Reliability And Validity And Clinical Practice Of The Chinese Version Of M.D Anderson Dysphagia Inventory

Background Dysphagia or swallowing dysfunction is defined as difficulty in having food from mouth to stomach. It’s very common that patients with head and neck cancer have signs and symptoms of swallowing problems, which is known to be present in up to50%-75%. Dysphagia can lead to dehydration and malnutrition as well as an increased risk of aspiration pneumonia, even death due to aspiration. Most negatively impact patients’ quality of life.With the purpose of evaluating the severity of dysphagia and its impact on patients quality of life(QOL), there are a few of head and neck cancer general measures which have limited number of items specifically related to swallowing function.Head and neck-specific measures,less affected by co-morbid illness,may be more precise and are usually more sensitive to clinical change.Up to now,only the M.D Anderson Dysphagia Inventory(MDADI) was designed specifically for evaluating the impact of dysphagia on the QOL of patients with head and neck cancer and its psychometric characteristics is well known and of sufficiently high quality. This study is to provide additional validity tests to determine the applicability in the Chinese head and neck cancer patients with dysphagia.Objective To translates the M.D Anderson Dyshagia Inventory (MDADI) into Chinese and test the reliability and validity of the Chinese version of MDADI with the samples in Chinese mainland. Analyze the feasibility of the scale and provide a proper instrument for better understanding of the impact of treatment of head and neck cancer on swallowing and of swallowing difficulty on patients’QOL.Methods Firstly, agreed and guided by Chen, the principal researcher of MDADI, MDADI was translated and adapted to Chinese according to west scale revising and evaluating procedure, this process were divided into forward-translation, back-translation, cultural adjusting and psychometric evaluation. Secondly, one hundred and twelve head and neck cancer patients’ with dysphagia were recruited and completed the MDADI and the Functional assessment of cancer of therapy-head and neck(FACT-H&N).Researchers completed the Performance Status Scale for Head&Neck Cancer Patients (PSS-HN) for each patient. Item-analysis were conducted for evaluating item discrimination internal reliability and test-retest for reliability; Convergent and discriminate validity were assessed by correlations between MDADI and FACT-H&N. Construct validity was also evaluated by factor analysis; Known-group validity was examined and statistically tested.Pearson correlation between MDADI and PSS-H&N demonstrated the criterion-related validity. SPSS16.0were used for to analyze the descriptive statistic, t test, F test and so on.Results (1) Translation of the MDADI from English to Chinese were performed with slight modifications to maintain semantic equivalence such that some words were substituted for others with the same meaning in order to achieve better communication. Results of psychometric indexes shows as follows:(2)Items discrimination:the results of t-test between items in high score group and items in low score group demonstrated most of items of the scale had discrimination. The internal consistency reliability of the MDADI was calculated using the Cronbach a coefficient. The Cronbach a coefficient of the MDADI total score was0.902; Test-retest reliability coefficients of the subscales ranged from0.662to863. The content validity of the scale was0.940.Spearman correlation coefficients between the MDADI subscales and the FACT-H&N subscales showed the convergent and discriminate validity; Factor analysis demonstrated that this scale had four subscales and the factors could explain60.673%of the total variance, items are not properly classified and are different from the original appraisal; The MDADI subscales were also sensitive to disease severity as measured by different food textures and follow-up time. Pearson correlation coefficients between the total scores of MDADI and PSS-H&N demonstrated the criterion-related validity was0.725.(4)The total score of the MDADI was significantly different from age,treatment, duration of follow-up and food texture(P<0.05).Conclusions the Chinese version of MDADI was easy to understand and well accepted by patients.When assessing the validity and reliability of the Chinese version of the MDADI, most of psychometric properties have been adequately met. So it’s recommended that the Chinese version of MDADI can be applicable to the assessment of the swallowing-related quality of life.