Reliability and validity of the Eating Assessment Tool-10 (Greek adaptation) in neurogenic and head and neck cancer-related oropharyngeal dysphagia

  • Athanasia Printza
  • Athanasios Kyrgidis
  • Elena Pavlidou
  • Stefanos Triaridis
  • Jannis Constantinidis
Head and Neck
  • 5 Downloads

Abstract

Purpose

Dysphagia is a symptom associated with significant morbidity and mortality, with profound impact on physical ability and quality of life. Many questionnaires have been used to assess patient-reported dysphagia, but issues related to developmental and measurement properties affect their wide applicability. The purpose of this study was to assess the validity and reliability of the Eating Assessment Tool-10 (EAT-10, Greek adaptation) in neurogenic and head and neck cancer-related dysphagia.

Methods

The study consisted of: item generation in the Greek language, internal consistency and reliability analysis, normative data generation, and validity analysis. Data were collected prospectively from 421 participants: 144 asymptomatic subjects, 146 patients with dysphagia, and 131 patients with dysphagia-related diagnoses. Validity was assessed by comparing scores of healthy and dysphagic participants, by comparing pre- and post-treatment scores, and by correlating the Greek-EAT-10 with fibreoptic endoscopic evaluation of swallowing (FEES).

Results

The mean participants’ age was 52.85 years (ranging from 18 to 85 years). All questionnaires were completed in less than 3 min. The overall internal consistency (assessed with Cronbach’s alpha) was 0.963. The test–retest reliability was excellent with Spearman’s rho ranging from 0.937 to 1. Dysphagic patients had a significantly higher score compared to healthy participants (p < 0.001). The mean EAT-10 improved significantly after treatment (Wilcoxon signed rank, p < 0.001). The Greek-EAT-10 and FEES scores were significantly correlated (Spearman’s rho = 0.69).

Conclusions

The EAT-10 is a valid, reliable, symptom-specific tool for the assessment of dysphagia, easily self-administered, and practical for clinical use.

Keywords

Dysphagia Swallowing Self-assessment questionnaire Validity Outcome Quality of life 

Notes

Acknowledgements

The authors thank for assistance with data collection Professors Nikolaos Grigoriadis, MD, Multiple Sclerosis Clinic, Evaggelos Pavlou, MD, Neuromuscular Disorders Unit, and Vasilios Liakopoulos, MD, Chronic Kidney Failure Unit. Professor Athanasia Printza, MD, PhD had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors Athanasia Printza, MD, MSc, PhD, Athanasios Kyrgidis, MD, MSc, PhD, Elena Pavlidou, MSc, Stefanos Triaridis, MD, MSc, PhD, and Jannis Constantinidis, MD, PhD, declare that there is no conflict of interest related to this paper.

Ethical approval

This study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments.

References

  1. 1.
    Locke GR 3rd, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3rd (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 112(5):1448–1456CrossRefPubMedGoogle Scholar
  2. 2.
    Wilkins T, Gillies R, Thomas A, Wagner P (2007) The prevalence of dysphagia in primary care patients: a HamesNet Research Network study. J Am Board Fam Med 20(2):144–150CrossRefPubMedGoogle Scholar
  3. 3.
    Eslick G, Talley N (2008) Dysphagia: epidemiology, risk factors and impact on quality of life—a population-based study. Aliment Pharmacol Ther 27:971–979CrossRefPubMedGoogle Scholar
  4. 4.
    Lindgren S, Janzon L (1991) Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia 6(4):187–192CrossRefPubMedGoogle Scholar
  5. 5.
    Bloem B, Lagaay A, van Beek W, Haan J, Roos R, Wintzen A (1990) Prevalence of subjective dysphagia in community residents aged over 87. BMJ 300:721–722CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mann G, Hankey G, Cameron D (2000) Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovasc Dis 10(5):380–386CrossRefPubMedGoogle Scholar
  7. 7.
    Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R (2005) Dysphagia after stroke: incidence, diagnosis, and pulmonary complications Stroke. 36(12):2756–2763Google Scholar
  8. 8.
    Takizawa C, Gemmell E, Kenworthy J, Speyer R (2016) A Systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson’s disease, Alzheimer’s disease, head injury, and pneumonia dysphagia. 31(3):434–441Google Scholar
  9. 9.
    Kalf J, de Swart B, Bloem B, Munneke M (2012) Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord 18(4):311–315CrossRefPubMedGoogle Scholar
  10. 10.
    Calcagno P, Ruoppolo G, Grasso MG, De Vincentiis M, Paolucci S (2002) Dysphagia in multiple sclerosis—prevalence and prognostic factors. Acta Neurol Scand 105:40–43CrossRefPubMedGoogle Scholar
  11. 11.
    Guan X, Wang H, Huang H, Meng L (2015) Prevalence of dysphagia in multiple sclerosis: a systematic review and meta-analysis. Neurol Sci 36(5):671–681CrossRefPubMedGoogle Scholar
  12. 12.
    de Sa J, Airas L, Bartholome E et al (2011) Symptomatic therapy in multiple sclerosis: a review for a multimodal approach in clinical practice. Ther Adv Neurol Disord 4(3):139–168CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Belafsky P, Mouadeb D, Rees C et al (2008) Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 117(12):919–924CrossRefPubMedGoogle Scholar
  14. 14.
    Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P (2002) Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 17(2):139–146CrossRefPubMedGoogle Scholar
  15. 15.
    Timmerman AA, Speyer R, Heijnen B, Klijn-Zwijnenberg I (2014) Psychometric characteristics of health-related quality of life questionnaires in oropharyngeal dysphagia. Dysphagia 29(2):183–198CrossRefPubMedGoogle Scholar
  16. 16.
    Etges C, Scheeren B, Gomes E, Barbosa L (2014) Screening tools for dysphagia: a systematic review. CoDAS 26(5):343–349CrossRefPubMedGoogle Scholar
  17. 17.
    Patel DA, Sharda R, Hovis KL et al (2017) Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus 1(30(5)):1–23CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Chen A, Frankowski R, Bishop-Leone J et al (2001) The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M.D. Anderson Dysphagia Inventory. Arch Otolaryngol Head Neck Surg 127(7):870–876PubMedGoogle Scholar
  19. 19.
    Govender R, Lee MT, Drinnan M et al (2016) Psychometric evaluation of the swallowing outcomes after laryngectomy (SOAL) patient-reported outcome measure. Head Neck 38(Suppl1):E1639–1645CrossRefPubMedGoogle Scholar
  20. 20.
    Bergamaschi R, Rezzani C, Minguzzi S et al (2009) Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. Funct Neurol 24(3):159–162PubMedGoogle Scholar
  21. 21.
    Schindler A, Mozzanica F, Monzani A et al (2011) Reliability and validity of the Italian Eating Assessment Tool. Ann Otol Rhinol Laryngol 122:717–724CrossRefGoogle Scholar
  22. 22.
    Nalbadian M, Vasilios N, Nikolaou A, Themelis C, Kouloulas A, Vital V (2010) Psychometric properties of the EORTC head and neck-specific quality of life questionnaire in disease-free Greek patients with cancer of pharynx and larynx. Qual Life Res 19:761–768CrossRefPubMedGoogle Scholar
  23. 23.
    Kyrgidis A, Triaridis S, Kontos K et al (2012) Quality of life in breast cancer patients with bisphosphonaterelated osteonecrosis of the jaws and patients with head and neck cancer: a comparative study using the EORTC QLQ-C30 and QLQ-HN35 questionnaires. Anticancer Res 32:3527–3534PubMedGoogle Scholar
  24. 24.
    Printza A, Kyrgidis A, Oikonomidou E, Triaridis S (2011) Assessing laryngopharyngeal reflux symptoms with the reflux symptom index: validation and prevalence in the Greek population. Otolaryngol Head Neck Surg 145(6):974–980CrossRefPubMedGoogle Scholar
  25. 25.
    Ward EC, Bishop B, Frisby J, Stevens M (2002) Swallowing outcomes following laryngectomy and pharyngolaryngectomy. Arch Otolaryngol Head Neck Surg 128(2):181–186CrossRefPubMedGoogle Scholar
  26. 26.
    Burnip E, Owen SJ, Barker S, Patterson JM (2013) Swallowing outcomes following surgical and non-surgical treatment for advanced laryngeal cancer. J Laryngol Otol 127(11):1116–1121CrossRefPubMedGoogle Scholar
  27. 27.
    Vesterinen M, Ruokonen H, Furuholm J, Honkanen E, Meurman JH (2012) Clinical questionnaire study of oral health care and symptoms in diabetic vs. non-diabetic predialysis chronic kidney disease patients. Clin Oral Investig 16(2):559–563CrossRefPubMedGoogle Scholar
  28. 28.
    Pinto AR, Silva RG, Pinato L (2016) Oropharyngeal swallowing in chronic renal failure. Codas 28(1):71–76CrossRefPubMedGoogle Scholar
  29. 29.
    Guillemin F, Bombardier C, Beaton D (1993) Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 46(12):1417–1432CrossRefPubMedGoogle Scholar
  30. 30.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL (1996) A penetration-aspiration scale. Dysphagia 11:93–98CrossRefPubMedGoogle Scholar
  31. 31.
    Speyer R, Cordier R, Kertscher B, Heijnen BJ (2014) Psychometric properties of questionnaires on functional health status in oropharyngeal dysphagia: a systematic literature review. Biomed Res Int.  https://doi.org/10.1155/2014/ PubMedPubMedCentralGoogle Scholar
  32. 32.
    Dwivedi RC, Chisholm EJ, Khan AS, Harris NJ, Bhide SA, St Rose S, Kerawala CJ, Clarke PM, Nutting CM, Rhys-Evans PH, Harrington KJ, Kazi R (2012) An exploratory study of the influence of clinico-demographic variables on swallowing and swallowing-related quality of life in a cohort of oral and oropharyngeal cancer patients treated with primary surgery. Eur Arch Otorhinolaryngol 269(4):1233–1239CrossRefPubMedGoogle Scholar
  33. 33.
    Georgopoulos VC, Perdikogianni M, Mouskenteri M et al (2017) Cross-cultural adaptation and validation of the SWAL-QoL questionnaire in Greek. Dysphagia.  https://doi.org/10.1007/s00455-017-9837-8 (Epub ahead of print) PubMedGoogle Scholar
  34. 34.
    Möller R, Safa S, Östberg P (2016) Validation of the Swedish translation of Eating Assessment Tool (S-EAT-10). Acta Otolaryngol 136(7):749–753CrossRefPubMedGoogle Scholar
  35. 35.
    Farahat M, Mesallam TA (2015) Validation and cultural adaptation of the Arabic version of the Eating Assessment Tool (EAT-10). Folia Phoniatr Logop 67(5):231–237CrossRefPubMedGoogle Scholar
  36. 36.
    Wang R, Xiong X, Zhang C, Fan Y (2015) Reliability and validity of the Chinese Eating Assessment Tool (EAT-10) in evaluation of acute stroke patients with dysphagia. Zhong Nan Da Xue Xue Bao Yi Xue Ban 40(12):1391–1399PubMedGoogle Scholar
  37. 37.
    Demir N, Serel Arslan S, İnal Ö, Karaduman AA (2016) Reliability and validity of the Turkish Eating Assessment Tool (T-EAT-10). Dysphagia 31(5):644–649CrossRefPubMedGoogle Scholar
  38. 38.
    Gonçalves MI, Remaili CB, Behlau M (2013) Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool—EAT-10. Codas 16(25):601–604CrossRefGoogle Scholar
  39. 39.
    Baijens LW, Clavé P, Cras P et al (2016) European Society for Swallowing Disorders—European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome. Clin Interv Aging 7(11):1403–1428CrossRefGoogle Scholar
  40. 40.
    de Lima Alvarenga EH, Dall’Oglio GP, Murano EZ, Abrahão M (2017) Continuum theory: presbyphagia to dysphagia? Functional assessment of swallowing in the elderly. Eur Arch Otorhinolaryngol.  https://doi.org/10.1007/s00405-017-4801-7 (Epub ahead of print) PubMedGoogle Scholar
  41. 41.
    Cheney DM, Siddiqui MT, Litts JK, Kuhn MA, Belafsky PC (2014) The ability of the 10-item Eating Assessment Tool (EAT-10) to predict aspiration risk in persons with dysphagia. Ann Otol Rhinol Laryngol 124(5):351–354CrossRefPubMedGoogle Scholar
  42. 42.
    Regan J, Lawson S, De Aguiar V (2017) The Eating Assessment Tool-10 predicts aspiration in adults with stable chronic obstructive pulmonary disease. Dysphagia.  https://doi.org/10.1007/s00455-017-9822-2. (Epub ahead of print) Google Scholar
  43. 43.
    Arrese LC, Carrau R, Plowman EK (2017) Relationship between the Eating Assessment Tool-10 and objective clinical ratings of swallowing function in individuals with head and neck cancer. Dysphagia 32(1):83–89CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.1st Otolaryngology Department, Medical Department, School of Health SciencesAristotle University of ThessalonikiThessalonikiGreece

Personalised recommendations