Original article| Volume 45, 102397, October 2020

Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis


      • Most of patients with MS have dysphagia and reduced swallowing related quality of life.
      • Early assessment of dysphagia is crucial for patients with MS in order to prevent aspiration pneumonia and other dysphagia-related complications.
      • An easy to score, rapid, reliable, validated and MS specific assessment tool should be used to screen dysphagia during routine clinical practice.
      • Patients with MS have documented dysphagia in SWALQoL and DYMUS questionnaires.
      • DYMUS is a MS-specific questionnaire that is well correlated to SWALQoL and it can be used as an initial screening tool in neurology clinics.



      Dysphagia is a life-threating symptom in patients with multiple sclerosis (MS) because aspiration pneumonia develops as a consequence of swallowing disorders. Dysphagia can be detected by using patient-reported outcome measures in order to prevent complications.


      To identify the dysphagia prevalence, severity, and swallowing related quality of life (QoL), by using two validated dysphagia questionnaires.


      Dysphagia in Multiple Sclerosis (DYMUS) and Swallowing Quality of Life (SWALQoL) questionnaires were collected from 64 patients with MS.


      The mean total SWALQoL score was 67.9 (±11.2) and the mean DYMUS score was 2.02 (±1.3). The highest mean SWALQoL subdomain score belonged to communication (76.7 ± 15.8), and the lowest score belonged to sleep (54.2 ± 12.2). There was a significant correlation between age and DYMUS and SWALQoL scores (r: 0.539 and r: -0.610 respectively, P < .001). Additionally, there was a significant moderate correlation between disease duration and DYMUS and SWALQoL scores (r: 0.693 and r: -0.697 respectively, P < .001). DYMUS and SWALQoL scores did not vary between males and females (P > .05). Patients with secondary progressive MS had higher DYMUS and lower SWALQoL scores (more dysphagia) than in primary progressive or relapsing-type MS.
      There was a strong, negative and statistically significant correlation between DYMUS and total SWALQoL scores (Spearman's rho: -0.862, p < .001).


      MS causes dysphagia and reduces QoL. Age, disease duration, and MS type are major factors that influence SWALQoL. DYMUS and SWALQoL are well correlated. DYMUS is an easy to answer tool that may advised for screening dysphagia in patients with MS.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • De Pauw A.
        • Dejaeger E.
        • D'Hooghe B.
        • et al.
        Dysphagia in multiple sclerosis.
        Clin. Neurol. Neurosurg. 2002; 104 (2002/07/26): 345-351
        • Printza A.
        • Kalaitzi M.
        • Bakirtzis C.
        • et al.
        Reliability and validity of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis (Greek version) and proposed modification.
        Mult. Scler. Relat. Disord. 2018; 23 (2018/05/20): 62-68
        • Pajouh S.D.
        • Moradi N.
        • Shaterzadeh Yazdi M.J.
        • et al.
        Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire.
        Mult. Scler. Relat. Disord. 2017; 17 (2017/10/23): 240-243
        • R Core Team
        R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna2013
        • Solaro C.
        • Rezzani C.
        • Trabucco E.
        • et al.
        Prevalence of patient-reported dysphagia in multiple sclerosis patients: an Italian multicenter study (using the DYMUS questionnaire).
        J. Neurol. Sci. 2013; 331 (2013/06/12): 94-97
        • Guan X.L.
        • Wang H.
        • Huang H.S.
        • et al.
        Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis.
        Neurol. Sci. 2015; 36 (2015/02/04): 671-681
        • Prosiegel M.
        Schelling A and Wagner-Sonntag E. Dysphagia and multiple sclerosis.
        Int. MS J. 2004; 11 (2004/05/06): 22-31
        • Ekberg O.
        • Hamdy S.
        • Woisard V.
        • et al.
        Social and psychological burden of dysphagia: its impact on diagnosis and treatment.
        Dysphagia. 2002; 17 (2002/04/17): 139-146
        • McHorney C.A.
        • Bricker D.E.
        • Robbins J.
        • et al.
        The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item reduction and preliminary scaling.
        Dysphagia. 2000; 15 (2000/06/06): 122-133
        • Belafsky P.C.
        • Mouadeb D.A.
        • Rees C.J.
        • et al.
        Validity and reliability of the Eating Assessment Tool (EAT-10).
        Ann. Otol. Rhinol. Laryngol. 2008; 117 (2009/01/15): 919-924
        • Bergamaschi R.
        • Rezzani C.
        • Minguzzi S.
        • et al.
        Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.
        Funct. Neurol. 2009; 24 (2009/12/19): 159-162
        • McHorney C.A.
        • Robbins J.
        • Lomax K.
        • et al.
        The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity.
        Dysphagia. 2002; 17 (2002/04/17): 97-114
        • Tenekeci E.G.
        • Kara B.
        • Cetiz A.
        • et al.
        Validity and Reliability of the Turkish Version of the questionnaire for the assessment of dysphagia in multiple sclerosis.
        Noro Psikiyatr. Ars. 2018; 55 (2016/09/20): 243-247
        • Demir N.
        • Arslan S.S.
        • Inal O.
        • et al.
        Reliability and Validity of the Turkish version of the swallow quality of life questionnaire.
        Turk. J. Physiother. R. 2016; 27 (DOI): 19-24
      1. Simko TWaV. R package "corrplot": visualization of a correlation matrix (Version 0.84, (2017).

      2. Revelle W.psych: procedures for personality and psychological research, (2019).

      3. Ligges JGaU.nortest: tests for normality, (2015).

      4. Hadley Wickham R.F., Lionel Henry and Kirill Müller. dplyr: a Grammar of data manipulation, (2019).

        • Printza A.
        • Triaridis S.
        • Kalaitzi M.
        • et al.
        Dysphagia prevalence, attitudes, and related quality of life in patients with multiple sclerosis.
        Dysphagia. 2019; (2019/11/09)
        • Ansari N.N.
        • Tarameshlu M.
        • Ghelichi L
        Dysphagia in multiple sclerosis patients: diagnostic and evaluation strategies.
        Degener. Neurol. Neuromuscul. Dis. 2020; 10 (2020/04/11): 15-28
        • Alali D.
        • Ballard K.
        • Bogaardt H
        The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires.
        Mult. Scler. Relat. Disord. 2018; 25 (2018/08/18): 227-231
        • Katz Sand I.
        Classification, diagnosis, and differential diagnosis of multiple sclerosis.
        Curr. Opin. Neurol. 2015; 28 (2015/04/19): 193-205
        • Printza A.
        • Boziki M.
        • Bakirtzis C.
        • et al.
        The modified DYMUS questionnaire is a reliable, valid and easy-to-use tool in the assessment of dysphagia in multiple sclerosis.
        Eur. J. Neurol. 2020; (2020/03/18)