Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Otolaryngology - Head and Neck Surgery, Weill Cornell Medicine, New York, NY.
J Bone Joint Surg Am. 2018 May 16;100(10):e66. doi: 10.2106/JBJS.17.01001.
Dysphagia and dysphonia are common complications after anterior cervical spine surgery; however, reported prevalences vary greatly due to a lack of reliable clinical standards for measuring postoperative swallowing and speech dysfunction. The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) was developed as a patient-derived, patient-reported instrument to measure dysphagia and dysphonia more accurately after anterior cervical spine surgery than existing indices.
This multiphase survey-development study implemented a mixed-methods approach. Phase 1 involved qualitative assessment of postoperative patient-reported swallowing or speaking deficiencies to assemble a draft survey. Phase 2 established test-retest reliability and finalized the 31-item HSS-DDI. Phase 3 compared the HSS-DDI with the Swallowing-Quality of Life (SWAL-QOL) questionnaire and the M.D. Anderson Dysphagia Inventory (MDADI) for validity and responsiveness.
Phase 1, performed to formulate the draft survey, included 25 patients who were asked about speech and swallowing dysfunction after anterior cervical spine surgery involving at least 3 vertebral levels. Phase 2 included 49 patients who completed the draft survey twice. The mean scores (and standard deviation) for each administration of the HSS-DDI were 67 ± 24 and 75 ± 22, the Cronbach alpha coefficients were both 0.97, and the intraclass correlation coefficient was 0.80. The 31-item HSS-DDI was finalized with all but 2 items having weighted kappa values of ≥0.40. Phase 3 included 127 patients and established external validity, with most correlation coefficients between the HSS-DDI and the SWAL-QOL and MDADI ranging from 0.5 to 0.7. Internal validity was established by identifying worsening HSS-DDI scores with increases in the number of vertebral levels involved (p = 0.02) and in the Surgical Invasiveness Index (p = 0.006). HSS-DDI responsiveness ascertained by effect size (0.73) was better than that of the SWAL-QOL and MDADI. The average administration time for the HSS-DDI was 2 minutes and 25 seconds.
The HSS-DDI is efficient, valid, and more responsive to change after anterior cervical spine surgery than existing surveys.
The HSS-DDI fills a gap in postoperative assessment by providing a reliable, more clinically sensitive, patient and condition-specific evaluation of dysphagia and dysphonia prospectively and longitudinally.
吞咽困难和发音障碍是颈椎前路手术后常见的并发症；然而，由于缺乏可靠的术后吞咽和言语功能评估标准，报告的患病率差异很大。为了更准确地测量颈椎前路手术后的吞咽困难和发音障碍，医院特殊外科吞咽和发音障碍量表（HSS-DDI）是一种由患者衍生、患者报告的工具，优于现有的指数。
本研究采用多阶段调查开发方法，采用混合方法。第 1 阶段涉及对术后患者报告的吞咽或言语缺陷的定性评估，以汇编一份草案调查。第 2 阶段建立了测试-重测信度，并最终确定了 31 项 HSS-DDI。第 3 阶段比较了 HSS-DDI 与吞咽生活质量问卷（SWAL-QOL）和 MD 安德森吞咽障碍量表（MDADI）的有效性和反应性。
第 1 阶段旨在制定草案调查，共纳入 25 例患者，这些患者在接受至少 3 个椎体水平的颈椎前路手术后报告了言语和吞咽功能障碍。第 2 阶段包括 49 例患者两次完成草案调查。HSS-DDI 每次评估的平均得分（和标准差）分别为 67 ± 24 和 75 ± 22，Cronbach α系数均为 0.97，组内相关系数为 0.80。最终确定了 31 项 HSS-DDI，除了 2 项，其余项目的加权kappa 值均≥0.40。第 3 阶段共纳入 127 例患者，确定了外部有效性，HSS-DDI 与 SWAL-QOL 和 MDADI 的大多数相关系数范围为 0.5 至 0.7。内部有效性通过确定随着受累椎体水平数（p = 0.02）和手术侵袭指数（p = 0.006）的增加，HSS-DDI 评分的恶化来建立。通过效应量（0.73）确定的 HSS-DDI 反应性优于 SWAL-QOL 和 MDADI。HSS-DDI 的平均管理时间为 2 分 25 秒。
HSS-DDI 在颈椎前路手术后比现有调查更有效、更有效且更能反映变化。
HSS-DDI 通过提供可靠、更具临床敏感性、针对患者和病情的前瞻性和纵向评估吞咽困难和发音障碍，填补了术后评估的空白。
