Abstract
The aim of this study was to validate the Swedish version of the dysphagia-specific quality-of-life questionnaire, the M. D. Anderson Dysphagia Inventory (MDADI). Patients with oropharyngeal dysphagia due to neurologic disease (n = 30) and head and neck (H&N) cancer patients with post-treatment subjective dysphagia (n = 85) were compared to an age- and gender-matched nondysphagic control group (n = 115). A formal forward–backward translation was performed and followed international guidelines. Validity and reliability were tested against the Short-Form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS). Internal-consistency reliability was calculated by means of Cronbach’s α coefficient. Test–retest reliability was assessed by intraclass correlation (ICC). Convergent and discriminant validity were assessed by correlations between MDADI, SF-36, and HADS. Known-group validity was examined and statistically tested. Of 126 eligible patients, 115 agreed to participate (response rate = 91.3%). The age of the participants ranged between 37 and 92 years. Most of the MDADI items showed good variability and only minor floor or ceiling effects in solitary items were found. The internal-consistency reliability (Cronbach’s α) of the MDADI total score was 0.88 (after correction for systematic errors in the subjects’ responses to two reversed questions). All estimates reached over the satisfactory >0.70 reliability standard for group-level comparison. ICC ranged between 0.83 and 0.97 in the test–retest. The mean MDADI total score was 66.9 (SD = 14.7) for the H&N cancer patients, 65.0 (16.9) for the neurologic patients, and 97.5 (4.4) for the control group (P < 0.001; study patients vs. controls). The MDADI was also sensitive to disease severity as measured by different food textures. The Swedish version of the MDADI showed good psychometric properties and is a valid instrument to assess dysphagia-related quality of life. It was also shown to be a reliable instrument after correction for systematic errors in the subjects’ responses to two reversed questions. Its known-group validity enables the differentiation between dysphagic and nondysphagic patients for group-level research.
Similar content being viewed by others
References
Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53:1483–9.
Shamburek RD, Farrar JT. Disorders of the digestive system in the elderly. N Engl J Med. 1990;322:438–43.
Francis DO, Weymuller EA Jr, Parvathaneni U, Merati AL, Yueh B. Dysphagia, stricture, and pneumonia in head and neck cancer patients: does treatment modality matter? Ann Otol Rhinol Laryngol. 2010;119:391–7.
Nguyen NP, Frank C, Moltz CC, et al. Impact of dysphagia on quality of life after treatment of head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005;61:772–8.
Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E. Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer—a randomized study. Head Neck. 2011. doi:10.1002/hed.21700.
Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36:2756–63.
Gonzalez-Fernandez M, Daniels SK. Dysphagia in stroke and neurologic disease. Phys Med Rehabil Clin N Am. 2008;19:867–88.
Alhashemi HH. Dysphagia in severe traumatic brain injury. Neurosciences (Riyadh). 2010;15:231–6.
Hind JA, Nicosia MA, Roecker EB, Carnes ML, Robbins J. Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. Arch Phys Med Rehabil. 2001;82:1661–5.
Enns R, Kazemi P, Chung W, Lee M. Eosinophilic esophagitis: clinical features, endoscopic findings and response to treatment. Can J Gastroenterol. 2010;24:547–51.
McHorney CA, Bricker DE, Kramer AE, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15:115–21.
Chen AY, Frankowski R, Bishop-Leone J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127:870–6.
Woisard V, Andrieux MP, Puech M. Validation of a self-assessment questionnaire for swallowing disorders (Deglutition Handicap Index). Rev Laryngol Otol Rhinol (Bord). 2006;127:315–25.
Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919–24.
McHorney CA, Robbins J, Lomax K, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17:97–114.
McHorney CA, Martin-Harris B, Robbins J, Rosenbek J. Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia. 2006;21:141–8.
Finizia C, Rudberg I, Bergqvist H, Rydén A. A cross-sectional validation study of the Swedish version of SWAL-QOL. Dysphagia. [Epub ahead of print].
Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.
Sullivan M, Karlsson J, Ware JE Jr. The Swedish SF-36 Health Survey—I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995;41:1349–58.
Ware JE Jr, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51:903–12.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
Chaturvedi SK, Shenoy A, Prasad KM, Senthilnathan SM, Premlatha BS. Concerns, coping and quality of life in head and neck cancer patients. Support Care Cancer. 1996;4:186–90.
Johansson M, Ryden A, Finizia C. Self evaluation of communication experiences after laryngeal cancer—a longitudinal questionnaire study in patients with laryngeal cancer. BMC Cancer. 2008;8:80.
Hinkle DE, Jurs SG, Wiersma W. Applied statistics for the behavioural sciences. 2nd ed. Boston: Houghton Mifflin; 1988.
Bland JM, Altman DG. Cronbach’s alpha. BMJ. 1997;314:572.
Bauer F, Seiss M, Grassel E, Stelzle F, Klotz M, Rosanowski F. Swallowing-related quality of life in oral cavity cancer. The German version of the Anderson Dysphagia Inventory. HNO. 2010;58:692–7.
Acknowledgments
This study was supported by the Swedish Cancer Society, the Research and Development Council, Västra Götaland (Sweden) County, and the Medical Faculty of Gothenburg University Sweden. This work was also supported by grants from the Sweden America Foundation and the Swedish Council for Working Life and Social Research.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Carlsson, S., Rydén, A., Rudberg, I. et al. Validation of the Swedish M. D. Anderson Dysphagia Inventory (MDADI) in Patients with Head and Neck Cancer and Neurologic Swallowing Disturbances. Dysphagia 27, 361–369 (2012). https://doi.org/10.1007/s00455-011-9375-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00455-011-9375-8