Abstract
Dysphagia is one of the most critical problems in patients with progressive neuromuscular diseases. However, clinically useful and practical scales to evaluate dysphagia are limited. Therefore, the aim of this study was to develop such a scale. An 8-stage Neuromuscular Disease Swallowing Status Scale (NdSSS) was developed and tested for its inter- and intrarater reliabilities, concurrent validity, and responsiveness. The NdSSS was used to evaluate 134 patients with Duchenne muscular dystrophy (DMD) and 84 patients with amyotrophic lateral sclerosis (ALS). Inter- and intrarater reliabilities were examined with weighted kappa statistics. Concurrent validity was assessed by correlating the NdSSS with the existing scales [Functional Oral Intake Scale (FOIS), Functional Intake LEVEL Scales (FILS), and ALS Functional Rating Scale-Revised Swallow (ALSFRS-R Sw)], using Spearman’s correlation coefficients. Responsiveness was determined with the standardized response mean (SRM). For inter- and intrarater reliabilities, the weighted kappas were 0.95 and 1.00, respectively, for DMD; and 0.98 and 0.98, respectively, for ALS. The NdSSS showed strong correlations with the FOIS (rs = 0.87 for DMD, rs = 0.93 for ALS, p < 0.001), FILS (rs = 0.89 for DMD, rs = 0.92 for ALS, p < 0.001), and ALSFRS-R SW (rs = 0.93, p < 0.001). SRMs were 0.65 for DMD and 1.21 for ALS. The SRM was higher in DMD patients for the NdSSS than for the other scales, while it was similar in ALS patients and the other scales. Our originally developed NdSSS demonstrated sufficient reliability, validity, and responsiveness in patients with DMD and ALS. It is also useful in evaluating dysphagia in patients with progressive neuromuscular diseases.
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References
Greenwood DI (2013) Nutrition management of amyotrophic lateral sclerosis. Nutr Clin Pract 28:392–399
Martigne L, Seguy D, Pellegrini N, Orlikowski D, Cuisset JM, Carpentier A, Tiffreau V, Guimber D, Gottrand F (2010) Efficacy and tolerance of gastrostomy feeding in Duchenne muscular dystrophy. Clin Nutr 29:60–64
Higo R, Tayama N, Nito T (2004) Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis. Auris Nasus Larynx 31:247–254
Cedarbaum JM, Stambler N, Malta E, Fuller C, Hilt D, Thurmond B, Nakanishi A (1999) The ALSFRS-R: a revised ALS functional rating scale that incorporates assessments of respiratory function. BDNF ALS Study Group (Phase III). J Neurol Sci 169:13–21
Crary MA, Mann GD, Groher ME (2005) Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil 86:1516–1520
Kunieda K, Ohno T, Fujishima I, Hojo K, Morita T (2013) Reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale. J Pain Symptom Manage 46:201–206
Swinyard CA, Deaver GG, Greenspan L (1957) Gradients of functional ability of importance in rehabilitation of patients with progressive muscular and neuromuscular diseases. Arch Phys Med Rehabil 38:574–579
Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A Penetration-Aspiration Scale. Dysphagia 11:93–98
Han TR, Paik NJ, Park JW, Kwon BS (2008) The prediction of persistent dysphagia beyond six months after stroke. Dysphagia 23:59–64
Kim J, Oh BM, Kim JY, Lee GJ, Lee SA, Han TR (2014) Validation of the videofluoroscopic dysphagia scale in various etiologies. Dysphagia 29:438–443
Garratt AM, Ruta DA, Abdalla MI, Russell IT (1994) SF 36 health survey questionnaire: II. Responsiveness to changes in health status in four common clinical conditions. Qual Health Care 3:186–192
Liang MH, Fossel AH, Larson MG (1990) Comparisons of five health status instruments for orthopedic evaluation. Med Care 28:632–642
Aloysius A, Born P, Kinali M, Davis T, Pane M, Mercuri E (2008) Swallowing difficulties in Duchenne muscular dystrophy: indications for feeding assessment and outcome of videofluroscopic swallow studies. Eur J Paediatr Neurol 12:239–245
Briani C, Marcon M, Ermani M, Costantini M, Bottin R, Iurilli V, Zaninotto G, Primon D, Feltrin G, Angelini C (1998) Radiological evidence of subclinical dysphagia in motor neuron disease. J Neurol 245:211–216
Shinonaga C, Fukuda M, Suzuki Y, Higaki T, Ishida Y, Ishii E, Hyodo M, Morimoto T, Sano N (2008) Evaluation of swallowing function in Duchenne muscular dystrophy. Dev Med Child Neurol 50:478–480
Jaffe KM, McDonald CM, Ingman E, Haas J (1990) Symptoms of upper gastrointestinal dysfunction in Duchenne muscular dystrophy: case-control study. Arch Phys Med Rehabil 71:742–744
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Wada, A., Kawakami, M., Liu, M. et al. Development of a new scale for dysphagia in patients with progressive neuromuscular diseases: the Neuromuscular Disease Swallowing Status Scale (NdSSS). J Neurol 262, 2225–2231 (2015). https://doi.org/10.1007/s00415-015-7836-y
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DOI: https://doi.org/10.1007/s00415-015-7836-y