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Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients

Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation i...

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Autores principales: Everton, Lisa F., Benfield, Jacqueline K., Hedstrom, Amanda, Wilkinson, Gwenllian, Michou, Emilia, England, Timothy J., Dziewas, Rainer, Bath, Philip M., Hamdy, Shaheen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190822/
https://www.ncbi.nlm.nih.gov/pubmed/32350338
http://dx.doi.org/10.1038/s41598-020-64208-9
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author Everton, Lisa F.
Benfield, Jacqueline K.
Hedstrom, Amanda
Wilkinson, Gwenllian
Michou, Emilia
England, Timothy J.
Dziewas, Rainer
Bath, Philip M.
Hamdy, Shaheen
author_facet Everton, Lisa F.
Benfield, Jacqueline K.
Hedstrom, Amanda
Wilkinson, Gwenllian
Michou, Emilia
England, Timothy J.
Dziewas, Rainer
Bath, Philip M.
Hamdy, Shaheen
author_sort Everton, Lisa F.
collection PubMed
description Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation information. Multiple approaches were taken to validate the DSRS, including concurrent- and predictive criterion validity, internal consistency, inter- and intra-rater reliability and sensitivity to change. This was done using data from four studies involving pharyngeal electrical stimulation in acute stroke patients with dysphagia, an individual patient data meta-analysis and unpublished studies (NCT03499574, NCT03700853). In addition, consensual- and content validity and the Minimal Clinically Important Difference (MCID) were assessed using anonymous surveys sent to UK-based Speech and Language Therapists (SLTs). Scores for consensual validity were mostly moderate (62.5–78%) to high or excellent (89–100%) for most scenarios. All but two assessments of content validity were excellent. In concurrent criterion validity assessments, DSRS was most closely associated with measures of radiological aspiration (penetration aspiration scale, Spearman rank rs = 0.49, p < 0.001) and swallowing (functional oral intake scale, FOIS, rs = −0.96, p < 0.001); weaker but statistically significant associations were seen with impairment, disability and dependency. A similar pattern of relationships was seen for predictive criterion validity. Internal consistency (Cronbach’s alpha) was either “good” or “excellent”. Intra and inter-rater reliability were largely “excellent” (intraclass correlation >0.90). DSRS was sensitive to positive change during recovery (medians: 7, 4 and 1 at baseline and 2 and 13 weeks respectively) and in response to an intervention, pharyngeal electrical stimulation, in a published meta-analysis. The MCID was 1.0 and DSRS and FOIS scores may be estimated from each other. The DSRS appears to be a valid tool for grading the severity of swallowing impairment in patients with post stroke dysphagia and is appropriate for use in clinical research and clinical service delivery.
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spelling pubmed-71908222020-05-05 Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients Everton, Lisa F. Benfield, Jacqueline K. Hedstrom, Amanda Wilkinson, Gwenllian Michou, Emilia England, Timothy J. Dziewas, Rainer Bath, Philip M. Hamdy, Shaheen Sci Rep Article Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation information. Multiple approaches were taken to validate the DSRS, including concurrent- and predictive criterion validity, internal consistency, inter- and intra-rater reliability and sensitivity to change. This was done using data from four studies involving pharyngeal electrical stimulation in acute stroke patients with dysphagia, an individual patient data meta-analysis and unpublished studies (NCT03499574, NCT03700853). In addition, consensual- and content validity and the Minimal Clinically Important Difference (MCID) were assessed using anonymous surveys sent to UK-based Speech and Language Therapists (SLTs). Scores for consensual validity were mostly moderate (62.5–78%) to high or excellent (89–100%) for most scenarios. All but two assessments of content validity were excellent. In concurrent criterion validity assessments, DSRS was most closely associated with measures of radiological aspiration (penetration aspiration scale, Spearman rank rs = 0.49, p < 0.001) and swallowing (functional oral intake scale, FOIS, rs = −0.96, p < 0.001); weaker but statistically significant associations were seen with impairment, disability and dependency. A similar pattern of relationships was seen for predictive criterion validity. Internal consistency (Cronbach’s alpha) was either “good” or “excellent”. Intra and inter-rater reliability were largely “excellent” (intraclass correlation >0.90). DSRS was sensitive to positive change during recovery (medians: 7, 4 and 1 at baseline and 2 and 13 weeks respectively) and in response to an intervention, pharyngeal electrical stimulation, in a published meta-analysis. The MCID was 1.0 and DSRS and FOIS scores may be estimated from each other. The DSRS appears to be a valid tool for grading the severity of swallowing impairment in patients with post stroke dysphagia and is appropriate for use in clinical research and clinical service delivery. Nature Publishing Group UK 2020-04-29 /pmc/articles/PMC7190822/ /pubmed/32350338 http://dx.doi.org/10.1038/s41598-020-64208-9 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Everton, Lisa F.
Benfield, Jacqueline K.
Hedstrom, Amanda
Wilkinson, Gwenllian
Michou, Emilia
England, Timothy J.
Dziewas, Rainer
Bath, Philip M.
Hamdy, Shaheen
Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
title Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
title_full Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
title_fullStr Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
title_full_unstemmed Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
title_short Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
title_sort psychometric assessment and validation of the dysphagia severity rating scale in stroke patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190822/
https://www.ncbi.nlm.nih.gov/pubmed/32350338
http://dx.doi.org/10.1038/s41598-020-64208-9
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