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A Cross-sectional Validation Study of the Swedish Version of SWAL-QOL

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Abstract

The purpose of this study was to evaluate the psychometric properties of the Swedish version of the Swallowing Quality of Life questionnaire (SWAL-QOL). The study design was cross-sectional and the study was performed in patients with subjective oropharyngeal dysphagia due to head and neck (H&N) cancer (n = 85) or neurological disease (n = 30) and in a sample of age- and gender-matched controls (mean age = 63 years, 57% males) without subjective dysphagia (n = 115). The Short-Form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) questionnaires were used for assessment of convergent and discriminant validity. The Swedish version of SWAL-QOL was well accepted, the response rate was high (>90%), and the number of missing items were very low (<1%). Overall, the questionnaire showed good to excellent psychometric properties, including floor and ceiling effects (range = 0–16 and 0–21%), internal consistency [Cronbach’s α > 0.70 for all domains except Eating Duration (0.69) and Sleep (0.68)], test–retest reliability (intraclass correlations = 0.75–0.98) and convergent and discriminant validity as assessed by correlations between SWAL-QOL and SF-36 and HADS. SWAL-QOL also proved able to differentiate between dysphagic and nondysphagic patients (P < 0.00001) (known-groups validity) and sensitive to disease severity as measured by different food textures.

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References

  1. 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(9):1483–9.

    Article  PubMed  Google Scholar 

  2. 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(12):1661–5.

    Article  PubMed  CAS  Google Scholar 

  3. Eslick GD, Talley NJ. Dysphagia: epidemiology, risk factors and impact on quality of life–a population-based study. Aliment Pharmacol Ther. 2008;27(10):971–9.

    Article  PubMed  CAS  Google Scholar 

  4. Jansson C, Wallander MA, Johansson S, Johnsen R, Hveem K. Stressful psychosocial factors and symptoms of gastroesophageal reflux disease: a population-based study in Norway. Scand J Gastroenterol. 2010;45(1):21–9.

    Article  PubMed  Google Scholar 

  5. FDA. Guidance for industry: patient-reported outcome measures: use in medical product development to support labeling claims: draft guidance, 2009.

  6. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24.

    PubMed  Google Scholar 

  7. Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin 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(7):870–6.

    PubMed  CAS  Google Scholar 

  8. Khaldoun E, Woisard V, Verin E. Validation in French of the SWAL-QOL scale in patients with oropharyngeal dysphagia. Gastroenterol Clin Biol. 2009;33(3):167–71.

    Article  PubMed  CAS  Google Scholar 

  9. 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(5):315–25.

    CAS  Google Scholar 

  10. McHorney CA, Bricker DE, Kramer AE, Rosenbek JC, Robbins J, Chignell KA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia. 2000;15(3):115–21.

    PubMed  CAS  Google Scholar 

  11. McHorney CA, Bricker DE, Robbins J, Kramer AE, Rosenbek JC, Chignell KA. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling. Dysphagia. 2000;15(3):122–33.

    PubMed  CAS  Google Scholar 

  12. McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, et al. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17(2):97–114.

    Article  PubMed  Google Scholar 

  13. Leow LP, Huckabee ML, Anderson T, Beckert L. The impact of dysphagia on quality of life in ageing and Parkinson’s disease as measured by the Swallowing Quality of Life (SWAL-QOL) Questionnaire. Dysphagia. 2010;25(3):216–20.

    Article  PubMed  Google Scholar 

  14. McKinstry A, Tranter M, Sweeney J. Outcomes of dysphagia intervention in a pulmonary rehabilitation program. Dysphagia. 2010;25(2):104–11.

    Article  PubMed  Google Scholar 

  15. Rinkel RN, Verdonck-de Leeuw IM, Langendijk JA, van Reij EJ, Aaronson NK, Leemans CR. The psychometric and clinical validity of the SWAL-QOL questionnaire in evaluating swallowing problems experienced by patients with oral and oropharyngeal cancer. Oral Oncol. 2009;45(8):e67–71.

    Article  PubMed  Google Scholar 

  16. Bogaardt HC, Speyer R, Baijens LW, Fokkens WJ. Cross-cultural adaptation and validation of the Dutch version of SWAL-QoL. Dysphagia. 2009;24(1):66–70.

    Article  PubMed  CAS  Google Scholar 

  17. Lam PM, Lai CK. The Validation of the Chinese version of the Swallow Quality-of-Life questionnaire (SWAL-QOL) using exploratory and confirmatory factor analysis. Dysphagia. 2011;26(2):117–24.

    Article  PubMed  Google Scholar 

  18. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516–20.

    Article  PubMed  Google Scholar 

  19. McMicken BL, Muzzy CL, Calahan S. Retrospective ratings of 100 first-time-documented stroke patients on the Functional Oral Intake Scale. Disabil Rehabil. 2010;32(14):1163–72.

    Article  PubMed  Google Scholar 

  20. Schache AG, Lieger O, Rogers P, Kelly A, Newman L, Kalavrezos N. Predictors of swallowing outcome in patients treated with surgery and radiotherapy for advanced oral and oropharyngeal cancer. Oral Oncol. 2009;45(9):803–8.

    Article  PubMed  CAS  Google Scholar 

  21. 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(12):1417–32.

    Article  PubMed  CAS  Google Scholar 

  22. 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(10):1349–58.

    Article  PubMed  CAS  Google Scholar 

  23. 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(11):903–12.

    Article  PubMed  Google Scholar 

  24. Sullivan M, Karlsson J. The Swedish SF-36 Health Survey III. Evaluation of criterion-based validity: results from normative population. J Clin Epidemiol. 1998;51(11):1105–13.

    Article  PubMed  CAS  Google Scholar 

  25. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.

    Article  PubMed  CAS  Google Scholar 

  26. Bergman B, Sullivan M, Sorenson S. Quality of life during chemotherapy for small cell lung cancer. I. An evaluation with generic health measures. Acta Oncol. 1991;30(8):947–57.

    Article  PubMed  CAS  Google Scholar 

  27. 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(3):186–90.

    Article  PubMed  CAS  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Mykletun A, Stordal E, Dahl AA. Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry. 2001;179:540–4.

    Article  PubMed  CAS  Google Scholar 

  30. Smith AB, Selby PJ, Velikova G, Stark D, Wright EP, Gould A, et al. Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychol Psychother. 2002;75(Pt 2):165–76.

    Article  PubMed  Google Scholar 

  31. Sullivan M, Karlsson J, Sjostrom L, Backman L, Bengtsson C, Bouchard C, et al. Swedish obese subjects (SOS)—an intervention study of obesity. Baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. Int J Obes Relat Metab Disord. 1993;17(9):503–12.

    PubMed  CAS  Google Scholar 

  32. Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.

    Google Scholar 

  33. Hinkle DE, Jurs SG, Wiersma W. Applied statistics for the behavioural sciences. 2nd ed. Boston: Houghton Mifflin; 1988.

    Google Scholar 

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Acknowledgment

This study was supported by the Swedish Cancer Society; the Research and Development Council, Västra Götaland (Sweden) County; the Cancer and Traffic Victims Campaign (CTRF), Stockholm, Sweden; and the Medical Faculty of Gothenburg University Sweden.

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Authors and Affiliations

  1. Department of Otolaryngology, Sahlgrenska University Hospital, Gothenburg University, 413 45, Gothenburg, Sweden

    Caterina Finizia, Ingrid Rudberg & Henrik Bergqvist

  2. AstraZeneca R&D, 431 83, Möndal, Sweden

    Anna Rydén

Authors
  1. Caterina Finizia
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  2. Ingrid Rudberg
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  3. Henrik Bergqvist
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  4. Anna Rydén
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Correspondence to Caterina Finizia.

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Finizia, C., Rudberg, I., Bergqvist, H. et al. A Cross-sectional Validation Study of the Swedish Version of SWAL-QOL. Dysphagia 27, 325–335 (2012). https://doi.org/10.1007/s00455-011-9369-6

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  • DOI: https://doi.org/10.1007/s00455-011-9369-6

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