Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
Speech and Language Therapy, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
Sci Rep. 2020 Apr 29;10(1):7268. doi: 10.1038/s41598-020-64208-9.
Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation information. Multiple approaches were taken to validate the DSRS, including concurrent- and predictive criterion validity, internal consistency, inter- and intra-rater reliability and sensitivity to change. This was done using data from four studies involving pharyngeal electrical stimulation in acute stroke patients with dysphagia, an individual patient data meta-analysis and unpublished studies (NCT03499574, NCT03700853). In addition, consensual- and content validity and the Minimal Clinically Important Difference (MCID) were assessed using anonymous surveys sent to UK-based Speech and Language Therapists (SLTs). Scores for consensual validity were mostly moderate (62.5-78%) to high or excellent (89-100%) for most scenarios. All but two assessments of content validity were excellent. In concurrent criterion validity assessments, DSRS was most closely associated with measures of radiological aspiration (penetration aspiration scale, Spearman rank rs = 0.49, p < 0.001) and swallowing (functional oral intake scale, FOIS, rs = -0.96, p < 0.001); weaker but statistically significant associations were seen with impairment, disability and dependency. A similar pattern of relationships was seen for predictive criterion validity. Internal consistency (Cronbach's alpha) was either "good" or "excellent". Intra and inter-rater reliability were largely "excellent" (intraclass correlation >0.90). DSRS was sensitive to positive change during recovery (medians: 7, 4 and 1 at baseline and 2 and 13 weeks respectively) and in response to an intervention, pharyngeal electrical stimulation, in a published meta-analysis. The MCID was 1.0 and DSRS and FOIS scores may be estimated from each other. The DSRS appears to be a valid tool for grading the severity of swallowing impairment in patients with post stroke dysphagia and is appropriate for use in clinical research and clinical service delivery.
脑卒中后吞咽困难（PSD）较为常见，且与不良预后相关。《吞咽困难严重程度分级量表》（DSRS）用于临床研究，可根据液体和饮食的改变以及喂养的监督要求来分级吞咽困难的严重程度，但该量表的验证信息有限。本研究通过四项涉及急性脑卒中伴吞咽困难患者使用咽电刺激的研究、一项个体患者数据荟萃分析和未发表的研究（NCT03499574、NCT03700853），采用同时和预测标准效度、内部一致性、观察者间和观察者内信度以及对变化的敏感性等多种方法对 DSRS 进行了验证。此外，还通过向英国言语治疗师（SLTs）发送匿名调查评估了共识和内容效度以及最小临床重要差异（MCID）。对于大多数情况，共识效度的评分大多为中度（62.5-78%）至高度或优秀（89-100%）。除了两项内容效度评估外，其余评估均为优秀。在同时的标准效度评估中，DSRS 与放射学吸入（渗透吸入量表，Spearman 秩 rs=0.49，p<0.001）和吞咽（功能性口腔摄入量表，FOIS，rs=-0.96，p<0.001）的测量指标最为密切相关；与损伤、残疾和依赖性的相关性虽然较弱，但仍具有统计学意义。预测标准效度也呈现出类似的关系。内部一致性（克朗巴赫α）为“良好”或“优秀”。观察者间和观察者内的可靠性大多为“优秀”（组内相关系数>0.90）。DSRS 对康复过程中的阳性变化敏感（中位数：基线时为 7、4 和 1，分别在 2 和 13 周时），在一项已发表的荟萃分析中，对电刺激咽肌的干预也敏感。MCID 为 1.0，DSRS 和 FOIS 评分可以相互估计。DSRS 似乎是一种评估脑卒中后吞咽困难患者吞咽障碍严重程度的有效工具，适用于临床研究和临床服务。
