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      Patient-Reported Outcome Measures zur Erfassung der gesundheitsbezogenen Lebensqualität bei Patienten mit Stimm- und Schluckstörungen Translated title: Patient-reported outcome measures for assessing health-related quality of life in patients with voice and swallowing disorders

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          Abstract

          Standardisierte und validierte Patientenbefragungen in Form von Fragebögen haben in der HNO-Heilkunde eine zunehmende Bedeutung. Die subjektive Bewertung von Symptomen und funktionellen Einschränkungen, aber auch der gesundheitsbezogenen Lebensqualität lassen sich mit sog. Patient-Reported Outcome Measures (PROM) erfragen. Diese Erhebungsinstrumente können neben der Anamnese und den objektiven Befunden als weitere wichtige Quelle zur Qualitätssicherung einer patientenzentrierten Versorgung genutzt werden. Im deutschsprachigen Raum gibt es mittlerweile einige PROM, die gezielt die Patientenperspektive bei Stimm- und Schluckstörungen erfragen. Bei Stimmpatienten werden v. a. die folgenden Fragebögen auf Basis des Voice Handicap Index (VHI), die auch international eingesetzt werden, angewandt: VHI-30, VHI-12i, VHI-9i. Im Bereich der oropharyngealen Dysphagie werden derzeit überwiegend die deutschen Versionen des Eating Assessment Tool-10 (EAT-10), des Sydney Swallow Questionnaire, SSQ (SSQ-G), des Swallowing Quality-of-Life Questionnaire (SWAL-QoL) und des MD Anderson Dysphagia Inventory (MDADI) eingesetzt.

          Translated abstract

          Standardized and validated patient surveys in the form of questionnaires are becoming increasingly important in otorhinolaryngology. Subjective symptoms and functional limitations but also health-related quality of life are assessed with so-called patient-reported outcome measures (PROMs). Besides patient history and objective findings, these questionnaires can be applied as another important source for ensuring the quality of patient-centered care. In German-speaking countries there are now several PROMs that specifically ask for the patient perspective on voice and swallowing disorders. For patients with voice disorders the following questionnaires based on the Voice Handicap Index (VHI), which are also used internationally, are mainly applied: VHI-30, VHI-12i, and VHI-9i. In the field of oropharyngeal dysphagia, the German versions of the Eating Assessment Tool-10 (EAT-10), des Sydney Swallow Questionnaire SSQ‑G, the Swallowing Quality of Life Questionnaire (SWAL-QoL), and the MD Anderson Dysphagia Inventory (MDADI) are currently mostly used.

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          Validity and reliability of the Eating Assessment Tool (EAT-10).

          The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10). The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses. A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (+/- SD) EAT-10 score of the normal cohort was 0.40 +/- 1.01. The mean EAT-10 score was 23.58 +/- 13.18 for patients with esophageal dysphagia, 23.10 +/- 12.22 for those with oropharyngeal dysphagia, 9.19 +/- 12.60 for those with voice disorders, 22.42 +/- 14.06 for those with head and neck cancer, and 11.71 +/- 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p <0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 +/- 10.5 to 5.2 +/- 7.4 after treatment (p <0.001). The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.
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            The Voice Handicap Index (VHI)

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              Validation of the German version of the Neck Disability Index (NDI)

              Background The Neck Disability Index (NDI) is the most commonly used outcome measure for neck pain. This study aimed to determine the psychometric properties of a German version of the NDI. Cross-cultural translation and psychometric testing of the NDI were performed. Methods The 10-item NDI was translated into German and administered to 558 patients with chronic unspecific neck pain (Mean age 49.9 ± 11.4 years, 76% female). The factor structure and reliability of the NDI were assessed using factor analysis, Cronbach’s alpha, split-half reliability (Spearman-Brown coefficient), and intra-class correlation (ICC2,1). To determine convergent validity, pain intensity (visual analog scale; VAS), pain on movement (VAS), and quality of life (Short Form 36 Health Survey Questionnaire; SF-36) were correlated with the NDI. Correlation with range of motion and sensitivity to change were also assessed in a subsample of 49 patients. Results The mean NDI score was 32.75 ± 13.09. Factor analysis revealed a single factor that explained 39.8% of the variance. Cronbach’s alpha was 0.81; Spearman-Brown coefficient was 0.80; and intra-class correlation was 0.81 (95% confidence interval = 0.78, 0.83). Significant correlations were found for pain intensity (r = 0.22, p < 0.01), pain on movement (r = 0.39, p < 0.01), quality of life (r = -0.30 to -0.45, p < 0.01), and range of motion (r = -0.34, p = 0.02). Patients who reported global improvement of health after an exercise or yoga intervention showed a higher decrease on the NDI than patients who reported no global improvement (p < 0.01). Conclusions The German version of the NDI has a comparable factor structure as the original version, acceptable psychometric properties, and is sensitive to change after physical activity. Neck disability is associated with other measures of neck pain.
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                Author and article information

                Contributors
                joerg.bohlender@usz.ch
                Journal
                HNO
                HNO
                Hno
                Springer Medizin (Heidelberg )
                0017-6192
                1433-0458
                7 August 2023
                7 August 2023
                2023
                : 71
                : 9
                : 549-555
                Affiliations
                [1 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, Abteilung Phoniatrie und Klinische Logopädie, Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, Universitätsspital Zürich, , Universität Zürich, ; Frauenklinikstrasse 24, 8091 Zürich, Schweiz
                [2 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, Universität Zürich, ; Zürich, Schweiz
                Article
                1346
                10.1007/s00106-023-01346-2
                10462546
                37550492
                43216cd9-0273-45c2-a227-0131561af164
                © The Author(s) 2023

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                History
                : 6 July 2023
                Funding
                Funded by: University of Zurich
                Categories
                Leitthema
                Custom metadata
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2023

                erhebungen und fragebögen,klinische relevanz,qualität der medizinischen versorgung,gesundheitsstatus,dysphagie,surveys and questionnaires,clinical relevance,quality of health care,health status,dysphagia

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