Highlights
- •DYMUS-SP has a good internal consistency and a good test-retest reliability.
- •DYMUS-SP detected three times more dysphagia than a dichotomous question.
- •DYMUS-SP can be helpful as a screening tool when combined with other measures.
Abstract
Background
Dysphagia is a common symptom in multiple sclerosis that can occur even early in the
disease course and can lead to serious complications. Early recognition and treatment
can promote comfort, safety and optimal nutritional status. Few dysphagia rating scales
are available in Spanish. The aim of this study was to translate the Dysphagia in
Multiple Sclerosis Questionnaire (DYMUS) into Spanish and to validate it.
Methods
Forward and backward translation method was used to translate the original English
version of DYMUS into Spanish. A pilot-study with 10 PwMS was carried on in order
to improve the intelligibility of the instrument, comprehensibility and content validity
of the questionnaire. The questionnaire was filled out by 100 PwMS who were asked
a dichotomous question on their swallowing (“Do you have swallowing troubles?”). Descriptive
data are presented as median and quartiles for continuous variables and frequency
and percentage for categorical ones. Internal consistency reliability was estimated
by Cronbach's alfa. Test-retest reliability was estimated by intraclass correlation
coefficient. Concurrent validity with a speech and language therapy assessment (SLT-A)
was measured with the weighted kappa statistic for the concordance for both dysphagia
type and degree categories.
Confirmatory factor analysis by means of structural equation models was used to verify
the two-factor (solids and liquids) structure of the DYMUS questionnaire. As the goodness
of fit evaluation was poor, an additional exploratory factor analysis was carried
out.
Results
Internal consistency was high. The globus sensation question and the weight loss questions
(item 3 and 10) are the least specific with dysphagia symptomatology so they are worst
correlated with the sum of the others (item-rest correlation, 0.243 and 0.248, respectively).
The test-retest reliability of the DYMUS among 40 patients using ICC was 0.75 (95%
CI 0.57 – 0.86). Concurrent validity with SLT-A was poor (weighted kappa 0.37 for
dysphagia type and 0.38 for dysphagia degree). The DYMUS questionnaire detected three
times more dysphagia (53% versus 17%) than the dichotomous question. Confirmatory
factors analysis failed to confirm the bidimensional structure (solid and liquid items)
often reported in other validation studies. The subsequent exploratory factor analysis
also identified two factors, but with poor interpretability.
Conclusion
DYMUS-SP scale is not a sufficiently useful scale to detect dysphagia in PwMS due
to the poor concurrent validity and the probable overdiagnosis of the condition; however,
it can be helpful as a screening tool when combined with other measures.
Keywords
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References
- Prevalence of dysphagia in multiple sclerosis and its related factors: systematic review and meta-analysis.Iran J. Neurol. 2018; 17 (Oct 7PMID: 31210903; PMCID: PMC6555886): 180-188
- The frequency of dysphagia and its impact on adults with multiple sclerosis based on patient-reported questionnaires.Mult. Scler. Relat. Disord. 2018; 25 (Epub 2018 Aug 8. PMID: 30118877): 227-231https://doi.org/10.1016/j.msard.2018.08.003
- Dysphagia in multiple sclerosis patients: diagnostic and evaluation strategies.Degener. Neurol. Neuromuscul. Dis. 2020; 10 (Mar 26PMID: 32273788; PMCID: PMC7114936): 15-28https://doi.org/10.2147/DNND.S198659
- Validation of the Persian version of the dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis.J. Res. Med. Sci. 2019; 24 (Jun 25PMID: 31333731; PMCID: PMC6611185): 52https://doi.org/10.4103/jrms.JRMS_248_18
- Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.Funct. Neurol. 2009; 24 (Jul-SepErratum in: Funct Neurol. 2010 Jul-Sep;25(3):124. D'Amico, Elio [corrected to D'Amico, Emanuele]. PMID: 20018144): 159-162
- ESPEN guideline clinical nutrition in neurology.Clin. Nutr. 2018; 37 (FebEpub 2017 Sep 22. PMID: 29274834): 354-396https://doi.org/10.1016/j.clnu.2017.09.003
- Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration.Clin. Nutr. 2008; 27 (DecEpub 2008 Sep 11. PMID: 18789561): 806-815https://doi.org/10.1016/j.clnu.2008.06.011
- Management of dysphagia in multiple sclerosis; current best practice.Expert. Rev. Gastroenterol. Hepatol. et al. 2019; 13 (. PMID: 30791843): 47-54https://doi.org/10.1080/17474124.2019.1544890
- Screening of dysphagia in relapsing-remitting multiple sclerosis patients in Montenegro.Neurosciences (Riyadh) Oct;. 2021; 26 (PMCID: PMC9037765): 331-338
Grasso M.G., Gamberini G., Patti F. et al., 2021. The Dysphagia in Multiple Sclerosis Questionnaire Correlates with Fiber-Optic Endoscopic Examination for Detecting Swallowing Deficits in MS. Dysphagia. Apr;36(2):192–197. doi: 10.1007/s00455-020-10119-w. Epub 2020 Apr 30.PMID: 32355992.
- Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis.Neurol. Sci. 2015; 36 (MayEpub 2015 Feb 3. PMID: 25647290): 671-681https://doi.org/10.1007/s10072-015-2067-7
- Validation of the Persian version of dysphagia in multiple sclerosis questionnaire for the assessment of dysphagia in multiple sclerosis.Iran J. Neurol. 2018; 17 (Jul 6PMID: 30886675; PMCID: PMC6420693): 99-104
- Validation of the Czech Version of the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS).Disphagia. 2022; (2022 Oct 26PMCID: PMC9607762): 1-9
- Diagnostic criteria for multiple sclerosis: 2010 revisions to the mcdonald criteria.Ann. Neurol. 2011; 69: 292-302https://doi.org/10.1002/ana.22366
- 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 (JulEpub 2018 May 10. PMID: 29778042): 62-68https://doi.org/10.1016/j.msard.2018.05.004
- Translation, cross-cultural adaptation and validation of the Portuguese version of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis.Springerplus. 2013; 2 (Jul 22PMID: 23961403; PMCID: PMC3728525): 332https://doi.org/10.1186/2193-1801-2-332
- Accuracy of the Brazilian version of the DYMUS questionnaire for the screening of oropharyngeal dysphagia in multiple sclerosis.Mult. Scler. Relat. Disord. 2021; 50 (May;Epub 2021 Feb 19. PMID: 33652231)102772https://doi.org/10.1016/j.msard.2021.102772
Scientia. Dipòsit d'Informació Digital del Departament de Salut (Generalitat de Catalunya i Col·legi de Logopedes de Catalunya), 2018. Atenció a la disfàgia orofaríngia en els diversos àmbits del sistema de salut. cientiasalut.gencat.cat/handle/11351/5694 (accessed 10th september 2021).
- Prevalence of dysphagia in a consecutive cohort of subjects with MS using fibre-optic endoscopy.Neurol. Sci. May. 2020; 41 (Epub 2019 Dec 20. PMID: 31863327): 1075-1079https://doi.org/10.1007/s10072-019-04198-3
- Screening of dysphagia by DYMUS (Dysphagia in multiple sclerosis) and SWALQoL (Swallowing quality of life) surveys in patients with multiple sclerosis.Mult. Scler. Relat. Disord. 2020; 45 (OctEpub 2020 Jul 14. PMID: 32707530)102397https://doi.org/10.1016/j.msard.2020.102397
Tenekeci, E.G., Kara, B., Çetiz, A. et al., 2016. Validity and Reliability of the Turkish Version of the Questionnaire for the Assessment of Dysphagia in Multiple Sclerosis. Noro Psikiyatr Ars. Sep 20;55(3):243–247. doi: 10.5152/npa.2016.18105. PMID: 30224871; PMCID: PMC6138226.
- Disfagia orofaríngea en pacientes afectados de esclerosis múltiple.Rev. Neurol. 2004; 39 (Oct 16-31Spanish. PMID: 15514895): 707-710
- Quality criteria were proposed for measurement properties of health status questionnaires.J. Clin. Epidemiol. 2007; 60: 34-42https://doi.org/10.1016/j.jclinepi.2006.03.012
Article info
Publication history
Published online: April 17, 2023
Accepted:
April 16,
2023
Received in revised form:
March 31,
2023
Received:
February 8,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
