Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
Department of Speech and Language Therapy, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2024 Nov;281(11):5885-5897. doi: 10.1007/s00405-024-08884-7. Epub 2024 Aug 6.
Swallowing disorders are highly interrelated with increased morbidity and mortality rates; therefore, early detection is crucial. Most screening tools rely on subjective observation, thus making objective assessment tools more vital. Timed Water Swallowing Test (TWST) is a screening tool used in the field providing quantitative data. This study aimed to investigate the swallowing parameters in a wide age range by using TWST and to expand the already existing normative data pool accordingly. It is also aimed to examine the reliability of the TWST and assess its validity in stroke survivors.
This study had a cross-sectional design. TWST carried out simultaneously along with surface EMG and laryngeal sensor on 196 healthy subjects aged 10 to 80 for normative data. Also, TWST carried out 30 patients having a history of recent stroke. Test-retest and inter-rater scoring analysis were used for reliability purposes, while Gugging Swallowing Screen (GUSS) test was used for validity purposes. Additionally, the correlations between the participants' TWST scores and GUSS scores were examined using the Spearman correlation coefficient.
The normative TWST data of healthy participants are tabulated and presented and their average swallowing capacity was found 13.73 ml/s. Furthermore, the mean swallowing capacity of stroke survivors was found 4.61 ml/s. As a result of validity analyses, a statistically strong and significant relationship was found between GUSS and TWST parameters (r = 0.775, p < 0.001). Intraclass correlation coefficient (ICC) and correlation values were found between moderate to good agreement between test-retest measurement (ICC = 0.563 to 0.891, p < 0.05). Also, the agreement between the raters was found to be significant (ICC = 0.949 to 0.995, p < 0.05).
TWST is a valid and reliable screening tool to evaluate dysphagia on given population. Although the test's performance on healthy individuals is adequate, more research is still needed to confirm that it can be used as a screening tool for stroke.
吞咽障碍与发病率和死亡率的升高高度相关；因此，早期发现至关重要。大多数筛查工具依赖于主观观察，因此客观评估工具更为重要。定时饮水吞咽测试（TWST）是一种在现场使用的筛查工具，可提供定量数据。本研究旨在通过 TWST 研究广泛年龄段的吞咽参数，并相应扩展现有的正常数据池。还旨在检查 TWST 的可靠性，并评估其在中风幸存者中的有效性。
本研究采用横断面设计。TWST 与表面肌电图和喉部传感器同时对 196 名年龄在 10 至 80 岁的健康受试者进行，以获取正常数据。此外，还对 30 名有近期中风病史的患者进行了 TWST。测试-重测和评分者间分析用于可靠性目的，而 Gugging 吞咽筛查（GUSS）测试用于有效性目的。此外，使用 Spearman 相关系数检查参与者的 TWST 评分和 GUSS 评分之间的相关性。
列出并呈现了健康参与者的 TWST 正常数据，他们的平均吞咽能力为 13.73ml/s。此外，中风幸存者的平均吞咽能力为 4.61ml/s。有效性分析结果表明，GUSS 和 TWST 参数之间存在统计学上强而显著的关系（r=0.775，p<0.001）。组内相关系数（ICC）和相关值表明，测试-重测测量之间存在中度至良好的一致性（ICC=0.563 至 0.891，p<0.05）。评分者之间的一致性也很显著（ICC=0.949 至 0.995，p<0.05）。
TWST 是一种有效的、可靠的筛查工具，可用于评估特定人群的吞咽障碍。尽管该测试在健康个体中的表现令人满意，但仍需要更多的研究来证实它可作为中风的筛查工具。
