Validity and reliability of the korean version of the MD anderson Dysphagia inventory for head and neck cancer patients

A Hard Truth to Swallow: Critically Evaluating the MD Anderson Dysphagia Inventory (MDADI) as an Endpoint in Human Papillomavirus-associated Oropharyngeal Cancer Trials

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.

Patient-reported outcome measures for dysphagia in head and neck cancer: A systematic review and appraisal of content validity and internal structure

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.

Cross-Cultural Adaptation and Validation of the Persian Version of the M. D. Anderson Dysphagia Inventory

Introduction  Dysphagia is a common issue in patients with head and neck cancer (HNC) and is known to negatively impact their quality of life. To evaluate the impact of dysphagia on the quality of life of HNC patients, the M. D. Anderson Dysphagia Inventory (MDADI) questionnaire was developed. Objective  The present study aimed to culturally adapt and validate the MDADI for Persian-speaking individuals. The MDADI is a self-administered questionnaire designed to assess the impact of dysphagia on the quality of life of HNC patients. Methods  The original MDADI questionnaire was translated into Persian using the forward-backward method, following the guidelines of the World Health Organization (WHO) for cultural adaptation. The content validity of the Persian version, MDADI-P, was assessed by 10 speech-language pathologists using the content validity index (CVI). Seventy-five HNC patients completed the MDADI-P to evaluate its convergent validity, which was determined by comparing the results with the Short-Form 36 (SF-36) questionnaire. Internal consistency and test-retest reliability were assessed using Cronbach α coefficient and intraclass correlation (ICC), respectively. Results  The scale content validity index (S-CVI) for the MDADI-P was 0.90, indicating good content validity. The MDADI-P demonstrated satisfactory internal consistency (Cronbach α coefficient = 0.728) and test-retest reliability (ICC = 0.91). The total MDADI-P score exhibited a significant correlation with the physical and mental components of the SF-36 (0.456 and 0.349, respectively, p  < 0.05). Conclusion  The findings of the present study confirm the suitability of the MDADI-P in terms of content validity, construct validity, internal consistency, and test-retest reliability.

Application of an L-shaped anterolateral thigh flap in reconstruction after hemiglossectomy

Objective

Tongue defect reconstruction is one of the key components of tongue cancer surgery. In this study, we used an L-shaped flap design adopted as a simple and efficient method to repair tongue defects after hemiglossectomy. Furthermore, we evaluated and contrasted the clinical effects of two methods, the L-shaped and traditional methods.

Study design

Fifteen patients in the L-shaped group and 20 patients in the traditional group were evaluated and compared in terms of postoperative complications, dysphagia, language function and appearance satisfaction.

Results

The results (Table 1) showed that there were 2 cases of donor area invalid traumas, and 2 patients had scar hyperplasia in the traditional group. The degree of global and functional dysphagia of the L-shaped group (2.60 ± 0.29 and 11.47 ± 1.38) was lower than that of the traditional group (3.55 ± 0.29 and 15.75 ± 1.22) (P < 0.05). In the language evaluation, the traditional group (3.20 ± 0.26) had lower scores than the L-shaped group (4.13 ± 0.30) (P < 0.05).

Conclusion

The L-shaped ALTP flap is a simple and efficient modification of ALTP, that can be used for half-tongue repair after radical operations for tongue cancer. It has better performance in the recovery of dysphagia and language function than the traditional ALTP flap.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12893-022-01473-7.

Factors related to dysphagia-specific quality of life in aged patients with neurologic disorders: A cross-sectional study

This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support-a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains-the subscales of dysphagia-specific quality of life-are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.

Translation and Validation of the Indonesian MD Anderson Dysphagia Inventory (MDADI) in Head and Neck Cancer Patients with Swallowing Disorders

Introduction  Dysphagia is common in head and neck cancer patients; it is associated with significant morbidity, including quality of life. Several instruments can be used to assess the quality of life of dysphagia patients, including the M.D Anderson dysphagia inventory (MDADI) questionnaire, which is sufficiently valid and reliable to improve the quality of life of patients with neurological disorders and head and neck cancer.

Objective  The purpose of the present study is to perform adaptation, cultural translation, and validation of the MDADI questionnaire for the Indonesian language.

Methods  This cross-sectional study assessed the validity and reliability of the MDADI Indonesian adaptation instrument in head and neck cancer patients with swallowing disorders in the Otorhinolaryngology clinic of the Dr. Sardjito hospital, Yogyakarta, from May to August 2019.

Results  There were 40 study subjects, including 31 men and 9 women. The MDADI instrument adapted to Indonesian is valid and reliable as an instrument for assessing the quality of life of patients with head and neck cancer with swallowing disorders, with r-values ranging from 0.314 to 0.939. Internal consistency shows that Cronbach's α is 0.915, and test-retest reliability (intra-class correlation) ranges from 0.919 to 0.985.

Conclusion  The translation and validation of the Indonesian MDADI instrument were performed as an instrument for assessing the quality of life of head and neck cancer patients with swallowing disorders.

The PRO-ACTIVE trial protocol: a randomized study comparing the effectiveness of PROphylACTic swallow InterVEntion for patients receiving radiotherapy for head and neck cancer

BACKGROUND

Swallowing therapy is commonly provided as a treatment to lessen the risk or severity of dysphagia secondary to radiotherapy (RT) for head and neck cancer (HNC); however, best practice is not yet established. This trial will compare the effectiveness of prophylactic (high and low intensity) versus reactive interventions for swallowing in patients with HNC undergoing RT.

METHODS

This multi-site, international randomized clinical trial (RCT) will include 952 adult patients receiving radiotherapy for HNC and who are at high risk for post-RT dysphagia. Participants will be randomized to receive one of three interventions for swallowing during RT: RE-ACTIVE, started promptly if/when dysphagia is identified; PRO-ACTIVE EAT, low intensity prophylactic intervention started before RT commences; or, PRO-ACTIVE EAT+EXERCISE, high intensity prophylactic intervention also started before RT commences. We hypothesize that the PRO-ACTIVE therapies are more effective than late RE-ACTIVE therapy; and, that the more intensive PRO-ACTIVE (EAT + EXERCISE) is superior to the low intensive PRO-ACTIVE (EAT). The primary endpoint of effectiveness is duration of feeding tube dependency one year post radiation therapy, selected as a pragmatic outcome valued equally by diverse stakeholders (e.g., patients, caregivers and clinicians). Secondary outcomes will include objective measures of swallow physiology and function, pneumonia and weight loss, along with various patient-reported swallowing-related outcomes, such as quality of life, symptom burden, and self-efficacy.

DISCUSSION

Dysphagia is a common and potentially life-threatening chronic toxicity of radiotherapy, and a priority issue for HNC survivors. Yet, the optimal timing and intensity of swallowing therapy provided by a speech-language pathologist is not known. With no clearly preferred strategy, current practice is fraught with substantial variation. The pragmatic PRO-ACTIVE trial aims to specifically address the decisional dilemma of when swallowing therapy should begin (i.e., before or after a swallowing problem develops). The critical impact of this dilemma is heightened by the growing number of young HNC patients in healthcare systems that need to allocate resources most effectively. The results of the PRO-ACTIVE trial will address the global uncertainty regarding best practice for dysphagia management in HNC patients receiving radiotherapy.

TRIAL REGISTRATION

The protocol is registered with the US Patient Centered Outcomes Research Institute, and the PRO-ACTIVE trial was prospectively registered at ClinicalTrials.gov , under the identifier NCT03455608 ; First posted: Mar 6, 2018; Last verified: Jun 17, 2021. Protocol Version: 1.3 (January 27, 2020).

Validity and Reliability of an Arabic Version of MD Anderson Dysphagia Inventory (MDADI)

Dysphagia is a common adverse event among head and neck (H&N) cancer patients. We aimed, for the first time, to validate the Arabic version of the MD Anderson Dysphagia Inventory (MDADI) among 82 Saudi Arabian patients with H&N cancer. We followed established validation guidelines and translated the 20-item MDADI using the forward-backward method. Our results revealed 100% feasibility. Test-retest reliability demonstrated acceptable interclass correlation coefficients (ICC) for the subscale domains (emotional = 0.973, physical = 0.971, and functional = 0.956) and composite score (ICC = 0.984). The Cronbach's alpha coefficients for the emotional, functional, and physical subscales were 0.937, 0.825, and 0.945, respectively (composite score = 0.975). We confirmed concurrent validity by demonstrating significant correlations between the domains of the Arabic MDADI and European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Head and Neck Module (QLQ-H&N35). Our study validated the Arabic version of the MDADI among H&N cancer patients from Saudi Arabia.

Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer-related unilateral vocal cord paralysis

BACKGROUND

Unilateral vocal cord paralysis may result from nerve compression by tumors or direct nerve injuries during tumor resections, which can cause dysphonia or dysphagia, and reduced quality of life.

OBJECTIVES

This prospective, single-group study aimed to investigate the effect of percutaneous injection laryngoplasty on voice and swallowing function in patients with cancer-related unilateral vocal cord paralysis.

METHODS

Patients underwent percutaneous injection laryngoplasty with hyaluronic acid under local anesthesia. Stroboscopy and videofluoroscopic swallowing study were conducted to evaluate the voice- and swallowing-related outcome measures, respectively. The participants were evaluated before injection laryngoplasty, as well as after two weeks and three months.

RESULTS

Injection laryngoplasty significantly improved the glottal gap, vocal fold position, Maximum Phonation Time, and Voice Handicap Index-10. Post-hoc analysis using Bonferroni correction showed that the improvements occurred within two post-treatment weeks and remained at three post-treatment months. In the subgroup analysis, the patients who underwent injection laryngoplasty within 8 weeks from onset showed significantly higher improvements in the videofluoroscopic dysphagia scale and swallowing function than the patients who received the procedure after 8 weeks or more.

CONCLUSION

Percutaneous injection laryngoplasty improves glottal closure and voice in patients with cancer-related unilateral vocal cord paralysis. Early injection laryngoplasty may lead to greater benefits on swallowing function.

LEVEL OF EVIDENCE

4.

Cultural Adaptation and Validation of Questionnaires for Evaluation of Health-Related Quality of Life with Dysphagia in Different Countries: A Systematic Review

Dysphagia can have devastating and long-lasting effects on the patient's health-related quality of life (HRQoL). In recent years, a number of questionnaires for the evaluation of the HRQoL of patients with dysphagia have been developed and have been adapted for use in different countries and cultures. However, problems may arise in the process of cultural adaptation and validation, which can affect the quality of the questionnaires and their measurements. This study was conducted to systematically summarize the cultural adaptation and validation of questionnaires for the evaluation of dysphagia-related HRQoL in different countries, assessing the varieties, measurement properties, and qualities of these questionnaires, with the aim of identifying the status of their adaptation and validation and ways in which they might be improved. Four databases were searched, and relevant articles were screened, with data from eligible reports extracted and reviewed. The methodological quality of the included articles was evaluated using the QualSyst critical appraisal tool. The HRQoL questionnaires for patients with dysphagia were assessed using the quality criteria for the measurement properties of health status questionnaires proposed by Terwee et al. and Timmerman et al. 29 studies published between 2008 and 2020 were included. The questionnaires described in these 29 studies were translated into 19 languages and culturally adapted to 21 countries. The adapted questionnaires were based on the Swallowing quality of life questionnaire (SWAL-QOL) by Mchorney et al., the Dysphagia Handicap Index (DHI) by Silbergleit et al., the M.D. Anderson Dysphagia Inventory (MDADI) by Chen et al., and the Eating Assessment Tool-10 (EAT-10) by Belafsky et al. It was found that the questionnaires were reliable and valid instruments for the assessment of dysphagia-related HRQoL, but the quality criteria for cultural adaptation and validation were not strictly followed, especially in the categories of criterion validity, agreement, responsiveness, and interpretability. In conclusion, although the questionnaires were found to be both reliable and valid, the quality criteria should be considered and strictly followed in the cultural adaptation and validation process in the future.

Validity and reliability of a French version of M.D. Anderson Dysphagia Inventory

OBJECTIVE

To assess the internal consistency, reliability, and clinical validity of a French version of the M.D. Anderson Dysphagia Inventory (Fr-MDADI).

METHODS

Patients addressed in the Swallowing Clinics of CHU Saint-Pierre Hospital (Brussels) and EpiCURA hospital (Ath, Belgium) for dysphagia completed Fr-MDADI, eating assessment tool-10 (EAT-10), dysphagia handicap index (DHI), and benefited from fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy. Seventy-two asymptomatic individuals composed the control group. The reliability of Fr-MDADI was assessed through a test-retest procedure. The validity was assessed by comparing Fr-MDADI with EAT-10 scores. Normative value of Fr-MDADI was calculated through the receiver operating characteristic (ROC) curve.

RESULTS

Forty-two patients and 77 healthy individuals completed the evaluations (33 males). The main etiology of dysphagia was head and neck cancers. The internal consistency was high regarding the Cronbach's alpha (0.864). The test-retest reliability was high for Fr-MDADI total scores (r_s = 0.849). The Fr-MDADI emotional, functional and physical subscores, and the total score exhibited high positive correlations with EAT-10 (r_s = 0.770) and DHI (r_s = 0.811), exhibiting high external validity. Patients had significant higher item and total score of Fr-MDADI compared with healthy individuals (control group), which indicated an adequate internal validity. About normative data, a Fr-MDADI > 13 was considered to be reflective of abnormalities. The 'swallowing-induced cough' item of the Fr-MDADI was significantly associated with the occurrence of aspirations regarding objective examinations (FEES or videofluoroscopy; p = 0.001).

CONCLUSION

The Fr-MDADI is a reliable and valid self-administered tool in the evaluation of the dysphagia of French-speaking patients.

Validation of the Dutch Version of the M.D. Anderson Dysphagia Inventory for Neurogenic Patients

BACKGROUND/AIM

The aim of this study was to validate the Dutch-language version of the M.D. Anderson Dysphagia Inventory (MDADI) for patients with neurogenic oropharyngeal dysphagia (OD).

METHODS

One hundred and seventy-eight patients with neurogenic OD and 92 healthy control subjects completed the MDADI and the Dutch version of the Swallowing Quality-of-Life Questionnaire (SWAL-QOL-NL). Exclusion criteria were: suffering from a concurrent head-and-neck oncological disease, scoring below 23 on a Mini Mental State Examination, being older than 85 years, and being illiterate or blind. None of the patients was in a palliative state of disease. Floor and ceiling effects, known-groups validity, internal consistency, construct validity, and criterion validity were assessed.

RESULTS

The MDADI total score showed no floor or ceiling effects for the patient group. Known-groups validity was confirmed by group differences in score distributions between patients and healthy control subjects. The internal consistency showed Cronbach's α-values ranging from 0.77 to 0.92. Correlations between the MDADI subscales and SWAL-QOL-NL domains were moderate to strong: 0.71, 0.70, and 0.62 (convergent construct validity). Correlations between the MDADI scores and the SWAL-QOL-NL domains general burden, food selection, eating duration, communication, mental health, social functioning, and frequency of symptoms were moderate to strong, ranging from 0.41 to 0.75. Weak correlations (<0.4) were found between the MDADI scores and the SWAL-QOL-NL domains eating desire, sleep, and fatigue.

CONCLUSION

The results of this study show that the Dutch translation of the MDADI is a psychometrically validated and suitable dysphagia-specific quality-of-life questionnaire for patients with neurogenic OD.

Reliability and Validity of the MD Anderson Dysphagia Inventory Among Japanese Patients

This study aimed to validate the Japanese version of a dysphagia-specific quality of life questionnaire, the MD Anderson Dysphagia Inventory (MDADI-J), and to verify trends between MDADI-J and Functional Oral Intake Scale (FOIS) scores. The original 20 MDADI items were translated using a forward-backward method following accepted cultural adaptation guidelines. Seventy-two patients with a history of head and neck cancer treatment completed the MDADI-J between October 2015 and August 2016. Concurrent validity was determined by correlations with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) instruments. Discriminant validity was examined using cancer stage grouping between stages I-II and III-IV. Additionally, trends between the FOIS and the MDADI-J total scores were analyzed using a trend test. The Cronbach's α coefficient of the MDADI-J total score was 0.92, indicating high internal consistency. The average inter-item correlation coefficients ranged from 0.39 to 0.49. ICC, an indicator of test-retest reliability, was 0.84 for the total score, and 0.58 to 0.81 for individual subscales. The total score and all subscales were significantly associated with the scores for each factor of the EORTC QLQ-C30 and EORTC QLQ-H&N35. The total score and all subscales were significantly different between clinical tumor stages I-II and III-IV. The total scores all increased with the progress of the FOIS. In conclusion, this study validated the Japanese version of the MDADI and showed that as FOIS scores deteriorate, MDADI-J scores tend to constantly decrease.

Psychometric Properties of the Chinese Version of the M.D. Anderson Dysphagia Inventory for Head and Neck Cancer Patients

BACKGROUND

Dysphagia is a common side effect of anticancer treatments in patients with head and neck cancer (HNC) and can worsen patients' quality of life. A well-established measure is essential to evaluate dysphagia in HNC patients.

OBJECTIVES

The aim of this study is to determine the psychometric properties of the Chinese version of the M.D. Anderson Dysphagia Inventory (MDADI-C) for HNC patients.

METHODS

A total of 220 subjects were included in the study. Reliability was examined by internal consistency (Cronbach's α) and test-retest reliability (intraclass correlation coefficient). Validity was evaluated with Spearman correlations (r).

RESULTS

The Cronbach's α and intraclass correlation coefficient of the MDADI-C were .923 and 0.942, respectively. The criterion validity of the MDADI-C was 0.777. The Spearman correlation coefficients of the MDADI-C with the European Organization for Research Into the Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (r = -0.851), Hospital Anxiety and Depression Scale (r = -0.424), radiotherapy dose (r = -0.553), and treatment regimens (r = -0.407) demonstrated good construct validity (all P < .01).

CONCLUSIONS

The MDADI-C demonstrated good psychometric properties and would be a valuable tool for clinicians to screen dysphagia rapidly and evaluate its impact on the quality of life of HNC patients.

IMPLICATIONS FOR PRACTICE

The MDADI-C could be used to document and monitor the dysphagia level of HNC patients for clinicians, nurses, and researchers. This validated questionnaire will help nurses and doctors to improve dysphagia management in HNC patients and will allow researchers to compare the study results across different countries.

Validation and Cultural Adaptation of the Arabic Version of the Eating Assessment Tool (EAT-10)

BACKGROUND AND OBJECTIVES

The Eating Assessment Tool (EAT-10) is a 10-item self-administered questionnaire. It is a noninvasive tool to measure patients' perception of their swallowing problems. The purposes of the present study were to develop an Arabic version of the EAT-10 and to evaluate its validity, consistency, and reliability in the Arabic-speaking population with oropharyngeal dysphagia.

SETTING AND DESIGN

This was a prospective study carried out at the Communication and Swallowing Disorders Unit, King Saud University, Riyadh, Saudi Arabia.

SUBJECTS AND METHODS

The Arabic EAT-10 was administered to 138 patients with oropharyngeal dysphagia and 83 control subjects. Internal consistency and test-retest reliability were evaluated. Content and clinical validity were studied, and the EAT-10 results were compared across patients and control groups.

RESULTS

The Arabic EAT-10 showed excellent internal consistency (Cronbach's α = 0.92). Also, good test-retest reliability was found for the total scores of the Arabic EAT-10 (intraclass correlation = 0.73). There was a significant difference in Arabic EAT-10 scores between the oropharyngeal dysphagia group and the control group (p < 0.001).

CONCLUSION

This study demonstrated that the Arabic EAT-10 is a valid tool that can be used for screening of dysphagia-related problems in an Arabic-speaking population.

What is a clinically relevant difference in MDADI scores between groups of head and neck cancer patients?

OBJECTIVE/HYPOTHESIS

To describe clinically relevant between-group differences in MD Anderson Dysphagia Inventory (MDADI) scores among head and neck cancer (HNC) patients.

STUDY DESIGN

Retrospective cross-sectional study was conducted in 1,136 HNC patients seen for modified barium swallow (MBS) studies.

METHODS

The MDADI was administered by written questionnaire at the MBS appointment. MD Anderson Dysphagia Inventory global, composite, and subscale scores were calculated. Anchor-based methods were employed to determine clinically meaningful between-group differences by feeding tube status, aspiration status (per MBS study), and diet level.

RESULTS

Mean MDADI scores for the 1,136 patients were: emotional 65.8 ± 17.3, functional 68.1 ± 19.6, physical 60.1 ± 18.6, global 59.3 ± 28.3, and composite 64.0 ± 17.1. Three hundred seventy-eight patients (33%) were feeding tube-dependent; 395 (34.8%) were aspirators; 122 (11%) were nothing per oral (Performance Status Scale-Head and Neck [PSS-HN] diet = 0); and 249 (22%) ate unrestricted, regular diets (PSS-HN diet = 100). Statistically significant (P < 0.0001) between-group differences (feeding tube vs. no feeding tube, aspirator vs. nonaspirator, oral vs. nonoral diet, PSS-HN diet levels) were observed for all mean MDADI scores (global, composite, and subscales). A mean difference of 10 points in composite MDADI scores differentiated feeding tube-dependent from nontube-dependent patients, aspirators from nonaspirators, and distinct PSS-HN diet levels.

CONCLUSIONS

We identify that a 10-point between-group difference in composite MDADI scores was associated with clinically meaningful between-group differences in swallowing function.

LEVEL OF EVIDENCE

4. Laryngoscope, 126:1108-1113, 2016.

Validity and Reliability of the Persian Version of the Dysphagia Handicap Index (DHI)

INTRODUCTION

The Dysphagia Handicap Index (DHI) is one of the instruments used for measuring a dysphagic patient's self-assessment. In some ways, it reflects the patient's quality of life. Although it has been recognized and widely applied in English speaking populations, it has not been used in its present forms in Persian speaking countries. The purpose of this study was to adapt a Persian version of the DHI and to evaluate its validity, consistency, and reliability in the Persian population with oropharyngeal dysphagia.

MATERIALS AND METHODS

Some stages for cross-cultural adaptation were performed, which consisted in translation, synthesis, back translation, review by an expert committee, and final proof reading. The generated Persian DHI was administered to 85 patients with oropharyngeal dysphagia and 89 control subjects at Zahedan city between May 2013 and August 2013. The patients and control subjects answered the same questionnaire 2 weeks later to verify the test-retest reliability. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared.

RESULTS

The Persian DHI showed good internal consistency (Cronbach's alpha coefficients range from 0.82 to 0.94). Also, good test-retest reliability was found for the total scores of the Persian DHI (r=0.89). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (P‹0.001).

CONCLUSION

The Persian version of the DHI achieved Face and translation validity. This study demonstrated that the Persian DHI is a valid tool for self-assessment of the handicapping effects of dysphagia on the physical, functional, and emotional aspects of patient life and can be a useful tool for screening and treatment planning for the Persian-speaking dysphagic patients, regardless of the cause or the severity of the dysphagia.

Pretreatment Dysphagia Inventory and videofluorographic swallowing study as prognostic indicators of early survival outcomes in head and neck cancer

BACKGROUND

The prognostic role of swallowing-related, pretreatment subjective and objective findings has not been investigated in detail. The authors evaluated the association between pretreatment MD Anderson Dysphagia Inventory (MDADI) or videofluorographic swallowing study (VFSS) results and standard outcomes, including early recurrence and survival, in patients with treatment-naïve head and neck squamous cell carcinoma (HNSCC).

METHODS

Patients with HNSCC (n = 191) who received treatment at the authors' institution and were examined by self-administered MDADI questionnaires and VFSS were prospectively enrolled. MDADI and VFSS findings were analyzed in correlation with clinicopathologic variables, and factors that predicted 2-year disease-free survival (DFS) and overall survival (OS) were identified using a Cox proportional-hazards regression model.

RESULTS

The 2-year OS and DFS rates were 80.1% and 77.5%, respectively. Clinical tumor (T) and lymph node (N) classifications, overall TNM stage, sex, tumor site, and educational level were significantly associated with specific MDADI subdomains, whereas Karnofsky performance score was significantly associated with all MDADI subdomains. After controlling for clinical factors, total scores, global assessment scores, and emotional and physical MDADI subscores were significantly predictive of 2-year OS and DFS (P < .05 for each). VFSS findings were not significantly associated with survival (P > .05).

CONCLUSIONS

The current results provide evidence of the prognostic role of the MDADI in predicting early survival outcomes in patients with HNSCC. The MDADI may be a practical and noninvasive method for the identification of patients at risk who would benefit from close follow-up.

Development of the Arabic Version of Dysphagia Handicap Index (DHI)

The Dysphagia Handicap Index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool for measuring the handicapping effect of dysphagia on the physical, functional, and emotional aspects of people's lives. The purposes of the present study were to develop an Arabic version of the DHI and to evaluate its validity, consistency, and reliability in the normal Arabic population with oropharyngeal dysphagia. This was a prospective study that was carried out at the Communication and Swallowing Disorders Unit, King Saud University. The generated Arabic DHI was administered to 94 patients with oropharyngeal dysphagia and 98 control subjects. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Arabic DHI showed excellent internal consistency (Cronbach's α = 0.95). Also, good test-retest reliability was found for the total scores of the Arabic DHI (r = 0.9, p = 0.001). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (p < 0.001). This study demonstrated that the Arabic DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on the physical, functional, and emotional aspects of patients and can be used by Arabic language speakers.

Hindi translation and validation of dysfunctional beliefs and attitudes about sleep (DBAS - 16)

OBJECTIVES

The objective of this study is to translate and validate the Dysfunctional Beliefs and Attitudes about Sleep Brief Version (DBAS-16)) in Hindi language.

MATERIALS AND METHODS

The scale was obtained online, and the permission for translation was obtained from the author. The translation of the scale was carried out following back translation method. The scale was applied on 63 participants attending the adult psychiatry OPD who were included in the study.

RESULTS

Thirty-two patients were having insomnia, and 31 patients were controls without insomnia. The results show that the translated version had good reliability with internal consistency (Chronbach alpha = 0.901).

CONCLUSION

The Hindi translation of DBAS-16 is a reliable tool for assessing the dysfunctional beliefs and attitude about sleep.