Psychometric Properties of the MDADI—A Preliminary Study of Whether Less is Truly More?

Abstract

The MD Anderson Dysphagia Inventory (MDADI) is a 20-item dysphagia-specific QOL questionnaire with four subscales: global, emotional, functional, and physical. It is widely used in clinical practice and in research; however, its psychometric properties have been under-researched. We aim to evaluate the organisation of the MDADI subscales and identify any redundant items. The MDADI is a routinely collected outcome measure at two centres in northeast England. Questionnaires completed at three months following treatment were extracted from these existing databases. Factor analysis was carried out with the aim of reducing redundancy among the set of questionnaire items. Cases with missing values were excluded. A total of 196 complete patient questionnaires were used in factor analysis. A one-factor model accounted for around 50% of the total variance in item responses. The top five endorsed items (abbreviated by the questionnaire item keywords: Excluded, Irritate, Esteem, Social, and Why) in this one factor appeared in three (emotional, functional, and physical) of the four supposed MDADI subscales, i.e. global, emotional, functional, and physical. Our results suggest an overlap of three MDADI subscales across the top five endorsed items. The content of the top five questions all appear related to the psychosocial aspects of swallowing. This implies some redundancy of the items in the original subscales of the questionnaire. Using the most endorsed items, it appears feasible to abbreviate the 20-item MDADI questionnaire to a 5-item “MiniDADI” questionnaire, which is likely to have greater utility in routine clinical practice outside of research settings.

Construct and discriminant validity testing of the FACE‐Q Head and Neck Cancer Module for assessing speech and swallowing outcomes for patients undergoing maxillectomy or mandibulectomy

“…Given patients undergoing treatment for head and neck tumors are often asked to complete multiple PROMs, some of which are nonintuitive to answer and score, they may find that there is a degree of overlap between the different instruments. This leads to an unnecessary time burden and risk that they might experience survey fatigue which could consequently reduce the accuracy and reliability of their responses 15 …”

“…This leads to an unnecessary time burden and risk that they might experience survey fatigue which could consequently reduce the accuracy and reliability of their responses. 15 The FACE-Q H&N is a relatively new PROM for use in patients with head and neck pathologies to describe functional, psychosocial, and experiential outcomes. While the instrument has been validated in some respects, 19 to date, its properties have not been compared to existing instruments widely used in research and clinical practice of speech and swallowing outcomes such as the MDADI and SHI.…”

“…Both the MDADI and SHI have recently had their psychometric qualities assessed and analyzed for item redundancy. While further testing is required before application into clinical practice, the MiniDADI is composed of five of the top loading questions from the MDADI, representing a considerable reduction in the time taken to complete the original questionnaire 15 . Similarly, the SHI has been refined and validated to 15‐items in the SHI‐15 16 .…”

“…While further testing is required before application into clinical practice, the MiniDADI is composed of five of the top loading questions from the MDADI, representing a considerable reduction in the time taken to complete the original questionnaire. 15 Similarly, the SHI has been refined and validated to 15-items in the SHI-15. 16 These are two examples of attempts made by researchers to reduce the response burden placed on patients required to complete these questionnaires.…”

Dysphagia Advances in Head and Neck Cancer

“…It has been translated into numerous languages with subsequent reliability and validity testing. Exploratory factor analysis suggests the MDADI could be abbreviated to just five key questions for clinical purposes, although further validation is required [ 6 ]. A between-group minimally clinical important difference of 10 points has been calculated for the total score [ 7 ].…”