. This approach demonstrated usefulness as a potential tool for improving assessment and management in complex care of infants and young children with severe neurological disorders.
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Affiliation(s)
- Simona Fiori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | | | | | | | | | - Tiziana Controzzi
- Department of Neonatal Intensive Care Unit, Santa Chiara Hospital, Pisa, Italy
| | - Roberta Battini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luca Filippi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Neonatal Intensive Care Unit, Santa Chiara Hospital, Pisa, Italy
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,IRCCS Stella Maris Foundation, Pisa, Italy
| | - Luna Gargani
- Institute of Clinical Physiology National Research Council of Italy (CNR), Pisa, Italy.,Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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Baqays A, Zenke J, Campbell S, Johannsen W, Rashid M, Seikaly H, El-Hakim H. Systematic review of validated parent-reported questionnaires assessing swallowing dysfunction in otherwise healthy infants and toddlers. J Otolaryngol Head Neck Surg 2021; 50:68. [PMID: 34863293 PMCID: PMC8642864 DOI: 10.1186/s40463-021-00549-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and toddlers (OHITs), is underappreciated. As the standard diagnostic tests are either invasive or scarce, valid parent-reported outcome (PRO) questionnaires could play a pivotal role in the understanding and managing SwD in this group. This article reviewed the literature on PRO questionnaires pertaining to SwD in OHITs. DATA SOURCE A librarian searched Prospero, Cochrane Library, Embase, Medline, PsycINFO, HaPI, CINAHL, and SCOPUS until February 2021 using the MeSH terms for deglutition and screening methods. REVIEW METHOD Questionnaires that examined disease-specific or eating and feeding concerns or difficulties were excluded. Two reviewers independently identified PRO questionnaires for SwD that were used in OHITs and extracted the author names, publication year, questionnaire name, the studied population, and the reported psychometric assessments. A quality assessment was performed based on consensus-based standards for the selection of health measurement instruments (COSMIN) and updated criteria for good measurement properties. RESULTS Of the 3488 screened articles, we identified only two questionnaires, the pediatric version of the Eating Assessment Tool (PEDI-EAT-10) and the PRO questionnaire for Swallowing Dysfunction in OHITs. The PEDI-EAT-10 authors assessed the validity and reliability on children with cerebral palsy. However, concerns were identified regarding the developmental process and the internal structure validity. The PRO questionnaire for SwD in OHITs meets criteria but has not yet been validated in the population of interest nor its psychometric properties assessed. CONCLUSION Two instruments were identified. The PED-EAT-10 exhibits methodological flaws, while Edmonton PRO questionnaire for SwD in OHITs awaits construct validation and could fill the current knowledge gap.
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Affiliation(s)
- Abdulsalam Baqays
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Julianna Zenke
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada
| | - Sandra Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Wendy Johannsen
- Department of Pediatric Speech Language Pathology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Marghalara Rashid
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3. 57 Walter MacKenzie Center, Edmonton, AB, T6H0R3, Canada.
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Wilson E, Simione M, Polley L. Paediatric oral sensorimotor interventions for chewing dysfunction: A scoping review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1316-1333. [PMID: 34423521 PMCID: PMC8585681 DOI: 10.1111/1460-6984.12662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Chewing dysfunction can have adverse effects on growth, development and quality of life. There is a lack of evidence-based consensus guidelines for sensorimotor intervention. To address this, we need to understand the current state of the science in clinical sensorimotor interventions for paediatric chewing dysfunction and systematically plan a research agenda and priorities for the field. AIMS The purpose of this scoping review was to examine the extent, range and nature of evidence for oral sensorimotor interventions for paediatric chewing dysfunction. METHODS & PROCEDURES This scoping review entailed five phases that included: identification of the research question; identification of relevant studies; study selection; data charting; and collation, summarization and report of the results. Treatment studies that were peer-reviewed and written in English were included. All studies involved a paediatric population and included an oral sensorimotor and/or chewing intervention. Information regarding study design, population, intervention, comparator, outcome measures and findings were extracted. MAIN CONTRIBUTION Of the 21 studies included in this scoping review, 53% were specific to children with cerebral palsy. All interventions were multi-component in nature and the treatment studies included a range of study designs, but few were controlled trials with comparators. A wide variety of outcomes measures were used within and across studies to determine treatment effectiveness. CONCLUSIONS & IMPLICATIONS The findings suggest that in a small number of studies, sensorimotor interventions provide preliminary evidence for effectiveness in specific populations. These and other treatment protocols must be trialled in additional clinical populations and settings to improve the evidence base for sensorimotor treatment of paediatric chewing dysfunction. This review also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment. WHAT THIS PAPER ADDS What is already known on the subject Paediatric feeding disorders are highly prevalent and children often have chewing dysfunction that results in significant negative consequences. We lack evidence-based sensorimotor treatment approaches for chewing dysfunction, which directly impacts the care clinicians can provide children. What this study adds to existing knowledge This scoping review is the first step in examining the literature to understand the current state of the science for oral sensorimotor interventions for paediatric chewing dysfunction. Few randomized controlled studies were identified and a majority included children with cerebral palsy. Most of the interventions were multi-component and included a variety of treatment approaches. What are the potential or actual clinical implications of this work? The results of this scoping review can be used as an initial reference for clinicians selecting treatment approaches for chewing dysfunction. It also serves to help prioritize research agendas and further motivates the need for consensus-based clinical guidelines for paediatric chewing treatment.
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Affiliation(s)
- Erin Wilson
- Speech and Feeding Disorders Laboratory, MGH Institute of Health Professions, Boston, MA, USA
| | - Meg Simione
- Division of General Pediatrics, Mass General Hospital for Children, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lydia Polley
- Department of Speech Pathology, Akron Children's Hospital, Akron, OH, USA
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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.
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Parr J, Pennington L, Taylor H, Craig D, Morris C, McConachie H, Cadwgan J, Sellers D, Andrew M, Smith J, Garland D, McColl E, Buswell C, Thomas J, Colver A. Parent-delivered interventions used at home to improve eating, drinking and swallowing in children with neurodisability: the FEEDS mixed-methods study. Health Technol Assess 2021; 25:1-208. [PMID: 33769272 PMCID: PMC8020453 DOI: 10.3310/hta25220] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Eating, drinking and swallowing difficulties are common in young children with neurodisability. These difficulties may lead to inadequate calorie intake, which affects a child's nutrition, growth and general physical health. OBJECTIVE To examine which interventions are available that can be delivered at home by parents to improve eating, drinking and swallowing in young children with neurodisability and are suitable for investigation in pragmatic trials. DESIGN This was a mixed-methods study that included focus groups, surveys, an update of published systematic reviews of interventions, a systematic review of measurement properties of existing tools, evidence mapping, evidence synthesis, a Delphi survey and stakeholder workshops. SETTING The study was carried out in NHS hospitals, community services, family homes and schools. PARTICIPANTS Parents of children who had neurodisability and eating, drinking and swallowing difficulties. Professionals from health and education. Young people with eating, drinking and swallowing difficulties or young people who had previously experienced eating, drinking and swallowing difficulties. DATA SOURCES Literature reviews; national surveys of parents and professionals; focus groups with parents, young people and professionals; and stakeholder consultation workshops. REVIEW METHODS An update of published systematic reviews of interventions (searched July-August 2017), a mapping review (searched October 2017) and a systematic review of measurement properties using COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) methodology (searched May 2018). RESULTS Significant limitations of the available research evidence regarding interventions and tools to measure outcomes were identified. A total of 947 people participated: 400 parents, 475 health professionals, 62 education professionals and 10 young people. The survey showed the wide range of interventions recommended by NHS health professionals, with parents and professionals reporting variability in the provision of these interventions. Parents and professionals considered 19 interventions as relevant because they modified eating, drinking and swallowing difficulties. Parents and professionals considered 10 outcomes as important to measure (including Nutrition, Growth and Health/safety); young people agreed that these were important outcomes. Stakeholder consultation workshops identified that project conclusions and recommendations made sense, were meaningful and were valued by parents and professionals. Parents and health professionals were positive about a proposed Focus on Early Eating, Drinking and Swallowing (FEEDS) toolkit of interventions that, through shared decision-making, could be recommended by health professionals and delivered by families. LIMITATIONS The national surveys included large numbers of parents and professionals but, as expected, these were not representative of the UK population of parents of children with eating, drinking and swallowing difficulties. Owing to the limitations of research evidence, pragmatic decisions were made about interventions that might be included in future research and outcomes that might be measured. For instance, the reviews of research found only weak or poor evidence to support the effectiveness of interventions. The review of outcome measures found only limited low-level evidence about their psychometric properties. CONCLUSIONS Opportunities and challenges for conducting clinical trials of the effectiveness of the FEEDS toolkit of interventions are described. Parents and professionals thought that implementation of the toolkit as part of usual NHS practice was appropriate. However, this would first require the toolkit to be operationalised through development as a complex intervention, taking account of constituent interventions, delivery strategies, implementation and manualisation. Subsequently, an evaluation of its clinical effectiveness and cost-effectiveness could be undertaken using appropriate research methods. FUTURE WORK Initial steps include FEEDS toolkit development and evaluation of its use in clinical practice, and identification of the most robust methods to measure valued outcomes, such as Nutrition and Growth. TRIAL REGISTRATION Current Controlled Trials ISRCTN10454425. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jeremy Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Taylor
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU), Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Helen McConachie
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Cadwgan
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Diane Sellers
- Sussex Community NHS Foundation Trust, Chailey Clinical Services, Lewes, UK
| | - Morag Andrew
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Johanna Smith
- Patient and Public Involvement, Newcastle University, Newcastle upon Tyne, UK
| | | | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Buswell
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Julian Thomas
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Allan Colver
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Validity and Reliability of the Turkish Version of the Pediatric Assessment Scale for Severe Feeding Problems. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2163-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baqays A, Johannsen W, Rashid M, Jaffal H, Hicks A, Jeffery C, Seikaly H, El-Hakim H. Parent-Reported Outcome Questionnaire for Swallowing Dysfunction in Healthy Infants and Toddlers: Construction and Content Validation. Otolaryngol Head Neck Surg 2020; 165:197-205. [PMID: 33287657 DOI: 10.1177/0194599820970950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is limited epidemiological information on swallowing dysfunction (SwD) in otherwise healthy infants and toddlers (OHITs). Cost, invasiveness, expertise, and resources constrain the repeatability and utility of instrumental diagnostic tests. A parent-reported outcomes (PRO) tool has the potential to mitigate these disadvantages. Hence, we set out to develop and validate a novel PRO tool to assess SwD in OHITs. STUDY DESIGN A mixed-method study. SETTING Tertiary pediatric center. METHODS We recruited parents of OHITs with SwD and excluded those with a confounding diagnosis (syndromes or neurological impairment). Interviews were conducted and thematically analyzed to extract the relevant domains and items. A similar analytical method was performed on the reports from a systematic review and literature search. Four verification sessions of parents and experts were conducted to maintain rigor. A panel of experts assessed and established the content validity of the items using a modified Delphi technique. RESULTS We achieved information saturation after interviewing 10 parents and generated 7 domains with 72 items. Over the course of 3 rounds of modified Delphi content validation, the domains were reduced to 3 (swallowing, breathing, and illness) containing 21 items; a content validity index of 82.1% was achieved. CONCLUSION We validated the content of a new PRO instrument to assess SwD in OHITs. The instrument is composed of 3 primary domains representing 21 items. This tool has the potential to screen for swallowing dysfunction and can assess management outcomes specifically for this population at a community level.
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Affiliation(s)
- Abdulsalam Baqays
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada.,Division of Otolaryngology, King Saud University, Riyadh, Saudi Arabia
| | - Wendy Johannsen
- Department of Pediatric Speech Language Pathology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hussein Jaffal
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Hicks
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Caroline Jeffery
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
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Abstract
OBJECTIVES The functional oral intake scale (FOIS), developed for adults based on the categories of consumable food has been adapted for infants. A FOIS for children is necessary as oral motor development continues after 1 year of age. This study proposed a FOIS for children and investigated the reliability and validity of the scale. METHODS We adapted the original FOIS into a scale for children by removing 2 item levels to generate a 5-point scale. This retrospective study included 194 children ages 1 to 7 years. Their nutrition records were evaluated separately by 2 raters using the FOIS for children. Dysphagia and aspiration severity were evaluated based on the findings from a videofluoroscopic swallowing study. For children partially dependent on tube feeding, medical records were investigated to determine whether full oral feeding was accomplished within 1 year. RESULTS The inter-rater reliability of FOIS for children had 97.4% agreement (weighted kappa = 0.985, intraclass correlation coefficient = 0.994). Significant associations were identified between the FOIS for children and aspiration severity (P < 0.001, r = 0.315) and dysphagia severity (P < 0.001, r = 0.287). The rate of reaching full oral feeding within 1 year was greater (71.4% vs 30%) in children at the FOIS 3 level (tube and oral feeding in parallel) than for children at FOIS 2 (tube-dependent with minimal oral intake). CONCLUSIONS The FOIS for children showed adequate reliability and validity and could be appropriate for documenting children's eating abilities and evaluating the effectiveness of interventions.
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Speyer R, Cordier R, Kim JH, Cocks N, Michou E, Wilkes-Gillan S. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Dev Med Child Neurol 2019; 61:1249-1258. [PMID: 31328797 DOI: 10.1111/dmcn.14316] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 12/31/2022]
Abstract
AIM To determine the prevalence of drooling, swallowing, and feeding problems in persons with cerebral palsy (CP) across the lifespan. METHOD A systematic review was conducted using five different databases (AMED, CINAHL, Embase, MEDLINE, and PubMed). The selection process was completed by two independent researchers and the methodological quality of included studies was assessed using the STROBE and AXIS guidelines. Meta-analyses were conducted to determine pooled prevalence estimates of drooling, swallowing, and feeding problems with stratified group analyses by type of assessment and Gross Motor Function Classification System level. RESULTS A total of 42 studies were included. Substantial variations in selected outcome measures and variables were observed, and data on adults were limited. Pooled prevalence estimates determined by meta-analyses were as high as 44.0% (95% confidence interval [CI] 35.6-52.7) for drooling, 50.4% (95% CI 36.0-64.8) for swallowing problems, and 53.5% (95% CI 40.7-65.9) for feeding problems. Group analyses for type of assessments were non-significant; however, more severely impaired functioning in CP was associated with concomitant problems of increased drooling, swallowing, and feeding. INTERPRETATION Drooling, swallowing, and feeding problems are very common in people with CP. Consequently, they experience increased risks of malnutrition and dehydration, aspiration pneumonia, and poor quality of life. WHAT THIS PAPER ADDS Drooling, swallowing, and feeding problems are very common in persons with cerebral palsy (CP). The prevalence of drooling, swallowing, and feeding problems is 44.0%, 50.4%, and 53.5% respectively. There are limited data on the prevalence of drooling, swallowing, and feeding problems in adults. Higher Gross Motor Function Classification System levels are associated with higher prevalence of drooling, swallowing, and feeding problems. There is increased risk for malnutrition, dehydration, aspiration pneumonia, and poor quality of life in CP.
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Affiliation(s)
- Renée Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - 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
| | - Jae-Hyun Kim
- Department of Linguistics, Macquarie University, Sydney, Australia
| | - Naomi Cocks
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Emilia Michou
- Department of Speech & Language Therapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Sarah Wilkes-Gillan
- Department of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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van Timmeren DEA, Deddens A, van Schrojenstein Lantman-de Valk HMJ, van der Schans CP, Krijnen WP, Waninge A, van der Putten AAJ. The convergent validity of a Dutch Screening tool for Dysphagia (Signaleringslijst Verslikken) for people with severe or profound intellectual and multiple disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:994-1001. [PMID: 30990246 DOI: 10.1111/jar.12592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dysphagia is potentially life-threatening and highly prevalent in people with severe/profound intellectual and multiple disabilities (SPIMD). The "Signaleringslijst Verslikken" (SV) is a frequently used Dutch screening tool to detect dysphagia. The aim was to examine the convergent validity of the SV for people with SPIMD. METHOD Direct support staff completed the SV, with speech and language therapists scoring a validated tool, the Dysphagia Disorders Survey (DDS), for 41 persons with SPIMD, aged ≥50 years. The results were compared for agreement using the McNemar's Test. RESULTS The proportion of agreement was 0.59 (95% CI 0.43-0.72). The SV did not detect dysphagia in 17 participants (44%) who were assessed as having dysphagia according to the DDS. The difference in proportion of detection of dysphagia between the two methods was significant (p < 0.0001). CONCLUSIONS The results suggest that the convergent validity of the SV is insufficient: the SV is not sensitive for detecting dysphagia in people with SPIMD.
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Affiliation(s)
- Dinette E A van Timmeren
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | | | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Department of Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Health Psychology Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Aly Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Royal Dutch Visio-De Brink, Vries, The Netherlands
| | - Annette A J van der Putten
- Faculty of Behavioural and Social Sciences, Department of Special Needs Education and Youth Care, University of Groningen, Groningen, The Netherlands
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