Swallowing Disorder in Multiple Sclerosis: Modified Version of the Screening Tool

IF 0.4 Q4 REHABILITATION Archives of Rehabilitation Pub Date : 2020-07-10 DOI:10.32598/RJ.21.2.3036.1
Z. Sadeghi, M. Afshar, A. Ebadi, Kowsar Baghban, Zahran Qureshi
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Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS). Materials & Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the Confirmatory Factor Analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. ‏ The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder - Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass Correlation Coefficient (ICC), inter-item correlation matrix, Mann-Whitney U test and rank correlation coefficient or Spearmanchr('39')s were used to inferential statistical analysis. Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of \"dysphagia of solids\" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs=0.693, P<0.001). A KR-20 reliability coefficient of the DYMUS was 0.856, indicating high internal consistency of the Persian translation of the questionnaire items. Test-retest reliability was excellent with 0.965 value. The results also showed that 65.7% of multiple sclerosis patients had a swallowing disorder. In terms of the dysphagia severity, 25.9% of participants had mild dysphagia, and 39.8% of participants had alarming dysphagia. DYMUS values were significantly correlated with disease duration (rs=0.198, P= 0.040), and EDSS (rs=0.235, P= 0.014) and significantly higher mean scores were observed in the patients with secondary progressive than the other subgroups of multiple sclerosis. Conclusion: The Persian adjusted 9-item questionnaire was demonstrated to be a simple, consistent, valid and reliable tool for the detection of patients who need more specific instrumental evaluations of swallowing. Also, about the dysphagia is very frequent in these patients, it is important that clinicians monitor these patients carefully even in early stages of the disease‏ for early detection and planning a rehabilitation program to the prevention of serious subsequence complications.","PeriodicalId":43655,"journal":{"name":"Archives of Rehabilitation","volume":"13 1","pages":"236-255"},"PeriodicalIF":0.4000,"publicationDate":"2020-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Rehabilitation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.32598/RJ.21.2.3036.1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 4

Abstract

Objective: Dysphagia is commonly encountered in Multiple Sclerosis (MS). It can consequently cause severe complications such as the increased risk of dehydration, malnutrition and aspiration pneumonia that associated with an increased risk of death in the late stages of the disease. These complications can be prevented with an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) is the only questionnaire developed specifically for patients with MS. The aim of the present study was translation and cross-culturally adaptation of DYMUS for the Persian population and estimation of the questionnairechr('39')s reliability and validity. Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS). Materials & Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the Confirmatory Factor Analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. ‏ The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder - Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass Correlation Coefficient (ICC), inter-item correlation matrix, Mann-Whitney U test and rank correlation coefficient or Spearmanchr('39')s were used to inferential statistical analysis. Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of "dysphagia of solids" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs=0.693, P<0.001). A KR-20 reliability coefficient of the DYMUS was 0.856, indicating high internal consistency of the Persian translation of the questionnaire items. Test-retest reliability was excellent with 0.965 value. The results also showed that 65.7% of multiple sclerosis patients had a swallowing disorder. In terms of the dysphagia severity, 25.9% of participants had mild dysphagia, and 39.8% of participants had alarming dysphagia. DYMUS values were significantly correlated with disease duration (rs=0.198, P= 0.040), and EDSS (rs=0.235, P= 0.014) and significantly higher mean scores were observed in the patients with secondary progressive than the other subgroups of multiple sclerosis. Conclusion: The Persian adjusted 9-item questionnaire was demonstrated to be a simple, consistent, valid and reliable tool for the detection of patients who need more specific instrumental evaluations of swallowing. Also, about the dysphagia is very frequent in these patients, it is important that clinicians monitor these patients carefully even in early stages of the disease‏ for early detection and planning a rehabilitation program to the prevention of serious subsequence complications.
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多发性硬化症的吞咽障碍:改良版的筛选工具
目的:吞咽困难是多发性硬化症(MS)的常见病。因此,它可能导致严重的并发症,如脱水、营养不良和吸入性肺炎的风险增加,这些风险与疾病后期死亡风险增加有关。这些并发症可以通过有效的筛查方案加以预防。多发性硬化症吞咽困难(DYMUS)是唯一专门为多发性硬化症患者开发的问卷。本研究的目的是为波斯人群翻译和跨文化适应DYMUS,并估计问卷的信度和效度。此外,我们调查了德黑兰多发性硬化症协会患者吞咽困难的频率和严重程度及其与多发性硬化症病程、病程和扩展残疾状态量表(EDSS)的关系。材料与方法:这是一项方法学和描述性分析研究。统计人群为2018年德黑兰多发性硬化症协会的多发性硬化症患者。研究样本由108名患者组成,他们是通过方便的抽样方法选择的。研究工具包括10项DYMUS问卷(在研究的第一部分,翻译并检验其心理测量特性),吞咽困难障碍指数和人口统计信息问卷。在方法学部分,完成了翻译和跨文化适应,并使用验证性因子分析(CFA)来评估结构效度和检验所提出模型的拟合优度。DYMUS和吞咽困难障碍指数(DHI)评分之间的关联被调查到收敛效度。计算项目间相关矩阵以评估问卷项目的同质性。采用Kuder - Richardson (KR-20)量表评估问卷的内部一致性。并对19名被试进行重测,以评估信度。最后,研究吞咽困难的频率和严重程度及其与MS病程、病程和EDSS的关系。采用r- 20信度系数、类内相关系数(ICC)、项目间相关矩阵、Mann-Whitney U检验、等级相关系数或Spearmanchr('39')s进行推理统计分析。结果:项目间相关矩阵分析表明,除第10项外,所有项目之间均呈正相关。根据项目间相关的结果,项目10的相关系数最低,从问卷中删除。CFA结果证实了DYMUS的“固体吞咽困难”和“液体吞咽困难”的双因素模型,并揭示了第10项对“固体吞咽困难”测量的贡献最小,删除该项后内部一致性增加。9项模型的解是样本的最佳拟合优度指标。收敛效度结果显示DYMUS与DHI呈正相关(rs=0.693, P<0.001)。DYMUS的KR-20信度系数为0.856,表明问卷题目波斯语翻译具有较高的内部一致性。重测信度极好,为0.965。结果还显示65.7%的多发性硬化症患者有吞咽障碍。从吞咽困难的严重程度来看,25.9%的参与者有轻度吞咽困难,39.8%的参与者有危重性吞咽困难。DYMUS值与病程显著相关(rs=0.198, P= 0.040), EDSS值与病程显著相关(rs=0.235, P= 0.014),继发性进展型多发性硬化症患者的平均评分显著高于其他亚组。结论:波斯调整的9项问卷被证明是一种简单、一致、有效和可靠的工具,用于检测需要更具体的吞咽仪器评估的患者。此外,吞咽困难在这些患者中非常常见,即使在疾病的早期阶段,临床医生也要仔细监测这些患者,以便早期发现并制定康复计划,以预防严重的后续并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Archives of Rehabilitation
Archives of Rehabilitation REHABILITATION-
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