, Volume 17, Issue 2, pp 97-114

First online:

The SWAL–QOL and SWAL–CARE Outcomes Tool for Oropharyngeal Dysphagia in Adults: III. Documentation of Reliability and Validity

  • Colleen A. McHorneyAffiliated withRoudebush VA Medical Center, Department of Internal Medicine and Geriatrics, Indiana University School of Medicine; Regenstrief Institute for Health Care; Indiana University Center for Aging Research, Indianapolis, Indiana
  • , JoAnne  RobbinsAffiliated withWilliam S. Middleton Memorial Veterans Hospital and University of Wisconsin–Madison Medical School, Madison, Wisconsin
  • , Kevin  LomaxAffiliated withPh.D. Program in Gerontology, Sanders–Brown Center on Aging, University of Kentucky, Louisville, Kentucky
  • , John C. RosenbekAffiliated withDepartment of Communicative Disorders, University of Florida, Gainesville, Florida
  • , Kimberly  ChignellAffiliated withWilliam S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
  • , Amy E. KramerAffiliated withDepartment of Surgery, University of Wisconsin–Madison Medical School, Madison, Wisconsin
  • , D. Earl BrickerAffiliated withACHOICE, Milwaukee, Wisconsin, USA

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Advances in the measurement of swallowing physiologic parameters have been clinician-driven, as has the development of intervention techniques to modify swallowing pathophysiology. However, a critical element to determining the success of such efforts will be established by the patients themselves. We conceptualized, developed, and validated the SWAL–QOL, a 93-item quality-of-life and quality-of-care outcomes tool for dysphagia researchers and clinicians. With 93 items, the SWAL–QOL was too long for practical and routine use in clinical research and practice. We used an array of psychometric techniques to reduce the 93-item instrument into two patient-centered outcomes tools: (1) the SWAL–QOL, a 44-item tool that assesses ten quality-of-life concepts, and (2) the SWAL–CARE, a 15-item tool that assesses quality of care and patient satisfaction. All scales exhibit excellent internal-consistency reliability and short-term reproducibility. The scales differentiate normal swallowers from patients with oropharyngeal dysphagia and are sensitive to differences in the severity of dysphagia as clinically defined. It is intended that the standardization and publication of the SWAL–QOL and the SWAL–CARE will facilitate their use in clinical research and clinical practice to better understand treatment effectiveness as a critical step toward improving patients' quality of life and quality of care.