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Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients

Dysphagia volume 34, pages 63–72 (2019)Cite this article

Abstract

The Dysphagia Handicap Index (DHI) is a 25-item questionnaire assessing the physical, functional, and emotional aspects of dysphagia patients’ quality of life (QoL). The study goal was to translate and validate the Hebrew-DHI. 148 patients undergoing fiberoptic endoscopic examination of swallowing (FEES) in two specialized dysphagia clinics between February and August 2017 filled the Hebrew-DHI and self-reported their dysphagia severity on a scale of 1–7. 21 patients refilled the DHI during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency), penetration and aspiration (1 point for penetration, 2 points for aspiration, per consistency). 51 healthy volunteers also filled the DHI. Internal consistency and test–retest reproducibility were used for reliability testing. Validity was established by comparing DHI scores of dysphagia patients and healthy controls. Concurrent validity was established by correlating the DHI score with the FEES score. Internal consistency of the Hebrew-DHI was high (Cronbach’s alpha = 0.96), as was the test–retest reproducibility (Spearman’s correlation coefficient = 0.82, p < 0.001). The Hebrew-DHI’s total score, and its three subscales (physical/functional/emotional) were significantly higher in dysphagia patients compared to those in healthy controls (median 38 pts, IQR 18–56 for dysphagia patients compared to 0, IQR 0–2 for healthy controls, p < 0.0001). A strong correlation was observed between the DHI score and the self-reported dysphagia severity measure (Spearman’s correlation coefficient = 0.88, p < 0.0001). A moderate correlation was found between the DHI score and the FEES score (Pearson’s correlation coefficient = 0.245, p = 0.003). The Hebrew-DHI is a reliable and valid questionnaire assessing dysphagia patients’ QoL.

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References

  1. Lindgren S, Janzon L. Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia. 1991;6:187–92.

    Article  CAS  PubMed  Google Scholar 

  2. Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The prevalence of dysphagia in primary care patients: a HamesNet research network study. J Am Board Fam Med. 2007;20:144–50.

    Article  PubMed  Google Scholar 

  3. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis. 2000;10:380–6.

    Article  CAS  PubMed  Google Scholar 

  4. Coates C, Bakheit AM. Dysphagia in Parkinson’s disease. Eur Neurol. 1997;38:49–52.

    Article  CAS  PubMed  Google Scholar 

  5. Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RAC, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ. 1990;300:721–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Garcia-Peris P, Paron L, Velasco C, de la Cuerda C, Camblor M, Breton I, Herencia H, Verdaguer J, Navarro C, Clave P. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clin Nutr. 2007;26:710–7.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Campbell BH, Spinelli K, Marbella AM, et al. Aspiration, weight loss and quality of life in head and neck cancer survivors. Arch Otolaryngol Head Neck Surg. 2004;130:1100–3.

    Article  PubMed  Google Scholar 

  9. Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17:139–46.

    Article  PubMed  Google Scholar 

  10. Higginson IJ, Carr AJ. Using quality of life measures in the clinical setting. BMJ. 2001;322:1297–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Timmerman AA, Speyer R, Heijnen BJ, Klijn-Zwijnenberg IR. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia. 2014;29(2):183–98.

    Article  PubMed  Google Scholar 

  12. 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.

    CAS  PubMed  Google Scholar 

  13. Gustafsson B, Tibbling L. Dysphagia, an unrecognized handicap. Dysphagia. 1991;6:193–9.

    Article  CAS  PubMed  Google Scholar 

  14. 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 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia Handicap Index: development and validation. Dysphagia. 2012;27:46–52.

    Article  PubMed  Google Scholar 

  17. Asadollahpour F, Baghban K, Asadi M. Validity and reliability of the Persian version of the Dysphagia Handicap Index (DHI). Iran J Otorhinolaryngol. 2015;27(3):185–91.

    PubMed  PubMed Central  Google Scholar 

  18. Mohamed F, Khalid HM, Tamer AM, Manal B, Sami A. Development of the Arabic version of Dysphagia Handicap Index (DHI). Dysphagia. 2014;29:459–67.

    Article  Google Scholar 

  19. Oda C, Yamamoto T, Fukumoto Y, Nakayama K, Sato M, Murata M, Kobayashi Y. Validation of the Japanese translation of the Dysphagia Handicap Index. Dovepress. 2017;11:193–8.

    Google Scholar 

  20. Cohen JT, Manor Y. Swallowing disturbance questionnaire for detecting dysphagia. Laryngoscope. 2011;121:1383–7.

    Article  PubMed  Google Scholar 

  21. Wild D, Grove A, Martin M, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health. 2005;8(2):94–104.

    Article  PubMed  Google Scholar 

  22. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2:216–9.

    Article  CAS  PubMed  Google Scholar 

  23. Fife TA, Butler SG, Langmore SE, Lester S, Wright SC Jr, Kemp S, Grace-Martin K, Lintzenich CR. Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients. Ann Otol Rhinol Laryngol. 2015;124(3):206–11.

    Article  PubMed  Google Scholar 

  24. O’Dea MB, Langmore SE, Krisciunas GP, Walsh M, Zanchetti LL, Scheel R, McNally E, Kaneoka AS, Guarino AJ, Butler SG. Effect of lidocaine on swallowing during FEES in patients with dysphagia. Ann Otol Rhinol Laryngol. 2015;124(7):537–44.

    Article  PubMed  Google Scholar 

  25. Rosenbek JC, Robbins JA, Roecker EB, Coyle JC, Wood JL. A penetration–aspiration scale. Dysphagia. 1996;11:93–8.

    Article  CAS  PubMed  Google Scholar 

  26. Neubauer PD, Hersey DP, Leder SB. Pharyngeal residue severity rating scales based on fiberoptic endoscopic evaluation of swallowing: a systematic review. Dysphagia. 2016;31(3):352–9.

    Article  PubMed  Google Scholar 

  27. Martino R, Beaton D, Diamant NE. Using different perspectives to generate items for a new scale measuring medical outcomes of dysphagia (MOD). J Clin Epidemiol. 2009;62(5):518–26.

    Article  PubMed  Google Scholar 

  28. Meyer TK, Pisegna JM, Krisciunas GP, Pauloski BR, Langmore SE. Residue influences quality of life independently of penetration and aspiration in head and neck cancer survivors. Laryngoscope. 2017;127(7):1615–21.

    Article  CAS  PubMed  Google Scholar 

  29. Silbergleit AK, LeWitt P, Junn F, Schultz LR, Collins D, Beardsley T, et al. Comparison of dysphagia before and after deep brain stimulation in Parkinson’s disease. Move Disord. 2012;27(14):1763–8.

    Article  Google Scholar 

  30. Wilmskoetter J, Bonilha H, Hong I, Hazelwood RJ, Martin-Harris B, Velozo C. Construct validity of the eating assessment tool (EAT-10). Disabil Rehabil. 2017;9:1–11.

    Article  Google Scholar 

  31. Cordier R, Joosten A, Clavé P, Schindler A, Bülow M, Demir N, Arslan SS, Speyer R. Evaluating the psychometric properties of the eating assessment tool (EAT-10) using Rasch analysis. Dysphagia. 2017;32(2):250–60.

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Yael Shapira-Galitz and Michael Drendel have contributed equally to this study.

Authors and Affiliations

  1. The Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Affiliated with the Hebrew University of Jerusalem, POB 1, 76100, Rehovot, Israel

    Yael Shapira-Galitz, Liat Shtreiffler-Moskovich & Yonatan Lahav

  2. The Department of Otololaryngology Head and Neck Surgery, Sheba Medical Center, Affiliated with the Tel Aviv University, Tel HaShomer, Israel

    Michael Drendel, Ruth Yousovich-Ulriech & Michael Wolf

Authors
  1. Yael Shapira-Galitz
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  2. Michael Drendel
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  3. Ruth Yousovich-Ulriech
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  4. Liat Shtreiffler-Moskovich
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  5. Michael Wolf
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  6. Yonatan Lahav
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Correspondence to Yael Shapira-Galitz.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Shapira-Galitz, Y., Drendel, M., Yousovich-Ulriech, R. et al. Translation and Validation of the Dysphagia Handicap Index in Hebrew-Speaking Patients. Dysphagia 34, 63–72 (2019). https://doi.org/10.1007/s00455-018-9914-7

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  • DOI: https://doi.org/10.1007/s00455-018-9914-7

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