Psychometrics of a Chinese translation of the swallowing questionnaire

The Huntington's Disease Dysphagia Scale

BACKGROUND

Little is known about the swallowing disturbances of patients with Huntington's disease; therefore, we developed the Huntington's Disease Dysphagia Scale.

METHODS

The scale was developed in four stages: (1) item generation, (2) comprehension testing, (3) evaluation of reliability, (4) item reduction and validity testing. The questionnaire was presented twice to 50 Huntington's disease patients and their caregivers. The Kruskal-Wallis test was used to evaluate whether the severity of swallowing difficulties increased with advancing disease. Pearson's correlation coefficient was used to examine the construct validity with the Swallowing Disturbance Questionnaire.

RESULTS

The final version contained 11 items with five response options and exhibited a Cronbach's alpha coefficient of 0.728. The severity of swallowing difficulties was significantly higher in more advanced Huntington's disease. The correlation with the Swallowing Disturbance Questionnaire was 0.734.

CONCLUSION

We developed a valid and reliable 11-item scale to measure the severity of dysphagia in Huntington's disease.

Development and validation of the Human Activity Profile into Chinese language: Lessons in determining equivalence

The Human Activity Profile (HAP), and associated Dyspnea Scale, is a self-report instrument for assessing levels of human activity. Although it has been used in studies examining the levels of activity in people, it is limited to people who are only able to understand English. However, many countries are multicultural with significant numbers of people whose native language is not English. This study sought to demonstrate the equivalence between the Chinese and English versions of the HAP and Dyspnea scales. Thirty-five bilingual university students completed both the Chinese and English versions of each questionnaire. There was 89% and 85% agreement between items across the HAP and Dyspnea Scale questionnaires, respectively. Although the psychometric evaluations suggested there was equivalence between the Chinese and English versions of both the HAP and Dyspnea Scale, lessons have been learnt regarding the different written forms of Chinese.

Instrument translation process: a methods review

BACKGROUND

Cross-cultural and international collaborative studies are needed in nursing research. Therefore, it is necessary to translate research instruments into the language of the culture being studied. In this methods review, different processes of instrument translation and evaluation of translation adequacy in published nursing research are described and classified into a hierarchy.

METHODS

Studies including translation of quantitative research instruments were reviewed. Forty-seven studies were included. These were classified into six categories.

RESULTS

Studies were classified into categories as follows: forward-only translation (2), forward-only translation with testing (7), back-translation (13), back-translation with monolingual test (18), back-translation with bilingual test (3), and back-translation with both monolingual and bilingual test (4). Strengths and weaknesses are analysed.

CONCLUSION

The studies reviewed used diverse methods of varying quality. There is need for consensus among researchers in how to achieve quality of instrument translation in cross-cultural research. Researchers should carefully attend to achieving and reporting evidence of the accuracy and validity of instrument translation. When back-translation fails to achieve semantic equivalence, the instrument development process should be replicated in the target language.

Efficacy of swallowing training for residents following stroke

BACKGROUND

The presence of dysphagia is associated with an increased risk of mortality, malnutrition, dehydration, compromised pulmonary function, and disability. Appropriate swallowing training can establish optimal nutritional status and eliminate or reduce the risk of developing medical complications associated with swallowing impairment.

AIM(S) OF THE STUDY

The aim of this study was to examine the functional swallowing and nutritional outcomes of swallowing training in institutionalized stroke residents with dysphagia.

DESIGN AND METHODS

A quasi-experimental parallel cluster design was used. Seven institutions with similar bed sizes were selected. All subjects in the experimental group received a structured swallowing training programme. The subjects in the experimental group (n = 40) received 30 minutes of swallowing training each day for 6 days per week for 8 weeks. The control group (n = 21) did not receive any training.

RESULTS

After swallowing training, mean differences in volume per second, volume per swallow, mid-arm circumference and body weight between pre- and post-training of the experimental group were significantly higher than for the control group, while mean differences in neurological examination and choking frequency during meals for the experimental group were significantly lower than in the control group.

CONCLUSION

This study used objective timed swallowing tests, a swallowing questionnaire, and a neurological examination to evaluate the effects of swallowing training. However, videofluroscopy is generally considered the best method for evaluating the pharyngeal and esophageal stages of swallowing, and introducing this technique is recommended for future studies. Furthermore, it is recommended that nursing professionals should conduct swallowing training protocols in stroke patients to help prevent aspiration from dysphagia.

Validating an instrument for clinical supervision using an expert panel

Use of research instruments standardised in English-speaking countries is commonplace in non-English speaking countries. This article describes technical, linguistic and conceptual issued raised in the translation and validation of an acceptable country-specific instrument. The Manchester Clinical Supervision Scale was validated for use in clinical supervision in Finland using quantitative and qualitative methods. The approach applied was triangulation. The focus of this paper, is to describe the item validation process of the scale using an expert panel (n=11) by means of the content validity index and panel interview. The process resulted in a country-specific 33-item instrument. The study indicated that content validity index and panel discussion are easy, but reliable ways of demonstrating the instrument's content validity.

Prevalence of impaired swallowing in institutionalized older people in taiwan

OBJECTIVES

To investigate the prevalence of impaired swallowing in residents at long-term care facilities (LTCFs) in Taiwan.

DESIGN

A chart review, a structured questionnaire completed at interview, a neurological examination, and a timed swallowing test were used to assess impairment and to gather demographic data.

SETTING

Nine skilled nursing facilities and nine intermediate-care facilities in metropolitan Taipei.

PARTICIPANTS

One thousand two hundred twenty-one conscious and unconscious residents with a mean age of 77.07.

MEASUREMENTS

Impaired swallowing was defined when a subject met two or more of the following criteria: self-report of swallowing difficulty, a score of 2 or more derived from a swallowing questionnaire combined with a neurological examination investigating symptoms and signs of impairment, and coughing/choking during a timed swallowing test or a measured swallowing rate (volume swallowed per second) below the 10th percentile as derived from a gender-based study of an older community in Taipei.

RESULTS

Of the 1,221 subjects, 356 (29.2%) were fed by tube. The prevalence rates for impaired swallowing as estimated were 97.5% and 31.9% for tube-fed and non-tube-fed subjects respectively, whereas the overall prevalence for tube-fed and non-tube-fed subjects altogether was 51.0%.

CONCLUSIONS

The findings may serve to increase awareness of this problem among healthcare professionals in LTCFs. Further research is contemplated to investigate whether early identification makes a difference in treatment choices and outcomes.