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McDowell L, King MT, Hutcheson KA, Ringash J, Yom SS, Corry J, Henson C, Mehanna H, Rischin D. A Hard Truth to Swallow: Critically Evaluating the MD Anderson Dysphagia Inventory (MDADI) as an Endpoint in Human Papillomavirus-associated Oropharyngeal Cancer Trials. Int J Radiat Oncol Biol Phys 2024; 120:805-822. [PMID: 38740309 DOI: 10.1016/j.ijrobp.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/16/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024]
Abstract
The MD Anderson Dysphagia Inventory (MDADI), a measure of swallowing-related quality of life, has become the preferred patient-reported outcome measure (PROM) in contemporary clinical trials evaluating the experience of human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPVOPSCC) survivors. With many potentially practice-changing studies using the MDADI composite score as either a primary or coprimary endpoint, or as a key secondary endpoint, it is important to understand its psychometric properties as judged by contemporary PROM standards, with a particular focus on its application to contemporary HPVOPSCC populations. In this critical review, we evaluate contemporary HPVOPSCC studies reporting MDADI outcomes, followed by a detailed evaluation of the psychometric properties of the MDADI. Although the focus of this review was the MDADI, the issues discussed are not unique to the MDADI and have broader applicability to the evaluation and assessment of other PROMs currently in use. First, it may be possible to improve administration of the instrument, as related to missing items, scoring, and the number of items required. Second, although in many instances, the MDADI has been intended as a direct or surrogate measure of swallowing physiology, the MDADI composite score captures a broader health-related quality of life construct affected by both swallowing and eating, the latter of which may be affected by a range of nonswallowing treatment-related toxicities. Finally, a clinically meaningful change of 10 in the MDADI composite score, widely accepted and applied to the clinical trial setting, represents an undoubtably clinically relevant difference in unselected head and neck cancer survivors. However, the smallest difference that might be clinically important to a highly functional HPVOPSCC cohort remains uncertain. Understanding the purpose and properties of the MDADI instrument and furthering the sophistication with which we apply it in this population would improve its interpretation in clinical trials.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia.
| | - Madeleine T King
- University of Sydney, School of Psychology, Sydney, New South Wales, Australia
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Division of Surgery, and Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - June Corry
- Genesiscare St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, United Kingdom
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Gardner D, Mitchell V, Frakking T, Weir KA, Canning A, Wenke RJ. Validated patient reported outcome measures in speech-language pathology: A scoping review of adult practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-30. [PMID: 39356797 DOI: 10.1080/17549507.2024.2399236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
PURPOSE Patient reported outcome measures (PROMs) are increasingly used to inform value-based healthcare. Within speech-language pathology (SLP), there is no synthesis of validated PROMs to guide professional practice. This scoping review systematically identifies and evaluates condition-specific PROMs across adult SLP practice. METHOD A literature search was performed to identify studies published until 18th February 2022 from MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration, and Web of Science. Abstracts and full texts were screened in Covidence. Relevant studies that validated PROMs in English were extracted and assessed using the "Checklist to operationalise measurement characteristics of PROMs" by two independent reviewers. RESULT Ninety-seven articles provided validation data for 71 PROMS across seven SLP practice areas. These included voice (n = 18), swallowing (n = 14), language (n = 11), fluency (n = 8), speech (n = 4), laryngectomy (n = 3), and cognitive-communication (n = 2). No PROMs were identified for augmentative and alternative communication (AAC) (n = 0). Quality ratings were variable on the Francis et al. checklist. CONCLUSION A range of validated PROMs were identified to guide SLP practice in measuring patient perceptions across a range of practice areas in adults. Opportunities for further development in SLP practice areas with limited PROMs, such as speech, cognitive-communication, and AAC are also highlighted.
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Affiliation(s)
- Danielle Gardner
- Speech Pathology Service, Gold Coast University Hospital, Southport, Australia
| | - Verity Mitchell
- Speech Pathology Service, Gold Coast University Hospital, Southport, Australia
| | - Thuy Frakking
- Speech Pathology Service, Gold Coast University Hospital, Southport, Australia
- Research Development Unit, Caboolture Hospital, Metro North Hospital & Health Service, Caboolture, Australia
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Herston, Australia
| | - Kelly Ann Weir
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
- Allied Health, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Angie Canning
- Speech Pathology Service, Gold Coast University Hospital, Southport, Australia
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
| | - Rachel Jane Wenke
- School of Health Sciences and Social Work, Griffith University, Southport, Australia
- Allied Health Research, Gold Coast University Hospital, Southport, Australia, and
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Shapira-Galitz Y, Anderson A, Balou M. Patient-Reported Outcome Measures for Swallowing: A Proposed Checklist. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-10. [PMID: 39151051 DOI: 10.1044/2024_ajslp-23-00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) are an important tool both in clinical practice and research involving patients with swallowing disorders. There are several challenges to be overcome and methodological details to be adequately reported to ensure rigor and transparency in studies utilizing PROMs in dysphagia research. For this reason, the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool developed to ensure rigor and transparency in dysphagia research, has devoted a domain to PROMs. The aim of this current article, as part of a larger forum of articles, is to present the PROM section of FRONTIERS and describe its development. METHOD A literature review was carried out on PROMs in the field of dysphagia by three members of the FRONTIERS collaborative to identify items that were necessary for the rigorous application and transparent reporting of PROMs utilized in research of swallowing disorders in human subjects. Framework items were then subjected to an iterative process of feedback and consensus among the three members of the working group as well as all members of the FRONTIERS collaborative. Items were flagged for review and revised as needed until consensus was achieved on the final list. The final item list was compared to existing critical appraisal tools for PROMs. RESULTS The final checklist for the PROMs domain included 20 "Yes/No" questions that can be broadly divided into three categories: (a) development and validation, (b) patient population, and (c) PROM administration method. Each item is presented with a rationale for its inclusion. CONCLUSIONS The use of the FRONTIERS Framework will serve researchers and those appraising quality of research involving PROMs. More broadly, the FRONTIERS Framework will facilitate improved rigor and transparency across dysphagia research. Special considerations and future goals are discussed.
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Affiliation(s)
- Yael Shapira-Galitz
- Department of Otolaryngology-Head & Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Amber Anderson
- Aerodigestive Research Core, College of Public Health and Health Professions, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Science, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Matina Balou
- NYU Voice Center, Department of Otolaryngology-Head & Neck Surgery, New York University Grossman School of Medicine
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Richmond M, DeVore EK, Song PC. Esophageal Dysphagia in Adults: When It Sticks. Otolaryngol Clin North Am 2024; 57:569-579. [PMID: 38604886 DOI: 10.1016/j.otc.2024.02.027] [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] [Indexed: 04/13/2024]
Abstract
Esophageal dysphagia is a common yet difficult to diagnose condition. This article underscores the role of detailed patient history and physical examinations, including prompt endoscopic evaluation, for accurate differentiation between esophageal and oropharyngeal dysphagia. The authors discuss the heightened importance of early intervention in certain patient groups, such as elderly individuals and patients with head and neck cancer, to mitigate the risk of malnutrition and infection. The authors delve into etiologic factors highlighting the complexity of clinical presentations and the significance of tailored management strategies.
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Affiliation(s)
- Miller Richmond
- Georgetown School of Medicine, 3900 Reservoir Road, NW, Washington, DC 20057, USA
| | - Elliana Kirsh DeVore
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
| | - Phillip C Song
- Department of Otolaryngology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Laryngology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.
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Jewell CC, Harnish SM, Brello J, Lanzi AM, Cohen ML. Poststroke Communication Ability Predicts Patient-Informant Discrepancies in Reported Activities and Participation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1854-1867. [PMID: 38625105 DOI: 10.1044/2024_ajslp-23-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Participation in life situations has been identified by people with aphasia (PWA) as an ultimate outcome of rehabilitation and is often measured with patient-reported outcome measures (PROMs) or informant-reported measures. It is known that PWA and informants do not always produce similar scores on measures of activities and participation. However, systematic differences between PWA and informants and the causes of these differences are not well understood. Here, we investigated these differences as a function of language impairment, perceived level of activity and participation success, and depressive symptoms. METHOD Participants were 29 PWA-informant dyads who completed a performance-based language assessment and three measures related to different aspects of activities and participation. Outcome variables were PWA-informant difference scores in the activities and participation measures. RESULTS PWA ratings of activities and participation were not statistically significantly associated with performance-based language severity. Hierarchical regression models with both language impairment and informant-reported scores as predictor variables explained 53%-71% of the variance in PWA-informant difference scores (all p < .05). In particular, mild communication challenges were associated with the PWA reporting significantly worse participation than the informant perceived. In contrast, more severe communication challenges were associated with the PWA reporting significantly better participation than the informant perceived. DISCUSSION These findings highlight the importance of measuring participation by PROM. The PWA's experience of participation is not related to their level of language impairment and is predictably different from their care partners' perspective. As others have also reported, "mild" aphasia is not so mild to the PWA. Similarly, "severe" may not be so severe to the PWA. Further research is needed to connect these findings with counseling and caregiver education. Research on response processes (e.g., response shift) is also warranted.
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Affiliation(s)
- Courtney C Jewell
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Jennifer Brello
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Alyssa M Lanzi
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Delaware Center for Cognitive Aging Research, Newark
| | - Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Delaware Center for Cognitive Aging Research, Newark
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Brown T, Almiento L, Yu ML, Bhopti A. The Sensory Processing Measure - Second Edition: A Critical Review and Appraisal. Occup Ther Health Care 2024; 38:842-875. [PMID: 37975837 DOI: 10.1080/07380577.2023.2280216] [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: 06/20/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
This paper aims to provide an overview and critique of the newly updated Sensory Processing Measure - second edition (SPM-2) to assist clinicians in understanding its strengths and limitations and in selecting an appropriate sensory processing scale that best meets their clients' needs. Using four established research methodological quality critique tools, the SPM-2's family of age-related versions was evaluated by administering the tools separately and discussed their scoring and findings to reach a consensus on all ratings. The tools identified several strengths and weaknesses of the SPM-2. The SPM-2's items on its age-related versions scored well in the criteria of internal consistency, test-retest reliability, explanation of the instrument design, construct validity, content validity, criterion validity and ease of administration, and scoring. However, a lack of normative data for participant groups outside of the United States, methodological limitations, and a lack of investigation into some important psychometric properties, particularly responsiveness, were identified as notable weaknesses of the SPM-2's items on its age-related versions based on the critique criteria. Overall, despite the areas needing further development and investigation, the SPM-2 is considered a psychometrically sound tool that provides a reliable and valid approach to measuring aspects of the sensory processing construct across the lifespan.
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Affiliation(s)
- Ted Brown
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
| | - Luca Almiento
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
| | - Mong-Lin Yu
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Victoria, Australia
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Perananthan V, Gupta S, Whitfield A, Craciun A, Cronin O, O'Sullivan T, Byth K, Sidhu M, Hourigan LF, Raftopoulos S, Burgess NG, Bourke MJ. When less is more: lower esophageal sphincter-preserving peroral endoscopic myotomy is effective for non-achalasia esophageal motility disorders. Endoscopy 2024; 56:431-436. [PMID: 38183976 DOI: 10.1055/a-2239-7371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
BACKGROUND Non-achalasia esophageal motility disorders (NAEMDs), encompassing distal esophageal spasm (DES) and hypercontractile esophagus (HCE), are rare conditions. Peroral endoscopic myotomy (POEM) is a promising treatment option. In NAEMDs, unlike with achalasia, the lower esophageal sphincter (LES) functions normally, suggesting the potential of LES preservation during POEM. METHODS This retrospective two-center observational study focused on patients undergoing LES-preserving POEM (LES-POEM) for NAEMD. Eckardt scores were assessed pre-POEM and at 6, 12, and 24 months post-POEM, with follow-up endoscopy at 6 months to evaluate for reflux esophagitis. Clinical success, defined as an Eckardt score ≤3, served as the primary outcome. RESULTS 227 patients were recruited over 84 months until May 2021. Of these, 16 underwent LES-POEM for an NAEMD (9 with HCE and 7 with DES). The median pre-POEM Eckardt score was 6.0 (interquartile range [IQR] 5.0-7.0), which decreased to 1.0 (IQR 0.0-1.8; P<0.001) 6 months post-POEM. This was sustained at 24 months, with an Eckardt score of 1.0 (IQR 0.0-1.8; P<0.001). Two patients (12.5%) developed Los Angeles grade A or B esophagitis. CONCLUSIONS LES-POEM for NAEMD demonstrates favorable clinical outcomes, with infrequent esophagitis and reintervention for LES dysfunction rarely required.
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Affiliation(s)
- Varan Perananthan
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
| | - Sunil Gupta
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
| | - Anthony Whitfield
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
| | - Ana Craciun
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- Gastroenterology and Hepatology, Centro Hospitalar Universitario de Lisboa Norte, Lisbon, Portugal
| | - Oliver Cronin
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
| | - Timothy O'Sullivan
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
| | - Karen Byth
- Western Sydney Local Health District Research and Education Network, Westmead Hospital, Westmead, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Mayenaaz Sidhu
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
| | - Luke F Hourigan
- Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
- Gallipoli Medical Research Institute, School of Medicine, The University of Queensland Greenslopes Clinical Unit, Brisbane, Australia
| | - Spiro Raftopoulos
- Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, Australia
- Faculty of Medicine, The University of Western Australia, Perth, Australia
- Faculty of Medicine, Curtin University, Perth, Australia
| | - Nicholas G Burgess
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, Australia
- School of Medicine, The University of Sydney Westmead Clinical School, Sydney, Australia
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Shrigiriwar A, Mony S, Fayyaz F, Onimaru M, Monachese M, Zhang L, Corre F, Azmeera P, Wu H, Wu CCH, Choi K, Gandhi A, Chalikonda D, Keane MG, Ghandour B, Villamarin-Corrales J, Schlachterman A, Tinto RR, Arévalo FE, Arbizu EA, Bapaye A, Velanovich V, Nieto J, Pawa R, Pawa S, Samanta J, Sedarat A, Eleftheriadis N, Saxena P, Bechara R, Al-Haddad MA, Familiari P, Ujiki M, Ramchandani M, Barret M, Chang K, Moll F, Pioche M, Inoue H, Khashab M. Clinical outcomes of peroral endoscopic myotomy with and without septotomy for management of epiphrenic diverticula: an international multicenter experience. Gastrointest Endosc 2024:S0016-5107(24)03205-X. [PMID: 38795736 DOI: 10.1016/j.gie.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 04/17/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND AIMS There are few data favoring the need for septotomy at the time of peroral endoscopic myotomy (POEM) or if POEM alone is sufficient. Our aim was to compare POEM outcomes with and without septotomy (POEM+S or POEM-S) in patients with symptomatic epiphrenic diverticula (ED) and an underlying motility disorder. METHODS This was an international, multicenter retrospective study involving 21 centers between January 2014 and January 2023. Patients with ED and an underlying motility disorder who underwent POEM were included. The primary outcome was clinical success (Eckardt score [ES] ≤3 or a 1-point drop in ES for patients with baseline ES <3) without the need for repeat surgical/endoscopic interventions during follow-up. RESULTS A total of 85 patients (mean age, 64.29 ± 17.1 years; 32 [37.6%] female) with ED and underlying motility disorder underwent POEM+S (n = 47) or POEM-S (n = 38). Patients in the POEM+S group had a significantly higher mean pre-POEM ES (7.3 ± 2.1 vs 5.8 ± 2; P = .002). The most common indication for POEM was achalasia (51% in the POEM+S cohort and 51.8% in the POEM-S cohort; P = .7). A posterior approach was favored in the POEM+S group (76.6% vs 52.6%; P = .02). A similar rate of technical success was seen in both groups (97.9% vs 100%; P = .1). The rate of adverse events was similar between the 2 cohorts (4.2% vs 8.1%; P = .6). The median length of hospital stay after POEM-S was significantly longer compared with POEM+S (2 days [interquartile range (IQR), 1-4 days] vs 1 day [IQR, 1-2 days]; P = .005). Clinical success was equivalent between the 2 groups (83% vs 86.8%; P = .6) at a median follow-up duration of 8 months (IQR, 3-19 months). CONCLUSIONS In patients with ED and an underlying motility disorder, both POEM+S and POEM-S are equally safe and effective, with similar procedure duration and a low recurrence rate at short-term follow-up. Future comparative prospective studies with long-term follow-up are required to validate these findings.
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Affiliation(s)
- Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Shruti Mony
- Division of Gastroenterology and Hepatology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Farimah Fayyaz
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Manabu Onimaru
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Marc Monachese
- Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, California, USA
| | - Linda Zhang
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Felix Corre
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Padmini Azmeera
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Hoover Wu
- Department of Surgery, NorthShore University Health System, Chicago, Illinois, USA
| | - Clement Chun Ho Wu
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kevin Choi
- The University of Sydney, Sydney, New South Wales, Australia
| | - Ashish Gandhi
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Divya Chalikonda
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Margaret G Keane
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ricardo Rio Tinto
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Navarrabiomed Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | | | | | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Vic Velanovich
- Division of General Surgery, the University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Jose Nieto
- Borland-Groover, Jacksonville, Florida, USA
| | - Rishi Pawa
- Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Swati Pawa
- Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Payal Saxena
- The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Bechara
- Gastroenterology and Endoscopy Unit, Digestive Disease Department, L'Pavillon-Edouard Herriot Hospital, Lyon, France
| | | | - Pietro Familiari
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
| | - Michael Ujiki
- Department of Surgery, NorthShore University Health System, Chicago, Illinois, USA
| | - Mohan Ramchandani
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Kenneth Chang
- Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, California, USA
| | - Frédéric Moll
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Mathieu Pioche
- Digestive Endoscopy Unit, Agostino Gemelli University Hospital, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
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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.
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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
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Krisciunas GP, Scheel R, Slavin M. Implementing Dysphagia Outcome Assessments into Clinical Settings: Leveraging Principles of Implementation, Dissemination, and Psychometrics. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:707-715. [PMID: 38284938 DOI: 10.1044/2023_ajslp-23-00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
PURPOSE Myriad dysphagia assessment tools have been designed, but their application is variable. This is partly due to a lack of implementation and dissemination strategy as well as to limited guidance regarding which instruments are optimally designed and best used for clinical and research applications. METHOD This tutorial provides a high-level overview of implementation and dissemination, their interaction with psychometrics and knowledge coproduction, and how these concepts relate to proper development and widespread application of contextually relevant, psychometrically optimized, evidence-based dysphagia assessment instruments. RESULTS A review of the literature identified two dysphagia assessment instruments that purposefully integrated implementation and dissemination processes after measurement development. Application of knowledge coproduction was not identified in any papers reporting development and testing of dysphagia assessment instruments. A better understanding of coproduction and psychometrics when developing measures, while simultaneously applying implementation science and dissemination strategies, can result in the development of optimal dysphagia assessment tools that are more consistently adopted into clinical practice. CONCLUSIONS Clinicians and researchers should promote the development of psychometrically sound measures, and employ principles of implementation science and effective dissemination strategies to advocate for, and promote the use of, well-designed instruments within their appropriate clinical contexts. Support from governing bodies and funding agencies could enhance future efforts to develop, and encourage widespread uptake of, optimally developed dysphagia assessment tools.
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Affiliation(s)
- Gintas P Krisciunas
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, MA
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Health Law, Policy & Management, Boston University School of Public Health, MA
| | - Rebecca Scheel
- Department of Otolaryngology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Mary Slavin
- Department of Health Law, Policy & Management, Boston University School of Public Health, MA
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Toft K, Best C, Donaldson J. Assessment of patients with head and neck cancer using the MD Anderson Dysphagia Inventory: Results of a study into its comprehensiveness, comprehensibility and relevance to clinical practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38441996 DOI: 10.1111/1460-6984.13026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The MD Anderson Dysphagia Inventory (MDADI) is a widely used patient-reported outcome measure (PROM) which assesses dysphagia-related quality of life (QoL) in head and neck cancer (HNC). Despite its common use in HNC research and clinical practice, few of its psychometric properties have been reappraised since its inception. The aim of this study was to perform a survey-based qualitative analysis of UK HNC clinicians' perceptions of the content validity of the MDADI, evaluating it across the parameters of relevance, comprehensiveness and comprehensibility as per the COSMIN guideline for PROM assessment. RESULTS Four themes relating to the content validity of the MDADI were identified: (1) MDADI items lack clarity of definition of the terms 'swallowing', 'eating' and 'dysphagia'; (2) the MDADI is perceived to be overly negative in tone including items that service users may find distressing or disempowering; (3) items in the tool are exclusory to specific subgroups of patients, such as those who are nil by mouth or socially isolated; and (4) modifications to the MDADI were suggested and encouraged to make it more clinically useful and patient-centred. CONCLUSIONS This study indicates that MDADI's content validity is 'insufficient' when rated by COSMIN parameters. This has significant implications for its continued use in HNC research and clinical practice. Further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. WHAT THIS PAPER ADDS What is already known on the subject The MD Anderson Dysphagia Inventory (MDADI) patient-reported outcome measure of dysphagia-related quality of life is widely used in clinical practice and international clinical trials. Content validity is considered to be the most important property of a tool when assessing its psychometric strengths and weaknesses; however, the MDADI's content validity has not been reappraised since its initial development. What this paper adds to existing knowledge This study presents UK speech and language therapists' opinions and experience of the content validity of the MDADI and this first reappraisal of its content validity since its initial development highlights several issues with this psychometric parameter of the tool. This study highlights that further re-evaluation of the content validity of the MDADI is warranted, with potential future amendment of items being indicated if the results of this study are corroborated in subsequent research. What are the potential or actual clinical implications of this work? Clinicians cannot assume that commonly used outcomes tools have strong psychometric profiles. Consideration of the content validity of outcomes tools during selection for use in clinical and research practice should be key, as this will encourage use of tools that produce relevant, valid data that can contribute meaningfully to patient-centred care.
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Affiliation(s)
- Kate Toft
- University of Stirling, Stirling, UK
- NHS Lothian; Western General Hospital, Edinburgh, UK
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Rao SJ, Nickel JC, Navarro NI, Madden LL. Readability Analysis of Spanish Language Patient-Reported Outcome Measures in Laryngology. J Voice 2024; 38:487-491. [PMID: 34742617 DOI: 10.1016/j.jvoice.2021.09.025] [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: 07/06/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laryngologists use patient-reported outcome measures (PROM) to determine the efficacy of an intervention or to evaluate a patient's symptomatology. PROMs should be developed for a diverse target audience, including patients of all literacy levels. The American Medical Association (AMA) recommends that PROMs are written at or below the sixth- grade level. In recent studies, readability scores for otolaryngology PROMs in English were above the recommended reading level. To date, there is limited data regarding the readability of Spanish PROMs. Thus, this study aims to report the readability of Spanish language PROMs in laryngology. METHODS This study analyzed nine Spanish language laryngology PROMs. The authors queried PROMs from PubMed and Google scholar based upon English language laryngology PROM systematic reviews. Common categories included voice, airway, dysphagia, and other laryngology PROMs. Only nine laryngology PROMs were translated and validated in the Spanish language and publicly available. The readability of Spanish PROMs was determined using a multi-lingual readability software by two readability indices: Fernández Huerta and INFLESZ. RESULTS The mean and standard deviation (SD) Fernández-Huerta was 75.25 (27.12) and INFLESZ was 71.25 (26.98). The average readability score per PROM in Spanish was: DI (84.19), EAT-10 (11.54), MDADI (64.92), RSI (57.22), SWAL-QoL (70.98), TVQ (87.64), VFI (99.46), VHI-10 (95.04), and VRQoL (88.28). CONCLUSION The mean readability of Spanish language laryngology PROMs was above the recommended reading level. Patient readability should be considered when developing laryngology PROMs translations and validations. Robust development and testing of novel PROMs are important to address the persistent, pervasive risks for Spanish speaking patients.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Noel I Navarro
- Bilingual/Bicultural Kato Verified Translator, Biomedical Quality Engineer, Fung Institute for Engineering Leadership, University of California, Berkeley, Berkeley, California, USA
| | - Lyndsay L Madden
- Department of Otolaryngology - Head & Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina USA.
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Mascarenhas A, Mendo R, O'Neill C, Franco AR, Mendes R, Simão I, Rodrigues JP. Current Approach to Dysphagia: A Review Focusing on Esophageal Motility Disorders and Their Treatment. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023; 30:403-413. [PMID: 38476159 PMCID: PMC10928869 DOI: 10.1159/000529428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/13/2023] [Indexed: 03/14/2024]
Abstract
Background Dysphagia is a prevalent condition which may severely impact the patient's quality of life. However, there are still lacking standardized therapeutic options for esophageal motility disorders. Summary Dysphagia is defined as a subjective sensation of difficulty swallowing which can result from oropharyngeal or esophageal etiologies. Regarding esophageal dysphagia, after excluding structural causes and esophageal mucosal lesions, high-resolution manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM has not only improved the sensitivity for detecting achalasia but has also expanded our understanding of spastic and hypomotility disorders of the esophageal body. The Chicago Classification v4.0 uses a hierarchical approach and provides a standardized diagnosis of esophageal motility disorders, allowing a tailored therapeutic approach. Dysphagia is often a long-term health problem that broadly impacts health and well-being and leads to physical and psychosocial disability, namely, malnutrition and aspiration pneumonia, as well as social isolation, depression, and anxiety. Apart from achalasia, most esophageal motility disorders tend to have a benign long-term course with symptoms of dysphagia and noncardiac chest pain that can improve significantly over time. Patient-reported outcomes (PROs) are self-assessment tools that capture the patients' illness experience and help providers better understand symptoms from the patients' perspective. Therefore, PROs have a critical role in providing patient-centered care. Key Messages Motility disorders should be ruled out in the presence of nonobstructive esophageal dysphagia, and treatment options should be considered according to the severity of symptoms reported by the patient.
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Affiliation(s)
- André Mascarenhas
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Rui Mendo
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Catarina O'Neill
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Ana Rita Franco
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Raquel Mendes
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Inês Simão
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - José Pedro Rodrigues
- Gastroenterology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Pathophysiology Autonomous Disciplinary Area, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Cortez-Aoyagi M, Gufstason E, Murphy A, van Mersbergen M. A Measure of Swallow Effort Using the Borg Category Ratio 10 Perceived Exertion Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2846-2857. [PMID: 37713539 DOI: 10.1044/2023_ajslp-23-00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE With the emphasis on patient-centered care, tools to adequately measure the experience of swallowing are an important part of clinical care. Swallowing effort is one such experience. However, few measurement tools capture swallowing effort in the moment of swallowing to quantify effort. The Borg Category Ratio 10 Perceived Exertion Scale (Borg CR 10), designed to track effort in a variety of tasks from lifting, breathing, and running, appears to be a likely candidate to measure swallowing effort in the moment of swallowing. METHOD In a quasi-random design, 32 healthy individuals, ages 40-80 years (average age: 63 years), consumed seven bolus consistencies in both small and large quantities, three times. Following each individual swallow, they rated the amount of effort it took to swallow each bolus using an adapted Borg CR 10 for swallowing effort. RESULTS Results showed significantly greater reports of swallowing effort on the Borg CR 10 for more adhesive consistencies, larger quantities, and increased number of swallows. CONCLUSION Results suggest that the Borg CR 10 is a reasonable measurement tool to capture patient-perceived effort in swallowing.
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Affiliation(s)
| | - Erin Gufstason
- Northern Illinois University, DeKalb
- UW Health in Northern Illinois, Rockford
| | - Amanda Murphy
- Northern Illinois University, DeKalb
- Chicago Public Schools, IL
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Rodrigues JP, Mascarenhas A, Félix C, Nascimento D, Correia H, Dias Curto J, Chagas C, Tato Marinho R, Mascarenhas Saraiva M. Translation, Cultural Adaptation and Validation of "PROMIS GI - Disrupted Swallowing" Scale for the Portuguese Language. ACTA MEDICA PORT 2023; 36:706-713. [PMID: 36961414 DOI: 10.20344/amp.19161] [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: 10/15/2022] [Accepted: 01/24/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Dysphagia is a prevalent condition (20%), and occurs more frequently in women and in older people. It negatively impacts innumerous aspects of patient's personal and professional lives. Patient-reported outcomes allow patients to directly quantify their experience regarding dysphagia and evaluate its true impact on quality of life. Among the scales available, Patient-Reported Outcomes Measurement Information System Gastrointestinal (PROMIS GI) Disrupted Swallowing stands out because it is a robust instrument that can be applied regardless of the type and etiology of dysphagia. The aim of this study was to translate, culturally adapt and validate PROMIS GI Disrupted Swallowing scale for the Portuguese-speaking population. MATERIAL AND METHODS Firstly, the seven items of the scale were translated and transculturally reviewed following the systematic method proposed by the Functional Assessment of Chronic Illness Therapy (FACIT). Afterwards, the pre-test version of the questionnaire was administered to a convenience sample (n = 6) for semantic evaluation, with the aim of detection and subsequent correction of possible problems in the translation. The final translated and certified version of the scale was administered to 200 voluntary adult participants (n = 123 healthy; n = 77 dysphagia) in Portugal, for evaluation of reliability and validity. RESULTS The Portuguese version of PROMIS GI Disrupted Swallowing presented acceptable internal consistency (coefficient of Cronbach's α of 0.919) and adequate test-retest reliability (intraclass correlation coefficient of 0.941). The translated version of the scale revealed a strong correlation with both Eckardt score (p < 0.001; ρ = 0.782) and the quality-of-life questionnaire EuroQol-5D (p < 0.001; ρ = -0.551), demonstrating evidence of convergent validity. CONCLUSION The Portuguese version of PROMIS GI Disrupted Swallowing scale presented conceptual, semantic, cultural and measurement equivalence relatively to the original items. The results attained demonstrated that the translation of this scale to Portuguese is reliable and valid for use both in clinical practice and for research purposes.
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Affiliation(s)
- José Pedro Rodrigues
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon; Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - André Mascarenhas
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Catarina Félix
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - David Nascimento
- Swallowing Disorders Unit. Department of Otolaryngology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Helena Correia
- Department of Medical Social Sciences. Northwestern University. Chicago. Illinois. Portugal
| | - José Dias Curto
- Department of Quantitative Methods. ISCTE Business School. Lisbon. Portugal
| | - Cristina Chagas
- Department of Gastroenterology. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisbon. Portugal
| | - Rui Tato Marinho
- Faculdade de Medicina. Universidade de Lisboa. Lisbon; Department of Gastroenterology and Hepatology. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
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Côté C, Brais B, Sèbiyo Batcho C, Brisson JD, Youssof S, Allegue DR, Gagnon C. Introducing the Dysphagiameter: a novel patient-reported outcome measure for evaluating dysphagia in oculopharyngeal muscular dystrophy - from conceptual framework to initial development. Neuromuscul Disord 2023; 33:856-865. [PMID: 37923656 DOI: 10.1016/j.nmd.2023.09.001] [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: 04/19/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is a rare late-onset muscle disease associated with progressive dysphagia. As there was no patient-reported outcome measure specific for the assessment of dysphagia in OPMD, the Dysphagiameter was developed. The Food and Drug Administration guidance was followed. In Phase 1, a systematic literature review and an expert consultation were conducted to identify the concepts of interest. It was decided that the instrument should assess difficulty swallowing using pictures of foods of various textures (part A) and impact of dysphagia on activities and participation (part B), as defined by the International Classification of Functioning, Disability and Health. In Phase 2, focus groups (n = 3) and online surveys (n = 55) were conducted to generate the items. Then, the food items for part A were selected and grouped into 17 textures by a panel of registered dietitians. Cognitive interviews were conducted (n = 23) to refine the instrument and assess its clarity and comprehensiveness. The final draft included 82 food items assessing the capacity to swallow foods and drinks (part A) and 10 items assessing the impact of dysphagia on activities and participation (part B). Item reduction and assessment of psychometrics properties, using Rasch analysis, are ongoing as part of Phase 3.
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Affiliation(s)
- Claudia Côté
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke (Québec) J1H 5N4, Canada; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Clinique des maladies neuromusculaires, Hôpital de Jonquière, 2230, rue de l'Hôpital, 7e étage, Jonquière (Québec) G7X 7X2, Canada.
| | - Bernard Brais
- Department of Neurology and Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, 845, rue Sherbrooke O, Montréal (Québec) H3A OG4, Canada; Rare Neurological Diseases Research Group, The Neuro (Montreal Neurological Institute-Hospital), 3801, rue University, Montréal (Québec) H3A 2B4, Canada
| | - Charles Sèbiyo Batcho
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Institut de réadaptation en déficience de Québec, 525, boul Wilfrid-Hamel, Québec (Québec) G1M 2S8, Canada; Département de réadaptation, Faculté de médecine, Université Laval, Pavillon Ferdinand-Vandry, 1050, rue de la Médecine, Québec (Québec) G1V 0A6, Canada
| | - Jean-Denis Brisson
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke (Québec) J1H 5N4, Canada; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Clinique des maladies neuromusculaires, Hôpital de Jonquière, 2230, rue de l'Hôpital, 7e étage, Jonquière (Québec) G7X 7X2, Canada
| | - Sarah Youssof
- Department of Neurology, Health Sciences, The University of New Mexico, MSC10 5620, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - Dorra Rakia Allegue
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 845, rue Sherbrooke O, Montréal (Québec) H3A 0G4, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, Pavillon Lindsay, 6363, chemin Hudson, 5e étage, Montréal (Québec) H3S 1M9, Canada
| | - Cynthia Gagnon
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke (Québec) J1H 5N4, Canada; Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Clinique des maladies neuromusculaires, Hôpital de Jonquière, 2230, rue de l'Hôpital, 7e étage, Jonquière (Québec) G7X 7X2, Canada
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Noorani M, Bolognone RK, Graville DJ, Palmer AD. The Association Between Dysphagia Symptoms, DIGEST Scores, and Severity Ratings in Individuals with Parkinson's Disease. Dysphagia 2023; 38:1295-1307. [PMID: 36692654 DOI: 10.1007/s00455-023-10555-4] [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: 09/23/2021] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
The Swallow Disturbance Questionnaire (SDQ) is a screening tool developed to identify patients with Parkinson's Disease (PD) in need of objective swallowing evaluation. In a previous investigation, the SDQ did not predict abnormal airway protection on a videofluoroscopic swallowing study (VFSS). This investigation was undertaken to determine whether SDQ scores were more accurate when a global measure was used. The Dynamic Imaging Grade for Swallowing Toxicity (DIGEST) is a validated measure that provides a safety, efficiency, and total severity grade based on VFSS. A secondary analysis was performed using data from 20 patients with PD who had participated in a standardized VFSS protocol. The study sample was predominantly male (80%) with an average age of 71 years, and an average PD duration of 9 years. Using an established cut-off score, participants were subdivided into those with "normal" (n = 10) and "abnormal" SDQ scores (n = 10). Recordings were scored using the DIGEST protocol by two blinded raters who also rated overall dysphagia severity from the VFSS. There was good agreement between the two raters on the DIGEST and strong correlations between DIGEST scores and clinician perceptions of dysphagia severity. Higher SDQ scores were associated with poorer Efficiency on the DIGEST but not Safety or Total scores. Consistent with other PD studies, subjective perceptions of dysphagia were poorly predictive of objective findings on VFSS. There is little information about the validity of the DIGEST for rating neurogenic dysphagia. Our study provides preliminary support for the use of the DIGEST in the PD population.
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Affiliation(s)
- Mehak Noorani
- Deptartment of Otolaryngology-Head & Neck Surgery, NW Center for Voice & Swallowing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Rachel K Bolognone
- Deptartment of Otolaryngology-Head & Neck Surgery, NW Center for Voice & Swallowing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Donna J Graville
- Deptartment of Otolaryngology-Head & Neck Surgery, NW Center for Voice & Swallowing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Andrew D Palmer
- Deptartment of Otolaryngology-Head & Neck Surgery, NW Center for Voice & Swallowing, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
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Zugasti Murillo A, Gonzalo Montesinos I, Cancer Minchot E, Botella Romero F. Hospital management of the patient with dysphagia. Survey and recommendations of SEEN nutrition area. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:1-9. [PMID: 37468415 DOI: 10.1016/j.endien.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/03/2022] [Indexed: 07/21/2023]
Abstract
INTRODUCTION The prevalence of dysphagia in hospitalized patients is extraordinarily high and little known. The goal of care should be to assess the efficacy and safety of swallowing, to indicate personalized nutritional therapy. The development of Dysphagia Units, as a multidisciplinary team, facilitates comprehensive care for this type of patient. MATERIAL AND METHODS A observational, cross-sectional, web-based survey-type study, focused on Spanish Society of Endocrinology and Nutrition department heads, was conducted in September-October 2021. The following data were analyzed: size and type of center, existence of a dysphagia unit, dysphagia screening, dietary and nutritional therapy, education and training of professionals and patients, codification, and quality of life evaluation. RESULTS 65 responses (39% of the total Endocrinology and Nutrition departments). 37% of hospitals have a Dysphagia Unit and 25% are developing it. 75.4% perform screening, with MECV-V in 80.6%, and VED (61.4%) and VFS (54.4%) are performed as main complementary tests. The centers have different models of oral diet, thickeners and nutritional oral supplements adapted to dysphagia. In 40% of the centers, no information is offered on dysphagia, nor on the use of thickeners, dysphagia is coded in 81%, 52.3% have specific nursing protocols and only 8% have scales for quality-of-life evaluation. CONCLUSIONS The high prevalence and the risk of serious complications require early and multidisciplinary management at the hospital level. The information received by the patient and caregiver about the dietary adaptations they need, is essential to minimize risks and improve quality of life.
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Affiliation(s)
- Ana Zugasti Murillo
- Sección de Nutrición Clínica, Servicio Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete Área de Nutrición de la SEEN, Albacete, Spain
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Jønsson CE, Poulsen L, Rölfing JD, Chhina H, Cooper A, Sørensen JA. Danish Linguistic Validation and Cultural Adaptation of the LIMB-Q Kids. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1107. [PMID: 37508603 PMCID: PMC10377942 DOI: 10.3390/children10071107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: Lower Limb deformities include many conditions where pain and physical limitations negatively impact the health-related quality of life (HRQL) of children. The ideal way to assess this impact is by using a Patient Reported Outcome Measure (PROM). Such a condition-specific PROM is under development, called LIMB-Q Kids. This study aimed to perform a translation and cultural adaption (TCA) of the LIMB-Q Kids for use in Danish-speaking children. (2) Methods: TCA guidelines established by the World Health Organization (WHO) and the Professional Society for Health Economics and Outcomes Research (ISPOR) were followed. This process consisted of two independent forward translations, a reconciliation meeting, a backward translation with an assessment, an expert meeting, cognitive interviews with patients, editing based on the interviews, and proofreading. (3) Results: The TCA process contributed to the Danish version of LIMB-Q Kids. The reconciliation meeting resulted in a reconciled Danish version. The revision of the backward translation led to 16 corrections, and after the expert panel meeting, 26 changes were made. Twelve cognitive interviews led to nine changes, which were validated by two further interviews. Proofreading led to no further comments. (4) Conclusions: The TCA process led to a linguistically validated and culturally adapted Danish version of LIMB-Q Kids. This version is being used in the international field test study.
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Affiliation(s)
- Christopher Emil Jønsson
- Research Unit for Plastic Surgery, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Jan Duedal Rölfing
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Harpreet Chhina
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Anthony Cooper
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Orthopaedics, BC Children's Hospital, Vancouver, BC V5Z 4H4, Canada
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
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Chesney N, Khwaounjoo P, Huckabee ML, Cakmak YO. Non-Contact Assessment of Swallowing Dysfunction Using Smartphone Captured Skin Displacements. SENSORS (BASEL, SWITZERLAND) 2023; 23:5392. [PMID: 37420560 DOI: 10.3390/s23125392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/09/2023]
Abstract
Early and accurate dysphagia diagnosis is essential for reducing the risk of associated co-morbidities and mortalities. Barriers to current evaluation methods may alter the effectiveness of identifying at-risk patients. This preliminary study evaluates the feasibility of using iPhone X-captured videos of swallowing as a non-contact dysphagia screening tool. Video recordings of the anterior and lateral necks were captured simultaneously with videofluoroscopy in dysphagic patients. Videos were analyzed using an image registration algorithm (phase-based Savitzky-Golay gradient correlation (P-SG-GC)) to determine skin displacements over hyolaryngeal regions. Biomechanical swallowing parameters of hyolaryngeal displacement and velocity were also measured. Swallowing safety and efficiency were assessed by the Penetration Aspiration Scale (PAS), Residue Severity Ratings (RSR), and the Normalized Residue Ratio Scale (NRRS). Anterior hyoid excursion and horizontal skin displacements were strongly correlated with swallows of a 20 mL bolus (rs = 0.67). Skin displacements of the neck were moderately to very strongly correlated with scores on the PAS (rs = 0.80), NRRS (rs = 0.41-0.62), and RSR (rs = 0.33). This is the first study to utilize smartphone technology and image registration methods to produce skin displacements indicating post-swallow residual and penetration-aspiration. Enhancing screening methods provides a greater chance of detecting dysphagia, reducing the risk of negative health impacts.
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Affiliation(s)
- Nikyta Chesney
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch 8140, New Zealand
| | - Prashanna Khwaounjoo
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Maggie-Lee Huckabee
- Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch 8140, New Zealand
| | - Yusuf Ozgur Cakmak
- Department of Anatomy, University of Otago, Dunedin 9016, New Zealand
- Centre for Bioengineering and Nanotechnology, University of Otago, Dunedin 9054, New Zealand
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Rudisch DM, Krasko MN, Burdick R, Broadfoot CK, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:176-187. [PMID: 37608845 PMCID: PMC10441627 DOI: 10.1007/s40141-023-00392-9] [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] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Purpose of Review Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions. Recent Findings Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations. Summary Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.
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Affiliation(s)
- Denis Michael Rudisch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Maryann N Krasko
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Courtney K Broadfoot
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
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Oleas R, Puga-Tejada M, Sánchez-Carriel M, Valero M, Martin-Delgado J, Ospina J, Muñoz-Jurado G, Egas-Izquierdo M, Arevalo-Mora M, Alvarado-Escobar H, Pitanga-Lukashok H, Baquerizo-Burgos J, Robles-Medranda C. Spanish translation and validation of a hybrid, health-related quality of life questionnaire for chronic esophageal conditions: NEQOL-S. Neurogastroenterol Motil 2023; 35:e14511. [PMID: 36502466 DOI: 10.1111/nmo.14511] [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] [Received: 06/03/2022] [Revised: 10/14/2022] [Accepted: 11/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic esophageal conditions (CEC) are associated with significant disease-related burden, disability, and costs. Health-related quality of life (HRQOL) constructs are intended to capture the physical, mental, social, and emotional aspects of a patient's life and how health status impacts these domains. The Northwestern Esophageal Quality of Life (NEQOL) can be used among esophageal diseases while maintaining sensitivity to specific conditions. We aimed to translate, cross-cultural adapt, and validate the NEQOL into Spanish. METHODS After language and cross-cultural adaptation, the NEQOL was applied to an outpatient clinic-based population in a single tertiary center. We analyzed the internal consistency, construct, criterion validity, and test-retest reliability of the questionnaire. The criterion validity was tested against the SF-12 questionnaire. KEY RESULTS After completing the translation process, no item was considered problematic. A total of 385 patients were included in the validation study. The internal consistency (Cronbach's alpha) for the total NEQOL-S score was 0.89. The NEQOL-S questionnaire showed moderate test-retest reliability (ICC = 0.828; 95% CI 0.755-0.881; p < 0.001). Criterion validity showed good coherence when correlated with the SF-12 survey (R2 = 0.538; 95% CI 0.491-0.585, p < 0.001). CONCLUSIONS AND INFERENCES The translated and cross-culturally adapted NEQOL-S showed good psychometric properties that allow its use in Spanish-speaking patients suffering from CEC.
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Affiliation(s)
- Roberto Oleas
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Miguel Puga-Tejada
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - María Sánchez-Carriel
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Manuel Valero
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jimmy Martin-Delgado
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jessenia Ospina
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Guillermo Muñoz-Jurado
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Martha Arevalo-Mora
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Haydee Alvarado-Escobar
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Hannah Pitanga-Lukashok
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
| | - Carlos Robles-Medranda
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador
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23
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Limpuangthip N, Phuckdeedindan M, Techapiroontong S. Clinician evaluation of removable complete denture quality: A systematic review of the criteria and their measurement properties. J Prosthet Dent 2023:S0022-3913(23)00017-3. [PMID: 36797082 DOI: 10.1016/j.prosdent.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
STATEMENT OF PROBLEM Different criteria have been developed and used for the clinician evaluation of removable complete denture (CD) quality. However, the optimal criteria under a specific clinical or research purpose are unclear. PURPOSE The purpose of this systematic review was to identify the development and clinical parameters of criteria for the clinician evaluation of CD quality and to evaluate the measurement properties of each criterion. MATERIAL AND METHODS An electronic search was conducted through PubMed, Scopus, and Cochrane Database of Systematic Reviews from database inception to April 2022. A hand search was conducted based on the references in the included studies. The measurement properties of the included CD quality criteria were assessed based on the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist and a previous study. The articles that supported the measurement properties of the original CD quality criteria were also included. RESULTS Of the 282 abstracts reviewed, 22 clinical studies were included; 17 original articles that developed a new CD quality criterion and 5 articles that additionally supported measurement properties of the original criterion. There were 18 CD quality criteria with 2 to 11 clinical parameters in each criterion, predominantly denture retention and stability, followed by denture occlusion and articulation, and vertical dimension. Sixteen criteria possessed criterion validity shown by its associations with patient performance or patient-reported outcomes. Responsiveness was reported when a CD quality change was detected after delivery of a new CD, denture adhesive use, or during postinsertion follow-up. CONCLUSIONS Eighteen criteria have been developed for clinician evaluation of CD quality with various clinical parameters, predominantly retention and stability. None of the included criteria met all measurement properties in the 6 assessed domains, but more than half of them had relatively high-quality assessment scores.
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Affiliation(s)
- Nareudee Limpuangthip
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
| | - Metavi Phuckdeedindan
- Research Assistant, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Canick J, Campbell JC, Cohen SM, Jones HN, Leiman DA, Raman S, Starr KNP. Preoperative dysphagia risk in community-dwelling adults aged ≥50 years: Prevalence and risk factors. Nutr Clin Pract 2023; 38:157-166. [PMID: 35788985 PMCID: PMC10026185 DOI: 10.1002/ncp.10889] [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: 03/03/2022] [Revised: 05/04/2022] [Accepted: 06/05/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Preoperative dysphagia screening is rare. The purpose of this study was to assess the prevalence and potential risk factors of preoperative dysphagia risk in adults preparing for surgery. METHODS The Eating Assessment Tool (EAT-10), Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and Sarcopenia Screening Tool (SARC-F) were self-administered in adults preparing for surgery to identify dysphagia, malnutrition, and sarcopenia risk, respectively. Other variables collected include clinical demographics, fall risk, and surgical history associated with increased dysphagia risk. Descriptive summary statistics, univariate analysis, and logistic regression were performed as appropriate. RESULTS The median age was 69 years and preoperative dysphagia risk was 9.6%. Among 357 patients completing both EAT-10 and PG-SGA SF or SARC-F, 7.3% had preoperative dysphagia and malnutrition risk and 7.2% had preoperative dysphagia and sarcopenia risk. Preoperative dysphagia risk was 2.7 times greater in those with prior surgical history associated with increased risk of dysphagia, 2.2 times higher in women, and almost twice as high in Black patients and patients with fall risk. Logistic regression revealed significant odds ratios (ORs) for prior surgical history associated with increased risk of dysphagia (OR, 2.95; 95% CI, 1.62-5.40) and male sex (OR, 0.52; 95% CI, 0.29-0.94), and a significant relationship between preoperative dysphagia and malnutrition risk (OR, 4.56; 95% CI, 2.02-10.28) when controlling for clinical variables. CONCLUSION The high prevalence of dysphagia risk alone and in combination with malnutrition and sarcopenia risk in community-dwelling adults underscores the need for standardized preoperative screening and optimization prior to surgery.
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Affiliation(s)
| | - James C. Campbell
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Seth M. Cohen
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Harrison N. Jones
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC
| | - David A. Leiman
- Department of Medicine, Division of Gastroenterology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
| | - Sudha Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Kathryn N. Porter Starr
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
- Durham VA Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC
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25
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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: 5] [Impact Index Per Article: 5.0] [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.
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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.
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Laparoscopic Esocardiomyotomy-Risk Factors and Implications of Intraoperative Mucosal Perforation. Life (Basel) 2023; 13:life13020340. [PMID: 36836695 PMCID: PMC9963844 DOI: 10.3390/life13020340] [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: 11/12/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Mucosal perforation during laparoscopic esocardiomyotomy is quite frequent, and its consequences cannot always be neglected. The purpose of the study is to investigate the risk factors for intraoperative mucosal perforation and its implications on the postoperative outcomes and the functional results three months postoperatively. MATERIAL AND METHODS We retrospectively identified the patients with laparoscopic esocardiomyotomy performed at Sf. Maria Hospital Bucharest, in the period between January 2017-January 2022 and collected the data (preoperative-clinic, manometric and imaging, intra-and postoperative). To identify the risk factors for mucosal perforations, we used logistic regression analysis. RESULTS We included 60 patients; intraoperative mucosal perforation occurred in 8.33% of patients. The risk factors were: the presence of tertiary contractions (OR = 14.00, 95%CI = [1.23, 158.84], p = 0.033206), the number of propagated waves ≤6 (OR = 14.50), 95%CI = [1.18, 153.33], p < 0.05), the length of esophageal myotomy (OR = 1.74, 95%CI = [1.04, 2.89] p < 0.05), the length of esocardiomyotomy (OR = 1.74, 95%CI = [1.04, 2.89] p < 0.05), and a protective factor-the intraoperative upper endoscopy (OR = 0.037, 95%CI = [0.003, 0.382] p < 0.05). CONCLUSIONS Identifying risk factors for this adverse intraoperative event may decrease the incidence and make this surgery safer. Although mucosal perforation resulted in prolonged hospital stays, it did not lead to significant differences in functional outcomes.
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Gulati A, Kidane J, Chang JL. Patient Reported Outcome Measures for Salivary Function: A Systematic Review. Laryngoscope 2023. [PMID: 36606658 DOI: 10.1002/lary.30550] [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: 07/12/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE A number of patient-reported outcome measures (PROMs) assess quality of life and symptom severity in patients with salivary gland dysfunction, but many vary in the extent of validation and domain types addressed. We identified PROMs validated to measure salivary gland function and analyzed key properties. DATA SOURCES PubMed, Web of Science, Embase, PsycInfo, and CINAHL. REVIEW METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Validated instruments with >1 item to assess salivary gland-related symptoms were included. PROMs were evaluated for developmental methodology, structure, validity, and reliability using Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria. RESULTS A total of 2059 abstracts were retrieved, and 133 full-text articles were reviewed. Sixteen PROMs assessing xerostomia (n = 7), sialadenitis (n = 4), Sjogren's syndrome (n = 2), Parkinson's-associated sialorrhea (n = 2), and oral systemic sclerosis (n = 1) were identified. Most (n = 15) were developed de novo, one was adapted from a pre-existing questionnaire. Eleven PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and 10 included test-retest data. Regarding content validity, four PROMs were developed with both patient and physician input, but none were rated as "adequate." All included comparisons against other questionnaires (n = 7), salivary flow rate (n = 9), and/or healthy controls (n = 3). The most rigorously developed PROM, the Xerostomia Inventory, was rated adequate in 6 out of 7 domains. CONCLUSIONS Several PROMs evaluate salivary function. The abilties of these PROMs to meet design and validation standards were variable, with notable limitations in content validity for all tools. New and updated PROMs assessing obstructive and inflammatory salivary symptoms should utilize patient and provider input. LEVEL OF EVIDENCE N/A Laryngoscope, 2023.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Joseph Kidane
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.,Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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Ribolsi M, Andrisani G, Di Matteo FM, Cicala M. Achalasia, from diagnosis to treatment. Expert Rev Gastroenterol Hepatol 2023; 17:21-30. [PMID: 36588469 DOI: 10.1080/17474124.2022.2163236] [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: 01/03/2023]
Abstract
INTRODUCTION Achalasia is an uncommon esophageal motility disorder and is characterized by alterations of the motility of the esophageal body in conjunction with altered lower esophageal sphincter (LES) relaxation. The clinical presentation of patients with achalasia may be complex; however, the most frequent symptom is dysphagia. The management of patients with achalasia is often challenging, due to the heterogeneous clinical presentation. AREAS COVERED The diagnosis and management of achalasia has significantly improved in the last years due to the growing availability of high-resolution manometry (HRM) and the implementation in the therapeutic armamentarium of new therapeutic endoscopic procedures. Traditional therapeutic strategies include botulinum toxin injected to the LES and pneumatic balloon dilation. On the other hand, surgical treatments contemplate laparoscopic Heller myotomy and, less frequently, esophagectomy. Furthermore, in the last few years, per oral endoscopic myotomy (POEM) has been proposed as the main endoscopic therapeutic alternative to the laparoscopic Heller myotomy. EXPERT OPINION Diagnosis and treatment of achalasia still represent a challenging area. However, we believe that an accurate up-front evaluation is, nowadays, necessary in addressing patients with achalasia for a more accurate diagnosis as well as for the best treatment options.
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Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | | | | | - Michele Cicala
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
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Rahayu Rarasati R, Herawati Juniati S, Yusuf M. Conformity between modified Swallowing Outcome After Laryngectomy questionnaire and Flexible Endoscopic Evaluation of Swallowing in laryngeal carcinoma patients after total laryngectomy. J Public Health Res 2022; 11:22799036221127624. [PMID: 36310823 PMCID: PMC9597034 DOI: 10.1177/22799036221127624] [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: 05/30/2022] [Accepted: 09/01/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND One of the impacts in anatomic laryngeal and phariyngeal changes after total laryngectomy (TL) is oropharyngeal dysphagia (OPD). The detection of neopharyngeal residue as a sign of OPD can be performed by videofluoroscopy (VFS) and flexible endoscopic evaluation of swallowing (FEES). The availability of these tools in rural areas is still limited, thus the treatment of OPD is not maximal. There is a need for a more practical tool, including the modified swallowing outcomes after laryngectomy (SOAL) questionnaire. METHODS This was an analytic observational diagnostic study with a cross-sectional approach. Samples were obtained in Otorhinolaryngology Oncology Clinic and Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, who filled SOAL modified questionnaire followed by FEES. Samples were obtained within 3 months from 10 May to 10 August 2021. The number of samples obtained through simple random sampling was 16 post-TL patients from a total population of 17 patients who met the inclusion and exclusion criteria. The conformity test between modified SOAL questionnaire and FEES was analyzed using McNemar comparison test and Kappa association test. RESULTS McNemar test showed no significant difference between both assessment tools (p > 0.05), and the Kappa test showed an association between both tools (p < 0.05). The results of this study stated that there was conformity between modified SOAL questionnaire and FEES in patients after TL in all types of food bolus had Kappa score of >0.81, showing a reliable association between these tools. Kappa test also showed that out of all three types of boluses, the soft bolus had the highest conformity with a Kappa score of 0.875, followed by thick bolus with 0.839, and watery bolus with 0.818. CONCLUSION There was a conformity between the results of the modified SOAL questionnaire and FEES in head and neck surgery patients after TL.
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Affiliation(s)
| | - Sri Herawati Juniati
- Sri Herawati Juniati, Department of
Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas
Airlangga- Dr. Soetomo General Academic Hospital Center, Surabaya, East Java,
Indonesia. Emails: ;
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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.
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Fernandes-Taylor S, Damico-Smith C, Arroyo N, Wichmann M, Zhao J, Feurer ID, Francis DO. Multicenter Development and Validation of the Vocal Cord Paralysis Experience (CoPE), a Patient-Reported Outcome Measure for Unilateral Vocal Fold Paralysis-Specific Disability. JAMA Otolaryngol Head Neck Surg 2022; 148:756-763. [PMID: 35797026 DOI: 10.1001/jamaoto.2022.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Unilateral vocal fold paralysis (UVFP) is a common and life-changing complication of cancer, trauma, and an estimated 500 000 head, neck, and chest surgeries performed annually in the US, among other causes (eg, idiopathic). Consequent disabilities are profound and often permanent and can include severe voice, swallowing, and breathing dysfunction and concomitant anxiety, isolation, and fear. Physiological measures often correlate poorly with patient-reported disability. The measure described herein was designed to be a comprehensive, psychometrically sound UVFP-specific patient-reported outcome measure (PROM) for use in clinical trials or at point of care. Objective To evaluate the reliability and validity of the CoPE (vocal Cord Paralysis Experience) PROM in a nationally representative sample for both clinical and research use. Design, Setting, and Participants This survey validation study was performed at 34 tertiary care centers across the US and included English-speaking adults with unilateral vocal fold immobility confirmed via laryngoscopy. Main Outcomes and Measures Reliability (internal consistency, alternate form, and test-retest) and validity (convergent and known-group). Results In total, 613 patients (mean [SD] age, 58 [15.3] years; 394 [64.5%] women) were recruited, and 555 (92.3%) completed surveys for all time points. Internal consistency was high in the overall 22-item PROM and psychosocial, swallow, and voice subscales (Cronbach α > 0.91). Intraclass correlations for individuals between the baseline and 2-week administrations were moderate for the overall score and subscales (intraclass correlations range, 0.66-0.80). There were significant differences between the online and 2-week paper administrations for the overall score and voice and psychosocial subscales (overall scale mean: 54.4 [95% CI, 49.7-59.1] vs 48.9 [95% CI, 43.7-54.0] at 2 weeks). The confirmatory model was found to be suitably fitted based on average r2 values 0.5 or greater for subscale and overall scores. Correlations between subscales and existing PROMs (Voice-Related Quality of Life, Eating Assessment Tool, and Communication Participation Item Bank) were all greater than 0.69, and mean PROM subscale scores were significantly different across known quartiles of existing PROMs. Conclusions and Relevance The findings of this survey validation study suggest that the CoPE PROM could serve as a psychometrically sound, comprehensive measure of UVFP-attributed disability suitable for use in clinical and research settings to assess within-person changes. The results will inform a user manual to facilitate use in clinical trials comparing the effectiveness and durability of treatments including behavioral (speech therapy), temporary (eg, injection augmentation), and permanent surgical treatments for UVFP.
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Affiliation(s)
| | | | | | | | - Jiwei Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Irene D Feurer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David O Francis
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison.,Endoscopy and Laryngology Section Editor, JAMA Otolaryngology-Head & Neck Surgery
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Manejo hospitalario del paciente con disfagia. Encuesta y recomendaciones del área de nutrición de la SEEN. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [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: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Savarino E, Bhatia S, Roman S, Sifrim D, Tack J, Thompson SK, Gyawali CP. Achalasia. Nat Rev Dis Primers 2022; 8:28. [PMID: 35513420 DOI: 10.1038/s41572-022-00356-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 02/07/2023]
Abstract
Achalasia is a rare disorder of the oesophageal smooth muscle characterized by impaired relaxation of the lower oesophageal sphincter (LES) and absent or spastic contractions in the oesophageal body. The key pathophysiological mechanism is loss of inhibitory nerve function that probably results from an autoimmune attack targeting oesophageal myenteric nerves through cell-mediated and, possibly, antibody-mediated mechanisms. Achalasia incidence and prevalence increase with age, but the disorder can affect all ages and both sexes. Cardinal symptoms consist of dysphagia, regurgitation, chest pain and weight loss. Several years can pass between symptom onset and an achalasia diagnosis. Evaluation starts with endoscopy to rule out structural causes, followed by high-resolution manometry and/or barium radiography. Functional lumen imaging probe can provide complementary evidence. Achalasia subtypes have management and prognostic implications. Although symptom questionnaires are not useful for diagnosis, the Eckardt score is a simple symptom scoring scale that helps to quantify symptom response to therapy. Oral pharmacotherapy is not particularly effective. Botulinum toxin injection into the LES can temporize symptoms and function as a bridge to definitive therapy. Pneumatic dilation, per-oral endoscopic myotomy and laparoscopic Heller myotomy can provide durable symptom benefit. End-stage achalasia with a dilated, non-functioning oesophagus may require oesophagectomy or enteral feeding into the stomach. Long-term complications can, rarely, include oesophageal cancer, but surveillance recommendations have not been established.
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Affiliation(s)
- Edoardo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), Padua, Italy. .,Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy.
| | - Shobna Bhatia
- Department of Gastroenterology, Sir HN Reliance Foundation Hospital, Mumbai, India
| | - Sabine Roman
- Hospices Civils de Lyon, Digestive Physiology, Hopital E Herriot, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Inserm U1032, LabTAU, Lyon, France
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | - Jan Tack
- Division of Gastroenterology, University Hospital of Leuven, Leuven, Belgium
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
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Vos EL, Nakauchi M, Capanu M, Park BJ, Coit DG, Molena D, Yoon SS, Jones DR, Strong VE. Phase II Trial Evaluating Esophageal Anastomotic Reinforcement with a Biologic, Degradable, Extracellular Matrix after Total Gastrectomy and Esophagectomy. J Am Coll Surg 2022; 234:910-917. [PMID: 35426405 PMCID: PMC9128801 DOI: 10.1097/xcs.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A biologic, degradable extracellular matrix (ECM) has been shown to support esophageal tissue remodeling, which could reduce the risk of anastomotic leak following total gastrectomy and esophagectomy. We evaluated the safety and efficacy of reinforcing the anastomosis with ECM in reducing anastomotic leak as compared to a matched cohort. STUDY DESIGN In this single-center, nonrandomized phase II trial, gastric or esophageal adenocarcinoma patients undergoing total gastrectomy or esophagectomy were recruited from November 2013 through December 2018. ECM was surgically wrapped circumferentially around the anastomosis. Anastomotic leak was assessed clinically and by contrast study and defined as clinically significant if requiring invasive treatment (grade 3 or higher). Anastomotic stenosis, other adverse events, symptoms, and dysphagia score were collected by standardized forms at regular follow-up visits at approximately postoperative days (POD) 21 and 90. Patients receiving ECM were compared to a cohort matched for surgery type and age. RESULTS ECM placement was not feasible in 9 of 75 patients (12%), resulting in 66 patients receiving ECM. Total gastrectomy was performed in 50 patients (76%) and esophagectomy in 16 (24%). Clinically significant anastomotic leak was diagnosed in 6 of 66 patients (9.1%) (3/50 [6.0%] after gastrectomy, 3/16 [18.8%] after esophagectomy); this rate did not differ from that in the matched cohort (p = 0.57). Stenosis requiring invasive treatment occurred in 8 patients (12.5%), and 10 patients (15.6%) reported not being able to eat a normal diet at POD 90. No adverse events related to ECM were reported. CONCLUSIONS Esophageal anastomotic reinforcement after total gastrectomy or esophagectomy with a biologic, degradable ECM was mostly feasible and safe, but was not associated with a statistically significant decrease in anastomotic leak.
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Affiliation(s)
- Elvira L Vos
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Masaya Nakauchi
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marinela Capanu
- Department of Surgery, Department of Epidemiology & Biostatistics (Capanu), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Coit
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel S Yoon
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vivian E Strong
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
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Cisternas D, Taft T, Carlson DA, Glasinovic E, Monrroy H, Rey P, Hani A, Ardila-Hani A, Leguizamo AM, Bilder C, Ditaranto A, Varela A, Agotegaray J, Remes-Troche JM, de León AR, de la Serna JP, Marin I, Serra J. The Brief Esophageal Dysphagia Questionnaire shows better discriminative capacity for clinical and manometric findings than the Eckardt score: Results from a multicenter study. Neurogastroenterol Motil 2022; 34:e14228. [PMID: 34342075 DOI: 10.1111/nmo.14228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Grading dysphagia is crucial for clinical management of patients. The Eckardt score (ES) is the most commonly used for this purpose. We aimed to compare the ES with the recently developed Brief Esophageal Dysphagia Questionnaire (BEDQ) in terms of their correlation and discriminative capacity for clinical and manometric findings and evaluate the effect of gastroesophageal reflux symptoms on both. METHODS Symptomatic patients referred for high-resolution manometry (HRM) were prospectively recruited from seven centers in Spain and Latin America. Clinical data and several scores (ES, BEDQ, GERDQ) were collected and contrasted to HRM findings. Standard statistical analysis was performed. KEY RESULTS 426 patients were recruited, 31.2% and 41.5% being referred exclusively for dysphagia and GERD symptoms, respectively. Both BEDQ and ES were independently associated with achalasia. Only BEDQ was independently associated with being referred for dysphagia and with relevant HRM findings. ROC curve analysis for achalasia diagnosis showed AUC of 0.809 for BEDQ and 0.765 for ES, with the main difference being higher BEDQ sensitivity (80.0% vs 70.8% for ES). GERDQ independently predicted ES but not BEDQ. In the absence of dysphagia (BEDQ = 0), GERD symptoms significantly determine ES. CONCLUSIONS AND INFERENCES Our study suggests both the BEDQ and ES can complementarily describe symptomatic burden in achalasia. BEDQ has several advantages over the ES in the dysphagia evaluation, basically due to its higher sensitivity for manometric diagnosis and independence of GERD symptoms. ES should be used as an achalasia-specific metric, while BEDQ is a better symptom-generic evaluating tool.
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Affiliation(s)
- Daniel Cisternas
- Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tiffany Taft
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dustin A Carlson
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Esteban Glasinovic
- Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Hugo Monrroy
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Rey
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Albis Hani
- San Ignacio Hospital, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Andres Ardila-Hani
- San Ignacio Hospital, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Claudio Bilder
- Hospital Universitario, Escuela de Medicina, Fundación Favaloro, Buenos Aires, Argentina
| | - Andres Ditaranto
- Hospital Universitario, Escuela de Medicina, Fundación Favaloro, Buenos Aires, Argentina
| | - Amanda Varela
- Hospital Universitario, Escuela de Medicina, Fundación Favaloro, Buenos Aires, Argentina
| | - Joaquin Agotegaray
- Hospital Universitario, Escuela de Medicina, Fundación Favaloro, Buenos Aires, Argentina
| | | | | | | | - Ingrid Marin
- University Hospital Germans Trias i Pujol, Motility and Functional Gut Disorders Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat Autonoma de Barcelona, Badalona, Spain
| | - Jordi Serra
- Digestive System Research Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University Hospital Vall d'Hebron, Barcelona, Spain
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Manduchi B, Che Z, Fitch MI, Ringash J, Howell D, Martino R. Psychometric properties of patient-reported outcome measures for dysphagia in head and neck cancer: a systematic review protocol using COSMIN methodology. Syst Rev 2022; 11:27. [PMID: 35168687 PMCID: PMC8848952 DOI: 10.1186/s13643-022-01903-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dysphagia (swallowing difficulty) is one of the most common and debilitating sequelae of head and neck cancer (HNC). Patient-reported outcome measures (PROMs) are a fundamental component of dysphagia outcomes evaluation, as they inform treatment consequences that cannot be captured by objective clinician measures. Many PROMs for dysphagia in HNC are available, but their validity is unclear. As a consequence, the selection of the most appropriate PROM for dysphagia in HNC is complex and often based on the clinician's personal preferences, rather than on valid psychometric properties. This protocol describes a systematic review aiming at (1) identifying PROMs specific to dysphagia symptoms, swallowing functional status, swallowing-related health status, and swallowing-related quality of life in HNC, (2) mapping them to our conceptual framework of dysphagia-related PROs, and (3) appraising their psychometric properties using the Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology. METHODS Six electronic databases will be searched from inception to December 2020 for all primary studies in any language and design detailing PROM development, reliability, validity, feasibility, interpretability, and/or cross-cultural adaptation. Eligibility criteria will target PROMs for patients with HNC (≥ 90% of the study sample) with ≥ 20% of their items pertaining to swallowing. Two independent raters will screen abstract and full texts and a third rater will resolve discrepancies. Data will be extracted on study, sample and PROM characteristics, and results of psychometric testing. PROMs will be mapped to our conceptual framework. The methodological quality of included PROMs and their psychometric properties will be appraised using the COSMIN risk of bias checklist and evidence will be summarized using a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. DISCUSSION This systematic review will provide a summary of existing dysphagia-related PROMs for people with HNC and a comprehensive account of their psychometric properties. We will provide recommendations on PROMs selection which will aid healthcare professionals to the most appropriate PROM based on its validity, reliability, feasibility, interpretability and suitability for clinical and research settings. Further recommendations will be made on areas of measurement property requiring further testing. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration ID: CRD42021237877.
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Affiliation(s)
- Beatrice Manduchi
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada. .,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada. .,The Swallowing Lab, University of Toronto, Toronto, ON, Canada.
| | - Zhiyao Che
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,The Swallowing Lab, University of Toronto, Toronto, ON, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.,The Swallowing Lab, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, University Health Network, Toronto, ON, Canada
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Dorsey YC, Song EJ, Leiman DA. Beyond the Eckardt Score: Patient-Reported Outcomes Measures in Esophageal Disorders. Curr Gastroenterol Rep 2021; 23:29. [PMID: 34850300 DOI: 10.1007/s11894-021-00831-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of patient reported outcome measures (PROMs) and summarize their role in assessing undifferentiated dysphagia and common esophageal disorders, including achalasia, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD). RECENT FINDINGS Given the subjective nature of swallowing disorders, accurate diagnoses often rely on capturing the patient experience. As a result, the number of PROMs used to characterize esophageal symptoms is increasing with a recent particular emphasis on EoE. Overall, esophageal-focused PROMs are used to interpret patient symptoms and quality of life, diagnosis, and symptom changes over time. There are limitations with each instrument, including factors affecting validity, reliability, accessibility, patient participation, and logistical implementation. PROM instruments can be helpful tools in the diagnosis and treatment of esophageal disorders. Instruments should be chosen based on factors such as target population and setting, including research, clinical, and quality improvement efforts. Future research should address how best to implement PROMs and integrate the obtained data with patient care.
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Affiliation(s)
- Y Claire Dorsey
- Division of Gastroenterology, Duke University School of Medicine, Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA
| | - Erin J Song
- Department of Medicine, Duke University, Durham, NC, USA
| | - David A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
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Wishart LR, Harris GB, Cassim N, Alimin S, Liao T, Brown B, Ward EC, Nund RL. Association Between Objective Ratings of Swallowing and Dysphagia-Specific Quality of Life in Patients Receiving (Chemo)radiotherapy for Oropharyngeal Cancer. Dysphagia 2021; 37:1014-1021. [PMID: 34625841 DOI: 10.1007/s00455-021-10364-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Abstract
The pervasive nature of dysphagia in the head/neck cancer (HNC) population necessitates a comprehensive evaluation approach, including both objective assessment of dysphagia, and subjective patient-reported functional measures. However, the congruence between clinician-rated and patient-perceived function is still not well understood. The current study investigated the association between objective clinician-rated swallow physiology (using the MBSImP) and patient-reported measures of swallowing-related quality of life (using the MDADI) in a secondary analysis of patients with oropharyngeal HNC treated with (chemo)radiotherapy. Seventy-nine patients with oropharyngeal HNC receiving (chemo)radiotherapy completed a standardised videofluoroscopic swallow study (VFSS) rated using the MBSImP, and the MDADI, at pre-treatment (baseline), 6 weeks and 3 months post-treatment as per a previous prospective RCT. Data on n = 67 participants were analysed as part of the secondary analysis. Association between MBSImP oral and pharyngeal composite scores versus MDADI Global and subscale scores was examined using ordinary least squares regression and mixed-effects general linear modelling (GLM). Univariable analyses demonstrated significant associations between MBSImP oral composite scores and each of the MDADI subscales, as well as the MBSImP pharyngeal composite scores and all MDADI subscales. GLM analysis revealed significant associations were maintained between MBSImP pharyngeal scores and the MDADI global and emotional subscale scores at the multivariable level, with the physical subscale trending towards significance. No significant association was observed between the MBSImP oral composite scores and any of the MDADI subscales at the multivariable level. This study found significant associations between objective measures of pharyngeal swallow physiology and patient-perceived swallowing-related quality of life. These findings suggest a higher degree of concordance between clinician-rated and patient-reported measures up to 3 months post-(C)RT than previously reported.
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Affiliation(s)
- Laurelie R Wishart
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia.
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.
- Centre for Functioning & Health Research, PO Box 6053, Buranda, Brisbane, QLD, 4102, Australia.
| | - Grace B Harris
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nabeela Cassim
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Stephanie Alimin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Ting Liao
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Bena Brown
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Brisbane, Australia
| | - Elizabeth C Ward
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca L Nund
- Centre for Functioning & Health Research, Metro South Hospital & Health Service, Brisbane, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Eraković JL, Radulović LB, Idrizović ZA, Roganović MB. Screening of dysphagia in relapsing-remitting multiple sclerosis patients in Montenegro. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2021; 26:331-338. [PMID: 34663705 PMCID: PMC9037765 DOI: 10.17712/nsj.2021.4.20210063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/11/2021] [Indexed: 05/07/2023]
Abstract
OBJECTIVES To perform screening of dysphagia in Montenegrin multiple sclerosis (MS) patients. Dysphagia is often neglected problem in patients with MS. METHODS We included 104 patients with relapsing-remitting MS who completed 3 questionnaires: dysphagia in multiple sclerosis (DYMUS), eating assessment tool-10 (EAT-10) and swallowing disturbance questionnaire (SDQ). Our study was performed in the clinic for neurology of the Clinical Center of Montenegro (Podgorica, Montenegro) and Polyclinic Neuron (Bijelo Polje, Montenegro) between November 2020 and December 2020. RESULTS Self-reported prevalence of this symptom in our group was simmilar to previously reported results. We did not find correlation between DYMUS and expanded disability status scale (EDSS), as it was reported before. Time spent from disease onset to diagnosis is strongly correlated with reported SDQ results. The population of dysphagia-patients is statistically significantly older compared to the non-dysphagia patients, and statistically higher mean values in this population of our subjects were proven on all 3 questionnaires used. CONCLUSION The importance of this issue is not just because it warns of potientially malnutrion in MS patients, but also important factor in therapy choosing algorithm in the era of orally used immunomodulatory drugs.
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Affiliation(s)
- Jevto Lj. Eraković
- From the Department of Neurology (Eraković, Radulović, Roganović), Clinical Centre of Montenegro, from the Faculty of Medicine (Radulović, Roganović), University of Montenegro, Podgorica, and from the Polyclinic Neuron (Idrizović), Bijelo Polje, Montenegro.
- Address correspondence and reprint request to: Dr. Jevto Lj. Eraković, Clinic for Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro. E-mail: ORCID ID: https://orcid.org/0000-0002-2108-0746
| | - Ljiljana B. Radulović
- From the Department of Neurology (Eraković, Radulović, Roganović), Clinical Centre of Montenegro, from the Faculty of Medicine (Radulović, Roganović), University of Montenegro, Podgorica, and from the Polyclinic Neuron (Idrizović), Bijelo Polje, Montenegro.
| | - Zilha A. Idrizović
- From the Department of Neurology (Eraković, Radulović, Roganović), Clinical Centre of Montenegro, from the Faculty of Medicine (Radulović, Roganović), University of Montenegro, Podgorica, and from the Polyclinic Neuron (Idrizović), Bijelo Polje, Montenegro.
| | - Milovan B. Roganović
- From the Department of Neurology (Eraković, Radulović, Roganović), Clinical Centre of Montenegro, from the Faculty of Medicine (Radulović, Roganović), University of Montenegro, Podgorica, and from the Polyclinic Neuron (Idrizović), Bijelo Polje, Montenegro.
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Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [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: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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Mari A, Abu Baker F, Pellicano R, Khoury T. Diagnosis and Management of Achalasia: Updates of the Last Two Years. J Clin Med 2021; 10:jcm10163607. [PMID: 34441901 PMCID: PMC8397142 DOI: 10.3390/jcm10163607] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Achalasia is a rare neurodegenerative disorder causing dysphagia and is characterized by abnormal esophageal motor function as well as the loss of lower esophageal sphincter (LES) relaxation. The assessment and management of achalasia has significantly progressed in recent years due to the advances in high-resolution manometry (HRM) technology along with the improvements and innovations of therapeutic endoscopy procedures. The recent evolution of HRM technology with the inclusion of an adjunctive test, fluoroscopy, and EndoFLIP has enabled more precise diagnoses of achalasia to be made and the subgrouping into therapeutically meaningful subtypes. Current management possibilities include endoscopic treatments such as Botulinum toxin injected to the LES and pneumatic balloon dilation. Surgical treatment includes laparoscopic Heller myotomy and esophagectomy. Furthermore, in recent years, per oral endoscopic myotomy (POEM) has established itself as a principal endoscopic therapeutic alternative to the traditional laparoscopic Heller myotomy. The latest randomized trials report that POEM, pneumatic balloon dilatation, and laparoscopic Heller's myotomy have comparable effectiveness and complications rates. The aim of the current review is to provide a practical clinical approach to dysphagia and to shed light on the most recent improvements in diagnostics and treatment of achalasia over the last two years.
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Affiliation(s)
- Amir Mari
- Department of Gastroenterology, Nazareth Hospital, Faculty of Medicine, Bar-Ilan University, Safed 16100, Israel
- Correspondence: ; Tel.: +972-46028814
| | - Fadi Abu Baker
- Hillel Yaffe Medical Center, Department of Gastroenterology and Hepatology, Hadera 38100, Israel;
| | | | - Tawfik Khoury
- Galilee Medical Center, Department of Gastroenterology, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 13100, Israel;
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43
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Anjos LMD, Silva FTMD, Pernambuco L. Translation and cross-cultural adaptation of the Swallow Outcomes After Laryngectomy (SOAL) Questionnaire for Brazilian Portuguese. Codas 2021; 33:e20200018. [PMID: 34133613 DOI: 10.1590/2317-1782/20202020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To adapt the Swallow Outcomes After Laryngectomy (SOAL) Questionnaire for the Brazilian culture. METHOD Validation study restricted to translation and cross-cultural adaptation. The following steps were taken: discussion of the need for the instrument in the Brazilian context, two independent translations, summary of the translations, analysis by a committee of 12 expert judges in dysphagia and oncology, analysis of the judges' comments and of the content validity indexes of each item and of the questionnaire as a whole, application of the questionnaire in a sample of 10 total laryngectomy patients, back translation and final summary. RESULTS It was necessary to perform semantic, syntactic/grammatical, experiential, idiomatic and content equivalences, mainly after the analysis by experts. The content validity indexes of each item and of the questionnaire were acceptable for all evaluated aspects. The back translation was equivalent to the original version. The comparison of the original, translated and back-translated versions indicated that the final version of the instrument was viable. CONCLUSION The SOAL was adapted to the Brazilian culture was developed. The validation process will continue using the version presented in this study.
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Affiliation(s)
- Larissa Mendonça Dos Anjos
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| | | | - Leandro Pernambuco
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.,Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
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Kolz JM, Alvi MA, Bhatti AR, Tomov MN, Bydon M, Sebastian AS, Elder BD, Nassr AN, Fogelson JL, Currier BL, Freedman BA. Anterior Cervical Osteophyte Resection for Treatment of Dysphagia. Global Spine J 2021; 11:488-499. [PMID: 32779946 PMCID: PMC8119911 DOI: 10.1177/2192568220912706] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVES When anterior cervical osteophytes become large enough, they may cause dysphagia. There is a paucity of work examining outcomes and complications of anterior cervical osteophyte resection for dysphagia. METHODS Retrospective review identified 19 patients who underwent anterior cervical osteophyte resection for a diagnosis of dysphagia. The mean age was 71 years and follow-up, 4.7 years. The most common level operated on was C3-C4 (13, 69%). RESULTS Following anterior cervical osteophyte resection, 79% of patients had improvement in dysphagia. Five patients underwent cervical fusion; there were no episodes of delayed or iatrogenic instability requiring fusion. Fusion patients were younger (64 vs 71 years, P = .05) and had longer operative times (315 vs 121 minutes, P = .01). Age of 75 years or less trended toward improvement in dysphagia (P = .09; OR = 18.8; 95% CI 0.7-478.0), whereas severe dysphagia trended toward increased complications (P = .07; OR = 11.3; 95% CI = 0.8-158.5). Body mass index, use of an exposure surgeon, diffuse idiopathic skeletal hyperostosis diagnosis, surgery at 3 or more levels, prior neck surgery, and fusion were not predictive of improvement or complication. CONCLUSIONS Anterior cervical osteophyte resection improves swallowing function in the majority of patients with symptomatic osteophytes. Spinal fusion can be added to address stenosis and other underlying cervical disease and help prevent osteophyte recurrence, whereas intraoperative navigation can be used to ensure complete osteophyte resection without breaching the cortex or entering the disc space. Because of the relatively high complication rate, patients should undergo thorough multidisciplinary workup with swallow evaluation to confirm that anterior cervical osteophytes are the primary cause of dysphagia prior to surgery.
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Affiliation(s)
- Joshua M. Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Atiq R. Bhatti
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Marko N. Tomov
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ahmad N. Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brett A. Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Brett A. Freedman, Department of Orthopedic
Surgery, Mayo Clinic Minnesota, 200 First St SW, Rochester, MN 55905, USA.
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45
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Roman S, Guadagnoli LA, Hastier A, Becam E, Craven MRA, Pandolfino JE, Napoléon M, Carlson DA, Mion F, Taft T. Validation in French of the Brief Esophageal Dysphagia Questionnaire in Patients Referred For Esophageal Manometry. Dysphagia 2021; 37:392-398. [PMID: 33830347 DOI: 10.1007/s00455-021-10290-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/25/2021] [Indexed: 12/30/2022]
Abstract
A brief esophageal dysphagia questionnaire (BEDQ) was recently developed in English to evaluate frequency and intensity of dysphagia. Our aim was to validate this questionnaire in French in a cohort of patients referred for esophageal manometry. Patients referred for esophageal high resolution manometry were offered to fill out different questionnaires including Eckart score, GERDQ score and BEDQ. BEDQ was translated in French by two French native speakers and experts in esophageal motility. Patients were grouped according to the indications of esophageal high resolution manometry (dysphagia, GERD, others). The total BEDQ score was calculated and compared between groups. The validation method used the assessment of internal consistency with Cronbach's alpha and reliability with Guttman split-half reliability. BEDQ questionnaire was completed by 608 patients (44% males, mean age 54 years). The total score had an excellent internal consistency (Cronbach's alpha = 0.90) and reliability (Guttman statistic = 0.92). The correlation was good with Eckardt score (r = 0.65, p < 0.001) but poor with the GERDQ score (r = 0.21, p < 0.01). Patients referred for dysphagia (n = 197) had an Eckardt score and a BEDQ score significantly higher than those referred for GERD or other indications (5.48 vs 3.65 and 3.53 respectively for Eckardt score and 15.85 vs 4.64 and 5.78 for BEDQ, p < 0.001). BEDQ is a valid questionnaire in French to assess dysphagia in clinical practice. It remains to be determined if this score is sensitive to symptom variation and thus useful for the follow up of patients with dysphagia.
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Affiliation(s)
- Sabine Roman
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France.
- Université Claude Bernard Lyon I, Explorations Fonctionnelles Digestives, Lyon, France.
| | - Livia Anna Guadagnoli
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Audrey Hastier
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
| | - Estelle Becam
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
| | - Meredith Ruth Ann Craven
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Marie Napoléon
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
| | - Dustin A Carlson
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Francois Mion
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
- Université Claude Bernard Lyon I, Explorations Fonctionnelles Digestives, Lyon, France
| | - Tiffany Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
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46
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Matsuo T, Matsuyama M. Detection of poststroke oropharyngeal dysphagia with swallowing screening by ultrasonography. PLoS One 2021; 16:e0248770. [PMID: 33730038 PMCID: PMC7968693 DOI: 10.1371/journal.pone.0248770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022] Open
Abstract
There are currently no standard evaluation tools for poststroke neurogenic oropharyngeal dysphagia. We previously suggested calculating the relative movements of the hyoid bone and larynx by ultrasonography to evaluate swallowing movement. Swallowing movement is altered in neurogenic oropharyngeal dysphagia. Therefore, the present study aimed to verify whether an ultrasonographic evaluation of swallowing movement facilitates the detection of neurogenic oropharyngeal dysphagia. Eighteen healthy male elderly participants (the healthy group) and 18 male stroke patients diagnosed with neurogenic oropharyngeal dysphagia (the dysphagia group) were enrolled. Participants swallowed 5 mL of liquid and water with an adjusted viscosity and the movements of the hyoid bone and larynx were visualized by ultrasonography. The results obtained revealed significant differences in laryngeal duration (static phase), laryngeal displacement (elevation phase), and the hyoid bone–laryngeal motion ratio (HL motion ratio) between the two groups. A multiple regression analysis was performed to adjust for confounding factors, and laryngeal duration (static phase) and the HL motion ratios were identified as factors affecting dysphagia. In the receiver operation characteristic curve of the two variations, the area under the curve for laryngeal duration (static phase) was 0.744 and the cut-off was 0.26 sec with 72.2% sensitivity and 88.9% specificity; the area under the curve for the HL motion ratio was 0.951 and the cut-off was 0.56 with 88.9% sensitivity and 88.9% specificity. Therefore, the objective evaluation of hyoid bone and larynx movements during swallowing by ultrasonography facilitated the detection of neurogenic oropharyngeal dysphagia.
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Affiliation(s)
- Takao Matsuo
- Faculty of Allied Health Sciences, Division of Speech-Language-Hearing Therapy, Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Asahigaoka, Kashiwara city, Osaka, Japan
- * E-mail:
| | - Miwa Matsuyama
- Department of Oral Health Care and Rehabilitation, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho, Tokushima city, Tokushima, Japan
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Pesce M, Sweis R. Advances and caveats in modern achalasia management. Ther Adv Chronic Dis 2021; 12:2040622321993437. [PMID: 33786159 PMCID: PMC7958157 DOI: 10.1177/2040622321993437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
Achalasia is a rare esophageal motility disorder characterized by the incomplete
relaxation of the lower esophageal sphincter (LES) and impaired peristaltic
activity. The advent of high-resolution manometry (HRM) and the rapidly evolving
role of therapeutic endoscopy have revolutionized the approach to the diagnosis
and management of achalasia patients in the last decade. With advances in HRM
technology and methodology, fluoroscopy and EndoFlip, achalasia can be
differentiated into therapeutically meaningful phenotypes with a high degree of
accuracy. Further, the newest treatment option, per-oral endoscopic myotomy
(POEM), has become a staple therapy following the last 10 years of experience,
and recent randomized trials appear to show no difference between POEM, graded
pneumatic dilatation and surgical Heller myotomy in terms of short- and
long-term efficacy or complication rate. On the other hand, how treatment
outcomes are measured as well as the risk of reflux following therapy remain
areas of contention. This review aims to summarize the recent advancements in
achalasia testing and therapy, describes the recent randomized clinical trials
as well as their potential setbacks, and touches on the future of personalizing
achalasia treatment.
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Affiliation(s)
- Marcella Pesce
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Rami Sweis
- University College London Hospital, GI Services, 235 Euston Rd, London, NW1 2BU, UK
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Lin DJ, Altamimi J, Pearce K, Wilson JA, Patterson JM. Psychometric Properties of the MDADI-A Preliminary Study of Whether Less is Truly More? Dysphagia 2021; 37:323-332. [PMID: 33709289 PMCID: PMC8948102 DOI: 10.1007/s00455-021-10281-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
The MD Anderson Dysphagia Inventory (MDADI) is a 20-item dysphagia-specific QOL questionnaire with four subscales: global, emotional, functional, and physical. It is widely used in clinical practice and in research; however, its psychometric properties have been under-researched. We aim to evaluate the organisation of the MDADI subscales and identify any redundant items. The MDADI is a routinely collected outcome measure at two centres in northeast England. Questionnaires completed at three months following treatment were extracted from these existing databases. Factor analysis was carried out with the aim of reducing redundancy among the set of questionnaire items. Cases with missing values were excluded. A total of 196 complete patient questionnaires were used in factor analysis. A one-factor model accounted for around 50% of the total variance in item responses. The top five endorsed items (abbreviated by the questionnaire item keywords: Excluded, Irritate, Esteem, Social, and Why) in this one factor appeared in three (emotional, functional, and physical) of the four supposed MDADI subscales, i.e. global, emotional, functional, and physical. Our results suggest an overlap of three MDADI subscales across the top five endorsed items. The content of the top five questions all appear related to the psychosocial aspects of swallowing. This implies some redundancy of the items in the original subscales of the questionnaire. Using the most endorsed items, it appears feasible to abbreviate the 20-item MDADI questionnaire to a 5-item “MiniDADI” questionnaire, which is likely to have greater utility in routine clinical practice outside of research settings.
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Affiliation(s)
- Daniel J Lin
- Translational and Clinical Research Institute, Newcastle University, 3rd Floor, William Leech Building, Medical School, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK. .,Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
| | - Jenan Altamimi
- Faculty of Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, UK
| | - Kim Pearce
- Faculty of Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, UK
| | - Janet A Wilson
- Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
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Huang WC, Tan ECH, Huang SS, Chou CJ, Chang WK, Chu YC. Postoperative Sore Throat Helps Predict Swallowing Disturbance on Postoperative Day 30 of Anterior Cervical Spine Surgery: A Secondary Exploratory Analysis of a Randomized Clinical Trial of Tracheal Intubation Modes. Dysphagia 2021; 37:37-47. [PMID: 33620562 DOI: 10.1007/s00455-021-10247-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/13/2021] [Indexed: 11/25/2022]
Abstract
Nasotracheal intubation benefits dysphonia recovery after anterior cervical spine surgery (ACSS). The aim of the present study was to investigate the effect of tracheal intubation modes on post-ACSS swallowing function and identify factors associated with deglutition on postoperative day 30 (POD 30). Adult patients were randomized to receive either nasotracheal or orotracheal intubation during surgery. A numerical rating scale (NRS) was used to assess postoperative sore throat, and the Bazaz grading system was used to assess the severity of swallowing disturbance. The primary endpoints were the effect of tracheal intubation modes on postoperative sore throat and deglutition. Thereafter, we further elucidated the predictors of swallowing disturbance on POD 30. Postoperative sore throat and swallowing disturbance did not differ between the nasotracheal and orotracheal intubation groups. A secondary dataset analysis revealed that among 108 patients with complete follow-up until POD 30, 71 (65.7%) presented complete recovery without swallowing disturbance, whereas 37 (34.3%) presented varying degrees of swallowing disturbance. Receiver operating characteristic curve analysis indicated that the NRS score for sore throat predicted a swallowing disturbance-free status on POD 30. The optimal cutoff values were ≤ 4 and ≤ 2 on PODs 1 and 2, respectively. The adjusted odds ratio (OR) for independent predictors was a sore throat NRS score of ≤ 4 on POD 1 (OR 3.2; 95% CI 1.29-7.89; P = 0.012) and score of ≤ 2 on POD 2 (OR 6.67; 95% CI 2.41-18.47; P < 0.001). Therefore, tracheal intubation mode did not affect the incidence of post-ACSS swallowing disturbance, and the severity of sore throat on PODs 1 and 2 could predict a swallowing disturbance-free status on POD 30.The trial was registered at clinicaltrials.gov (Trial No. NCT03240042, date of registration 10/17/2017).
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Affiliation(s)
- Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Elise Chia-Hui Tan
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, and Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology and Institute of Medicine, Chung Shan Medical University, and Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chi-Jen Chou
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital and Institute of Medicine, National Yang-Ming University, Taipei, Taiwan.
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50
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[The German Sydney Swallow Questionnaire : Reliability and validity in patients with oropharyngeal dysphagia]. HNO 2021; 69:969-977. [PMID: 33608794 PMCID: PMC8613080 DOI: 10.1007/s00106-021-01000-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Sydney Swallow Questionnaire (SSQ) is a self-report inventory assessing subjective symptoms of oropharyngeal dysphagia with strong content, construct, discriminant, and predictive validity and test-retest reliability in a range of patient populations. OBJECTIVE The main aim of this work was to assess the validity and reliability of the German version of the SSQ (SSQ-G). MATERIALS AND METHODS In a cross-validation study, 48 adult German-speaking patients (12 women, 36 men) with neurogenic (n = 16), structural (n = 16), and functional (n = 16) oropharyngeal dysphagia were assessed with the SSQ‑G and the MD Anderson Dysphagia Inventory (MDADI). Cronbach's α was applied to assess the reliability. Criteria and construct validity were investigated using the Spearman correlation coefficient. RESULTS With Cronbach's α = 0.94, the internal consistency of the SSQ‑G was excellent. The SSQ‑G questions 1 and 17 showed a moderately significant and highly significant correlation coefficient of -0.43 and -0.45, respectively, with MDADI question 1 (p < 0.5, p < 0.001). Between questions 8, 11, and 12 of the SSQ‑G and questions 7, 13, and 10 of the MDADI, coefficients of -0.48 to -0.55 showed a moderate to strong highly significant correlation (p < 0.001). Thus, the reliability and criterion and construct validity were statistically confirmed. CONCLUSION The German version of the SSQ (SSQ-G) allows a reliable and valid assessment of functional swallowing difficulties. In combination with questionnaires on symptom-specific quality of life, such as the MDADI, a more differentiated clinical analysis of swallowing problems is thus possible.
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