Oropharyngolaryngeal Disorders in Scleroderma: Development and Validation of the SLS Scale

Abstract

Systemic sclerosis (SSc) is a multisystemic disorder characterized by functional and structural abnormalities of small blood vessels and fibrosis of the skin and internal organs. Eighty percent of subjects with SSc have orofacial manifestations. No tests for oral manifestations have been validated for this pathology, and in the literature there are few studies of speech therapy for subjects with SSc. These facts suggested the need for an exhaustive assessment of mouth mobility and muscle strength, and also of swallowing and voice, in order to plan a targeted and effective speech therapy. The Scleroderma Logopedic Scale (SLS) has been developed to assess disorders in five domains: Impairment, Swallow, Voice, Multifield, and Quality of Life. Perception of these disorders was assessed in 84 subjects with SSc and in 40 healthy subjects. After the first draft, a shorter form (39 items) was obtained after statistical analysis. This scale showed good discriminant and concurrent validity. Internal consistency was good: three of five subscales had a Cronbach alpha coefficient higher than 0.8. The test/retest coefficient for the total score was 0.94. Thirty-six percent of examined subjects showed moderate to severe oropharyngolaryngeal disorders. Swallowing disorders and impairment of mouth (e.g., decrease in mobility and strength) were the most commonly reported problems. Conversely, the change of voice due to the pathology was not perceived as a problem. Fifty-five percent of subjects reported a decreased level of quality of life.

Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation

“…Condition-specific measures were heterogeneous and included: esophageal cancer 19–23 , oropharyngeal dysphagia related to cancer 24–27 , oropharyngeal dysphagia 28–30 , eosinophilic esophagitis 13, 16, 31 , dysphagia related to anterior spine surgery 32, 33 , Parkinson’s disease 34, 35 , benign esophageal disease 12 , total laryngectomy-related dysphagia 36 , esophageal stricture 14 , achalasia 18 , esophageal disorders 37 , multiple sclerosis 38 , and systemic sclerosis 39 . Seven were designed to assess patients with general dysphagia 15, 40–45 , and one was a screening tool for dysphagia among geriatric patients 23 .…”

“…15, 20, 25, 34, 39 Three validated a pre-existing PRO measure in a new target population. 16, 27, 45 Two validated a pre-existing PRO measure using a different recall period 40, 42 , and two further refined previously developed health-related quality of life measures related to esophageal cancer 21, 23 .…”

“…Some instruments demonstrated test-retest reliability (SSQ, DSQ, MDQ, MDQ-2w, EAT-10, MDQ-30) 29, 33, 37, 40–42 , while others showed internal consistency (DSST, MADS, QL-Eso-Ca, EORTC QLQ-OG25, EORTC QLQ-OES18, SDQ, DYMUS, SDQ-D) 17–19, 21, 23, 35, 38, 45 . Several measures demonstrated both internal consistency and test-retest reliability (PROMIS-GI, FACT-E, MDADI, DSS, SSQ, SWAL-QOL, SWAL-CARE, ROMP-Swallowing, SOAL, SLS, DHI, ESQ) 15, 20, 24, 26–28, 30, 34, 36, 39, 43, 44 .…”

Impact of systemic sclerosis oral manifestations on patients’ health‐related quality of life: A systematic review

“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] • 5 studies evaluated the use of scales. [28][29][30][31][32] SMIRANI ET AL.…”

The spectrum of orofacial manifestations in systemic sclerosis: a challenging management

“…The MHISS has been developed in French and validated in French, Italian, and Dutch (Mouthon et al , ; Maddali‐Bongi et al , ; Schouffoer et al , ). Vitali et al created the Scleroderma Logopedic Scale (SLS) to assess the oropharyngeal area disorders in SSc patients (Vitali et al , ). This 58‐items scale is divided into five subscales (Impairment, Swallow, Voice, Multifield and Quality of life) but seems more difficult to use in the daily practice.…”