Printza A, Boziki M, Bakirtzis C, Nikolaidis I, Kalaitzi M, Triaridis S, Grigoriadis N
First Otolaryngology Department, Medical Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Second Neurology Department, Medical Department, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Eur J Neurol. 2020 Jul;27(7):1231-1237. doi: 10.1111/ene.14219. Epub 2020 Apr 10.
Many patients with multiple sclerosis (MS) present swallowing difficulties. Dysphagia is associated with significant morbidity and mortality, has a profound impact on the quality of life but is under-reported by patients. The objective was to investigate the psychometric properties of the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire and examine whether item reduction improves them.
The participants, 153 patients with MS and 104 healthy controls, completed the DYMUS and the Eating Assessment Tool 10 (EAT-10). The study consisted of factor, reliability and validity analysis of DYMUS, and item reduction, reliability, validity analysis and normative data generation for the modified DYMUS (mod-DYMUS).
The internal consistency of DYMUS was excellent (Cronbach's alpha 0.886). Test-retest reliability was good for all the items. Factor and reliability analysis, along with other psychometric features, supported item reduction. The mod-DYMUS (consisting of items 1 and 3-7) showed improved internal consistency (Cronbach's alpha 0.903) and inter-item correlation coefficients (0.558-0.657), good test-retest reliability, excellent criterion validity and improved convergent validity. Patients had significantly higher mean mod-DYMUS score than controls (P < 0.001), and dysphagic patients (EAT-10 ≥ 3) had significantly higher mod-DYMUS than non-dysphagic patients (P < 0.001). A strong positive and significant correlation was noted between the mod-DYMUS and the EAT-10 (P < 0.001). A mod-DYMUS score of 1 or higher indicates dysphagia.
Item reduction improves the psychometric properties of DYMUS. The mod-DYMUS is a valid, reliable, low-burden, screening tool for the detection of dysphagia in MS, which can enhance personalized assessment and guide management decisions that better respond to individual patients' needs.
许多多发性硬化症（MS）患者存在吞咽困难。吞咽困难与显著的发病率和死亡率相关，对生活质量有深远影响，但患者报告不足。目的是研究多发性硬化症吞咽困难（DYMUS）问卷的心理测量特性，并检验项目缩减是否能改善这些特性。
153例MS患者和104例健康对照完成了DYMUS和饮食评估工具10（EAT - 10）。该研究包括DYMUS的因子、信度和效度分析，以及修改后的DYMUS（mod - DYMUS）的项目缩减、信度、效度分析和常模数据生成。
DYMUS的内部一致性极佳（Cronbach's α系数为0.886）。所有项目的重测信度良好。因子和信度分析以及其他心理测量特征支持项目缩减。mod - DYMUS（由项目1和3 - 7组成）显示出更好的内部一致性（Cronbach's α系数为0.903）和项目间相关系数（0.558 - 0.657），良好的重测信度，出色的效标效度和更好的收敛效度。患者的mod - DYMUS平均得分显著高于对照组（P < 0.001），吞咽困难患者（EAT - 10≥3）的mod - DYMUS得分显著高于无吞咽困难患者（P < 0.001）。mod - DYMUS与EAT - 10之间存在强正相关且具有显著性（P < 0.001）。mod - DYMUS得分1或更高表明存在吞咽困难。
项目缩减改善了DYMUS的心理测量特性。mod - DYMUS是一种有效、可靠、低负担的筛查工具，用于检测MS患者的吞咽困难，可加强个性化评估并指导管理决策，更好地满足个体患者的需求。
