Development, Validity and Reliability of Dysphagia Assessment Test in Iranian Adults after Stroke

Document Type : Original Article


1 Speech and Language Pathology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran

2 Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran


Introduction: Many patients who have had strokes suffer from dysphagia which can lead to aspiration pneumonia in 20% to 25% of cases. Early assessment of dysphagia has can reduce the risk of death and the cost of medical care. The present study developed a questionnaire to assess dysphagia in adult patients who have suffered strokes and determined the validity and reliability of the content.
Methods: The phases of the study consisted of item generation, analysis of content validity and determination of reliability. To assess the content validity, the primary questionnaire was rated by five experts on swallowing disorders. Items with low scores were removed from the questionnaire. Next, 30 stroke patients were assessed using the final questionnaire and the reliability was assessed by Cronbach's alpha.
Results: The average scores of the items ranged from 0.4 to 1. Only two items were omitted because of insufficient content validity. The Cronbach's alpha was 0.71 and the standard error of deviation was 4.96, signifying that the reliability was acceptable.
Conclusion: This questionnaire has good content validity and reliability. Although it can be used for clinical assessment of stroke patients who suffer from dysphagia, the concurrent validity should be determined by comparison with to a gold standard such as videofluoroscopy.


  1. Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia. 2001;16(1):7-18. doi: 10.1007/PL00021290
  2. Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005;86(8):1516-20. doi: 10.1016/j.apmr.2004.11.049
  3. González-Fernández M, Sein MT, Palmer JB. Clinical experience using the Mann assessment of swallowing ability for identification of patients at risk for aspiration in a mixed-disease population. Am J Speech Lang Pathol. 2011;20(4):331-6. doi: 10.1044/1058-0360(2011/10-0082)
  4. Nishiwaki K, Tsuji T, Liu M, Hase K, Tanaka N, Fujiwara T. Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables. J Rehabil Med. 2005;37(4):247-51. doi: 10.1080/16501970510026999
  5. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919-24. doi: 10.1177/000348940811701210
  6. Rinkel RN, Verdonck-de Leeuw IM, Langendijk JA, van Reij EJ, Aaronson NK, Leemans CR. The psychometric and clinical validity of the SWAL-QOL questionnaire in evaluating swallowing problems experienced by patients with oral and oropharyngeal cancer. Oral Oncol. 2009;45(8):e67-71. doi:10.1016/j.oraloncology.2009.03.003
  7. Patel R. Assessment of swallowing disorders.  Swallowing–Physiology, Disorders, Diagnosis and Therapy: Springer; 2015. p. 49-60. doi: 10.1007/978-81-322-2419-8_4
  8. Wallace KL, Middleton S, Cook IJ. Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterol. 2000;118(4):678-87. doi: 10.1016/S0016-5085(00)70137-5
  9. Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the MD Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;127(7):870-6.
  10. Schindler A, Mozzanica F, Ginocchio D, Peri A, Bottero A, Ottaviani F. Reliability and clinical validity of the Italian Reflux Symptom Index. J Voice. 2010;24(3):354-8. doi: 10.1016/j.jvoice.2008.08.008
  11. Logemann JA. The evaluation and treatment of swallowing disorders. Curr Opin Otolaryngol Head Neck Surg. 1998;6(6):395-400. doi: 10.1097/00020840-199812000-00008
  12. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner DL, et al. The toronto bedside swallowing screening test (TOR-BSST) development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40(2):555-61. doi: 10.1161/STROKEAHA.107.510370
  13. DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with stroke. Arch Phys Med Rehabil. 1994;75(12):1284-6.
  14. Bergamaschi R, Minguzzi S, Amato MP, Patti F, Bonavita S, Grasso MG, et al. Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. Funct Neurol. 2009;24(3):159.
  15. Colodny N. Validation of the caregiver mealtime and dysphagia questionnaire (CMDQ). Dysphagia. 2008;23(1):47-58. doi: 10.1007/s00455-007-9094-3
  16. Mann G. MASA, the mann assessment of swallowing ability: Cengage Learning; 2002.
  17. Edmiaston J, Connor LT, Loehr L, Nassief A. Validation of a dysphagia screening tool in acute stroke patients. Am J Crit Care. 2010;19(4):357-64. doi: 10.4037/ajcc2009961
  18. Hinds N, Wiles C. Assessment of swallowing and referral to speech and language therapists in acute stroke. QJM. 1998;91(12):829-35. doi: 10.1093/qjmed/91.12.829
  19. Fraenkel JR, Wallen NE, Hyun HH. How to design and evaluate research in education: McGraw-Hill New York; 1993.