새로운 연하곤란 임상 척도의 개발과 타당도 평가
Development and Validation of a New Screening Test for Dysphagia
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Objective: To develop a new screening test for dysphagia patients with various etiologies. Method: We investigated 10 widely used screening tests based on previous studies. Contents of the screening tests were summarized into 76 items. By using modified Delphi technique, 23 items showing high average score (＞3.5) were selected as candidates for the new Clinical Dysphagia Scale (nCDS). A total of 216 dysphagia patients with various etiologies were tested with these items and underwent videofluoroscopic swallowing study (VFSS) simultaneously. We analyzed these data in statistical and clinical aspects to determine which items were more correlated with VFSS findings and which items are more appropriate for the screening test. Content validity was re-evaluated by consensus in an expert meeting. Consequentially, 8 items were selected for the nCDS. Result: The nCDS included 8 items: swallowing difficulty, structural defect (oral cavity, pharynx, larynx, or esophagus), lip sealing, tongue movement (forward and side to side), saliva swallowing, wet voice or gurgling voice (pre-swallowing), 5 ml water swallowing test (2 times), and laryngeal elevation during swallowing. The sensitivity and specificity of the nCDS score for detecting necessity of food modification were 83.8% and 58.3%, respectively. It was also well correlated with the functional dysphagia scale derived from the VFSS (Pearson's coefficient 0.525, P ＜0.01). Conclusion: The nCDS is not only a good screening test for detecting necessity of food modification, but also a good diagnostic tool for evaluation of general swallowing function. Furthermore, it is simply applicable to dysphagic patients with various etiologies. (JKDS 2013;3:20-25)
Abstract
Objective: To develop a new screening test for dysphagia patients with various etiologies. Method: We investigated 10 widely used screening tests based on previous studies. Contents of the screening tests were summarized into 76 items. By using modified Delphi technique, 23 items showing high average score (＞3.5) were selected as candidates for the new Clinical Dysphagia Scale (nCDS). A total of 216 dysphagia patients with various etiologies were tested with these items and underwent videofluoroscopic swallowing study (VFSS) simultaneously. We analyzed these data in statistical and clinical aspects to determine which items were more correlated with VFSS findings and which items are more appropriate for the screening test. Content validity was re-evaluated by consensus in an expert meeting. Consequentially, 8 items were selected for the nCDS. Result: The nCDS included 8 items: swallowing difficulty, structural defect (oral cavity, pharynx, larynx, or esophagus), lip sealing, tongue movement (forward and side to side), saliva swallowing, wet voice or gurgling voice (pre-swallowing), 5 ml water swallowing test (2 times), and laryngeal elevation during swallowing. The sensitivity and specificity of the nCDS score for detecting necessity of food modification were 83.8% and 58.3%, respectively. It was also well correlated with the functional dysphagia scale derived from the VFSS (Pearson's coefficient 0.525, P ＜0.01). Conclusion: The nCDS is not only a good screening test for detecting necessity of food modification, but also a good diagnostic tool for evaluation of general swallowing function. Furthermore, it is simply applicable to dysphagic patients with various etiologies. (JKDS 2013;3:20-25)
참고문헌 (27)
- Cook IJ, "Timing of videofluoroscopic, manometric events, and bolus transit during the oral and pharyngeal phases of swallowing", Dysphagia, 4, pp.8~15 (1989)
- Perlman A, "Electromyographic activity from human laryngeal, pharyngeal, and submental muscles during swallowing", J Appl Physiol, 86, pp.1663~1669 (1999)
- Teasell R, "The incidence, management, and complications of dysphagia in patients with medullary strokes admitted to a rehabilitation unit", Dysphagia, 17, pp.115~120 (2002)
- Teasell RW, "An evidence-based review of stroke rehabilitation", Top Stroke Rehabil, 10, pp.29~58 (2003)
- Gariballa S, "Assessment and treatment of nutritional status in stroke patients", Postgrad Med J, 74, pp.395~399 (1998)
- Splaingard M, "Aspiration in rehabilitation patients : videofluoroscopy vs bedside clinical assessment", Arch Phys Med Rehabil, 69, pp.637~640 (1988)
- Smithard DG, "Can bedside assessment reliably exclude aspiration following acute stroke?", Age Ageing, 27, pp.99~106 (1998)
- DePippo KL, "The Burke dysphagia screening test : validation of its use in patients with stroke", Arch Phys Med Rehabil, 75, pp.1284~1286 (1994)
- Hinds N, "Assessment of swallowing and referral to speech and language therapists in acute stroke", QJM, 91, pp.829~835 (1998)
- Massey R, "The Massey bedside swallowing screen", J Neurosci Nurs, 34, pp.252~260 (2002)
- Nishiwaki K, "Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables", J Rehabil Med, 37, pp.247~251 (2005)
- Perry L, "Screening swallowing function of patients with acute stroke. part one: Identification, implementation and initial evaluation of a screening tool for use by nurses", J Clin Nurs, 10, pp.463~473 (2001)
- Kidd D, "Aspiration in acute stroke : a clinical study with videofluoroscopy", QJM, 86, pp.825~829 (1993)
- Trapl M, "Dysphagia bedside screening for acute-stroke patients the gugging swallowing screen", Stroke, 38, pp.2948~2952 (2007)
- Martino R, "The toronto bedside swallowing screening test(TOR-BSST)development and validation of a dysphagia screening tool for patients with stroke", Stroke, 40, pp.555~561 (2009)
- Han TR, "The clinical functional scale for dysphagia in stroke patients", Korean J Stroke, 3, pp.153~157 (2001)
- Han TR, "The prediction of persistent dysphagia beyond six months after stroke", Dysphagia, 23, pp.59~64 (2008)
- 정세희, "비디오 투시 연하 검사에 근거한 연하곤란 임상 척도의 타당도 평가", Annals of Rehabilitation Medicine, 29(4), pp.343~350 (2005), 대한재활의학회
- Custer RL, "The modified Delphi technique-A rotational modification", JVTE, 15, pp.1~10 (1999)
- "American Speech-Language-Hearing Association National Outcomes Measurement System: adults speech-language pathology user's guide", ~ (2003)
- DeVellis RF, "Scale development : theory and applications" (1999), Sage Publications
- Nicosia MA, "Age effects on the temporal evolution of isometric and swallowing pressure", J Gerontol A Biol Sci Med Sci, 55, pp.M634~M640 (2000)
- Robbins J, "Oropharyngeal swallowing in normal adults of different ages", Gastroenterology, 103, pp.823~829 (1992)
- Daggett A, "Laryngeal penetration during deglutition in normal subjects of various ages", Dysphagia, 21, pp.270~274 (2006)
- Yeh SJ, "Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit", J Neurol Sci, 306, pp.38~41 (2011)
- Martino R, "Screening for oropharyngeal dysphagia in stroke : insufficient evidence for guidelines", Dysphagia, 15, pp.19~30 (2000)
- 송원우, "비디오 투시 연하 검사에 근거한 Gugging Swallowing Screen의 타당도 평가", Annals of Rehabilitation Medicine, 33(6), pp.704~710 (2009), 대한재활의학회