The SWAL-QOL and SWAL-CARE Outcomes Tool for Oropharyngeal Dysphagia in Adults: III. Documentation of Reliability and Validity

Abstract

Advances in the measurement of swallowing physiologic parameters have been clinician-driven, as has the development of intervention techniques to modify swallowing pathophysiology. However, a critical element to determining the success of such efforts will be established by the patients themselves. We conceptualized, developed, and validated the SWAL-QOL, a 93-item quality-of-life and quality-of-care outcomes tool for dysphagia researchers and clinicians. With 93 items, the SWAL-QOL was too long for practical and routine use in clinical research and practice. We used an array of psychometric techniques to reduce the 93-item instrument into two patient-centered outcomes tools: (1) the SWAL-QOL, a 44-item tool that assesses ten quality-of-life concepts, and (2) the SWAL-CARE, a 15-item tool that assesses quality of care and patient satisfaction. All scales exhibit excellent internal-consistency reliability and short-term reproducibility. The scales differentiate normal swallowers from patients with oropharyngeal dysphagia and are sensitive to differences in the severity of dysphagia as clinically defined. It is intended that the standardization and publication of the SWAL-QOL and the SWAL-CARE will facilitate their use in clinical research and clinical practice to better understand treatment effectiveness as a critical step toward improving patients' quality of life and quality of care.

Effects of Therapy for Dysphagia in Parkinson’s Disease: Systematic Review

“…The assessment consisted of EMG with a nasal cannula and an endoscopic evaluation of swallowing (FEES). A dysphagia quality-of-life questionnaire (SWAL-QOL) was filled out only before treatment [25]. Disease severity according to the H-Y scale and statistical analysis were described.…”

Cross-cultural Adaptation and Validation of the Dutch Version of SWAL-QoL

“…According to McHorney et al [6], coefficients ranged from 0.79 to 0.91, allowing the SWAL-QoL to be used only for group-level research according to Bland and Altman [5]. Thus, SWAL-QoL also allows researchers to derive sum scores for each of the ten concepts from the raw data provided by the questionnaire.…”

Swallowing markers in spinal and bulbar muscular atrophy

“…Pharyngeal barium residue and times of piecemeal deglutition (multiple repeated swallows) were measured blindly by two independent evaluators as described previously. To evaluate the validity of the measurements, the SBMA functional rating scale (SBMAFRS),18 SWAL‐QOL symptom subscores,19, 20 and Swallowing Disturbance Questionnaire–Japanese (SDQ‐J) were used 21, 22. Data were analyzed by intraclass correlation (1, 1) for reproducibility and Spearman's rank correlation for validity.…”