PMID- 32350338 OWN - NLM STAT- MEDLINE DCOM- 20201124 LR - 20231113 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 10 IP - 1 DP - 2020 Apr 29 TI - Psychometric assessment and validation of the dysphagia severity rating scale in stroke patients. PG - 7268 LID - 10.1038/s41598-020-64208-9 [doi] LID - 7268 AB - Post stroke dysphagia (PSD) is common and associated with poor outcome. The Dysphagia Severity Rating Scale (DSRS), which grades how severe dysphagia is based on fluid and diet modification and supervision requirements for feeding, is used for clinical research but has limited published validation information. Multiple approaches were taken to validate the DSRS, including concurrent- and predictive criterion validity, internal consistency, inter- and intra-rater reliability and sensitivity to change. This was done using data from four studies involving pharyngeal electrical stimulation in acute stroke patients with dysphagia, an individual patient data meta-analysis and unpublished studies (NCT03499574, NCT03700853). In addition, consensual- and content validity and the Minimal Clinically Important Difference (MCID) were assessed using anonymous surveys sent to UK-based Speech and Language Therapists (SLTs). Scores for consensual validity were mostly moderate (62.5-78%) to high or excellent (89-100%) for most scenarios. All but two assessments of content validity were excellent. In concurrent criterion validity assessments, DSRS was most closely associated with measures of radiological aspiration (penetration aspiration scale, Spearman rank rs = 0.49, p < 0.001) and swallowing (functional oral intake scale, FOIS, rs = -0.96, p < 0.001); weaker but statistically significant associations were seen with impairment, disability and dependency. A similar pattern of relationships was seen for predictive criterion validity. Internal consistency (Cronbach's alpha) was either "good" or "excellent". Intra and inter-rater reliability were largely "excellent" (intraclass correlation >0.90). DSRS was sensitive to positive change during recovery (medians: 7, 4 and 1 at baseline and 2 and 13 weeks respectively) and in response to an intervention, pharyngeal electrical stimulation, in a published meta-analysis. The MCID was 1.0 and DSRS and FOIS scores may be estimated from each other. The DSRS appears to be a valid tool for grading the severity of swallowing impairment in patients with post stroke dysphagia and is appropriate for use in clinical research and clinical service delivery. FAU - Everton, Lisa F AU - Everton LF AD - Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK. AD - Speech and Language Therapy, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK. FAU - Benfield, Jacqueline K AU - Benfield JK AD - Vascular Medicine, Division of Medical Sciences and GEM, University of Nottingham, Royal Derby Hospital Centre, Derby, UK. FAU - Hedstrom, Amanda AU - Hedstrom A AD - Vascular Medicine, Division of Medical Sciences and GEM, University of Nottingham, Royal Derby Hospital Centre, Derby, UK. FAU - Wilkinson, Gwenllian AU - Wilkinson G AD - Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK. AD - Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK. FAU - Michou, Emilia AU - Michou E AD - GI Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medicine Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK. AD - Speech Language Pathology, Communication Disorders and Dysphagia, University of Patras, Patras, Greece. FAU - England, Timothy J AU - England TJ AUID- ORCID: 0000-0001-5330-8584 AD - Vascular Medicine, Division of Medical Sciences and GEM, University of Nottingham, Royal Derby Hospital Centre, Derby, UK. FAU - Dziewas, Rainer AU - Dziewas R AD - Department of Neurology, University Hospital Munster, Munster, Germany. FAU - Bath, Philip M AU - Bath PM AUID- ORCID: 0000-0003-2734-5132 AD - Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK. philip.bath@nottingham.ac.uk. AD - Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK. philip.bath@nottingham.ac.uk. FAU - Hamdy, Shaheen AU - Hamdy S AUID- ORCID: 0000-0001-9640-7427 AD - GI Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medicine Sciences, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PT - Validation Study DEP - 20200429 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 SB - IM MH - Aged MH - *Deglutition Disorders/etiology/pathology/physiopathology/psychology MH - Female MH - Humans MH - Male MH - Middle Aged MH - Psychometrics MH - *Stroke/complications/pathology/physiopathology MH - United Kingdom PMC - PMC7190822 COIS- Phagenesis Ltd funded the STEPS and PHAST-TRAC trials. P.M. Bath is Stroke Association Professor of Stroke Medicine and a NIHR Senior Investigator, and undertakes consultancy work for Phagenesis. S. Hamdy is Professor of Neurogastroenterology and a board director and CSO of Phagenesis and hold stocks/shares in the company. R. Dziewas is a Professor of Neurology: no competing interests. T. England is a Clinical Associate Professor at the University of Nottingham: no competing interests. E. Michou, L. Everton, J. Benfield, A. Hedstrom, G. Wilkinson: no competing interests. EDAT- 2020/05/01 06:00 MHDA- 2020/11/25 06:00 PMCR- 2020/04/29 CRDT- 2020/05/01 06:00 PHST- 2020/01/17 00:00 [received] PHST- 2020/03/30 00:00 [accepted] PHST- 2020/05/01 06:00 [entrez] PHST- 2020/05/01 06:00 [pubmed] PHST- 2020/11/25 06:00 [medline] PHST- 2020/04/29 00:00 [pmc-release] AID - 10.1038/s41598-020-64208-9 [pii] AID - 64208 [pii] AID - 10.1038/s41598-020-64208-9 [doi] PST - epublish SO - Sci Rep. 2020 Apr 29;10(1):7268. doi: 10.1038/s41598-020-64208-9.