Skip to main content

Dysphagia in Multiple Sclerosis: Evaluation and Validation of the DYMUS Questionnaire



The 10-item Dysphagia in Multiple Sclerosis (DYMUS) questionnaire is a self-administered tool used to identify swallowing problems in adults with MS. The questionnaire was not validated against other existing questionnaires to assess its convergent validity. Moreover, its test–retest reliability was not measured previously. Therefore, the purpose of this study was to assess the factor analysis, internal consistency and test–retest reliability of the DYMUS, as well as its convergent validity against an established and validated questionnaire, the EAT-10.


English-speaking adults with MS in New South Wales, Australia who were seen for routine medical check-ups were invited to complete two questionnaires across two phases. One hundred participants completed phase 1, while 55 completed phase 2. Statistical analyses were performed to investigate the psychometric properties of the DYMUS questionnaire.


Internal consistency (Cronbach’s Alpha) reduced the DYMUS questionnaire from ten to five items. The shortened version of the DYMUS showed high internal consistency (alpha = 0.904). It also showed satisfactory reproducibility, and adequate correlation with the 10-item Eating Assessment Tool (EAT-10).


Evaluation of the DYMUS resulted in a shortened version of the questionnaire with five questions related to dysphagia. This shortened version is considered an easy and useful tool in identifying patients with MS-related dysphagia.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Tassorelli C, et al. Dysphagia in multiple sclerosis: from pathogenesis to diagnosis. Neurological Sciences. 2008;29(Suppl 4):S360–3.

    Article  PubMed  Google Scholar 

  2. Hartelius L, Svensson P. Speech and swallowing symptoms associated with parkinsons-disease and multiple-sclerosis—a survey. Folia Phoniatrica Et Logopaedica. 1994;46(1):9–17.

    Article  PubMed  CAS  Google Scholar 

  3. Prosiegel M, Schelling A, Wagner-Sonntag E. Dysphagia and multiple sclerosis. Int Ms J. 2004;11(1):22–31.

    PubMed  CAS  Google Scholar 

  4. Leder SB, Novella S, Patwa H. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in patients with amyrotrophic lateral sclerosis. Dysphagia. 2004;19(3):177–81.

    Article  PubMed  Google Scholar 

  5. Belafsky PC, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24.

    Article  PubMed  Google Scholar 

  6. Poorjavad M, et al. Oropharyngeal dysphagia in multiple sclerosis. Mult Scler. 2010;16(3):362–5.

    Article  PubMed  Google Scholar 

  7. Bergamaschi R, et al. Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. Funct Neurol. 2009;24(3):159–62.

    PubMed  Google Scholar 

  8. Sales DS, et al. Translation, cross-cultural adaptation and validation of the Portuguese version of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. SpringerPlus. 2013;2(1):1–6.

    Article  CAS  Google Scholar 

  9. Orlandoni P, Jukic P. Health-related quality of life and functional health status questionnaires in oropharyngeal dysphagia. J Aging Res Clin Pract. 2016;5(1):31–7.

    Google Scholar 

  10. Speyer R, et al. Psychometric properties of questionnaires on functional health status in oropharyngeal dysphagia: a systematic literature review. Biomed Res Int. 2014;2014:1–11.

    Article  Google Scholar 

  11. Bergamaschi R, et al. The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci. 2008;269(1):49–53.

    Article  PubMed  CAS  Google Scholar 

  12. Terwee CB, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.

    Article  PubMed  Google Scholar 

  13. Cordier R, et al. Evaluating the psychometric properties of the Eating Assessment Tool (EAT-10) using Rasch analysis. Dysphagia. 2017;32(2):250–60.

    Article  PubMed  CAS  Google Scholar 

  14. Möller R, Safa S, Östberg P. Validation of the Swedish translation of eating assessment tool (S-EAT-10). Acta Otolaryngol. 2016;136(7):749–53.

    Article  PubMed  Google Scholar 

  15. Demir N, et al. Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia. 2016;31:644–9.

    Article  PubMed  Google Scholar 

  16. Rolstad S, Adler J, Rydén A. Response burden and questionnaire length: is shorter better? A review and meta-analysis. Value Health. 2011;14(8):1101–8.

    Article  PubMed  Google Scholar 

  17. McHorney CA, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling. Dysphagia. 2000;15(3):122–33.

    Article  PubMed  CAS  Google Scholar 

  18. World Medical Association. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4.

    Article  CAS  Google Scholar 

  19. Verma K. Base of a research: good clinical practice in clinical trials. J Clin Trials. 2013;3(1):100–28.

    Article  Google Scholar 

  20. Cheney DM, et al. The Ability of the 10-Item Eating Assessment Tool (EAT-10) to predict aspiration risk in persons with dysphagia. Ann Otol Rhinol Laryngol. 2015;124(5):351–4.

    Article  PubMed  Google Scholar 

  21. Nogueira DS, et al. Measuring outcomes for dysphagia: validity and reliability of the European Portuguese Eating Assessment Tool (P-EAT-10). Dysphagia. 2015;30(5):511–20.

    Article  PubMed  Google Scholar 

  22. Bland JM, Altman DG. Cronbach’s alpha. BMJ (Clinical research ed.). 1997;314(7080):572.

    Article  CAS  Google Scholar 

  23. Altman DG. Practical statistics for medical research. New York: Chapman and Hall; 1991.

    Google Scholar 

  24. McHorney CA, 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 

  25. Ratner B. The correlation coefficient: its values range between + 1 − 1, or do they? J Target Meas Anal Mark. 2009;17(2):139–42.

    Article  Google Scholar 

  26. Orton S-M, et al. Sex ratio of multiple sclerosis in Canada: a longitudinal study. Lancet Neurol. 2006;5(11):932–6.

    Article  PubMed  Google Scholar 

  27. Corso MJ, et al. Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux. Dig Dis Sci. 1998;43(7):1513–7.

    Article  PubMed  CAS  Google Scholar 

  28. Habek M, Hojsak I, Brinar VV. Nutrition in multiple sclerosis. Clin Neurol Neurosurg. 2010;112(7):616–20.

    Article  PubMed  Google Scholar 

  29. Schwarz S, Leweling H. Multiple sclerosis and nutrition. Mult Scler. 2005;11(1):24–32.

    Article  PubMed  CAS  Google Scholar 

  30. McMahon SR, et al. Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics. 2003;111(4):e299–303.

    Article  PubMed  Google Scholar 

  31. Schleyer TK, Forrest JL. Methods for the design and administration of web-based surveys. JAMIA. 2000;7(4):416–25.

    PubMed  PubMed Central  CAS  Google Scholar 

  32. Suresh K, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Human Reprod Sci. 2012;5(1):7–13.

    Article  Google Scholar 

Download references


The authors gratefully acknowledge Therese Burke and Linda Mekhael for their contribution and support during the data collection phase of the study.


The author(s) received no financial support for the research, authorship, and/or publication of this article. Al Ali was supported by a scholarship from Kuwait University, and Ballard was supported by Australian Research Council Future Fellowship FT120100355.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Dalal Alali.

Ethics declarations

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.


Appendix 1: DYMUS Questionnaire

The questionnaire involves ten questions that assess dysphagia for solids and liquids in patients with MS. Patients are instructed to answer the questions with Yes or No based on their present state, with the exception of the last question, which refers to the past 6 months.

figure a

Appendix 2: EAT-10

The questionnaire involves ten questions that assess dysphagia in patients with MS. Patients are instructed to circle an answer between 0 and 4 based on what degree they experience the problem.

1. My swallowing problem has caused me to lose weight 0 1 2 3 4
2. My swallowing problem interferes with my ability to go out for meals      
3. Swallowing liquids takes extra effort      
4. Swallowing solids takes extra effort      
5. Swallowing pills takes extra effort      
6. Swallowing is painful      
7. The pleasure of eating is affected by my swallowing      
8. When I swallow food sticks in my throat      
9. I cough when I eat      
10. Swallowing is stressful      

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Alali, D., Ballard, K., Vucic, S. et al. Dysphagia in Multiple Sclerosis: Evaluation and Validation of the DYMUS Questionnaire. Dysphagia 33, 273–281 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Dysphagia
  • Deglutition
  • Multiple sclerosis
  • Questionnaire
  • Validation