Wang Jing, Chen Caixia, Qin Yuzhen, Zeng Jing, Zhang Chunhua, Wang Liugen, Li Heping, Zeng Xi
Zhengzhou University First Affiliated Hospital, Zhengzhou, China.
Zhengzhou University, Zhengzhou, China.
Ann Med. 2025 Dec;57(1):2548980. doi: 10.1080/07853890.2025.2548980. Epub 2025 Aug 20.
Oropharyngeal Dysphagia (OD) has become a public health issue and early screening has practical significance. The Standardized Swallowing Assessment (SSA) is a clinician-driven, simple, and efficient screening tool but has yet to be validated in Chinese communities.
This study aimed to cross-culturally adapt and validate the SSA in Chinese community-dwelling older adults and explore its optimal cut-off value.
The SSA was cross-culturally adapted according to a 5-stage process. Reliability included internal consistency, inter-rater reliability, and test-retest reliability. Cronbach's alpha was used to assess its internal consistency. The other reliability analyses were conducted using Pearson's correlation. Validity analysis included convergent and concurrent validity. For the convergent validity, the correlation between the SSA and Penetration-Aspiration Scale (PAS) or 10-item Eating Assessment Tool (EAT-10) was analyzed using Spearman's correlation and Mann-Whitney tests. For concurrent validity, the association between the gold standard and the SSA was analyzed using Kruskal-Wallis and Mann-Whitney tests. Receiver Operating Characteristic (ROC) analysis was used to explore the optimal cutoff value.
A total of 466 and 79 Chinese community-dwelling older adults were included in the first and second assessments, respectively. The Cronbach's coefficients for the total scale and each step were >0.7. The Pearson correlation coefficients were >0.8 for test-retest reliability ( = 79) and >0.9 for inter-rater reliability ( = 143), indicating excellent temporal stability and consistency across different raters. There were significant correlations between the SSA and both the EAT-10 ( > 0.5, < 0.001) and PAS ( > 0.4, < 0.001). There were significant differences in the SSA scores between the participants with the EAT-10 ≤ 3 and those with the EAT-10 > 3 ( < 0.001), or those with the PAS ≤ 3 and those with the PAS > 2 ( < 0.001). The Kruskal-Wallis test showed significant differences in the SSA scores across clinical severity ( = 142.388, < 0.001). The optimal cutoff value was found to be 21.0 to distinguish healthy individuals from OD patients (C-index = 0.801, sensitivity = 0.983, specificity = 0.610), and to be 28.0 to differentiate mild OD from moderate-to-severe OD (C-index = 0.875, sensitivity = 0.914, specificity = 0.736).
The SSA showed good reliability and validity among community-dwelling older adults in China, and the optimal cutoff values were 21.0 and 28.0.
口咽吞咽困难（OD）已成为一个公共卫生问题，早期筛查具有实际意义。标准化吞咽评估（SSA）是一种由临床医生主导的、简单且有效的筛查工具，但尚未在中国社区中得到验证。
本研究旨在对中国社区居住的老年人进行SSA的跨文化调适和验证，并探索其最佳截断值。
根据一个5阶段的过程对SSA进行跨文化调适。可靠性包括内部一致性、评分者间信度和重测信度。使用Cronbach's α评估其内部一致性。其他可靠性分析使用Pearson相关性进行。效度分析包括收敛效度和同时效度。对于收敛效度，使用Spearman相关性和Mann-Whitney检验分析SSA与渗透-误吸量表（PAS）或10项饮食评估工具（EAT-10）之间的相关性。对于同时效度，使用Kruskal-Wallis和Mann-Whitney检验分析金标准与SSA之间的关联。使用受试者工作特征（ROC）分析来探索最佳截断值。
第一次和第二次评估分别纳入了466名和79名中国社区居住的老年人。总量表和每个步骤的Cronbach系数均>0.7。重测信度（n = 79）的Pearson相关系数>0.8，评分者间信度（n = 143）的Pearson相关系数>0.9，表明具有出色的时间稳定性和不同评分者之间的一致性。SSA与EAT-10（r > 0.5，P < 0.001）和PAS（r > 0.4，P < 的之间均存在显著相关性。EAT-10≤3的参与者与EAT-10>3的参与者之间（P < 0.001），或PAS≤3的参与者与PAS>3的参与者之间（P < 0.001），SSA得分存在显著差异。Kruskal-Wallis检验显示，不同临床严重程度的SSA得分存在显著差异（χ² = 142.388，P < 0.001）。发现最佳截断值为21.0，以区分健康个体与OD患者（C指数 = 0.801，敏感性 = 0.983，特异性 = 0.610）；最佳截断值为28.0，以区分轻度OD与中度至重度OD（C指数 = 0.875，敏感性 = 0.914，特异性 = 0.736）。
SSA在中国社区居住的老年人中显示出良好的可靠性和效度，最佳截断值为21.0和28.0。
