Patient-Reported Outcome Measures for Dysphagia in Head and Neck Cancer: A Systematic Review and Appraisal of Content Validity and Internal Structure
Head & Neck
Manduchi, B., Che, Z., et al. (2024).
Head & Neck, 46(4), 951-972.
This systematic review explores the content validity and internal structure of various patient-reported outcome measures (PROMs) for individuals with dysphagia secondary to head and neck cancer (HNC). This review uses the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards for psychometric measurement.
Peterborough K. M. Hunter Charitable Foundation (Canada); Canada Excellence Research Chairs
From database inception to Februrary 2023
Studies of any design
94 studies investigating 36 PROMs
36 PROMs were identified for use in individuals with dysphagia secondary to HND. However, the Swallowing Outcome After Laryngectomy (SOAL) was the only measure to meet COSMIN standards for both sufficient content validity and internal structure (Cronbach's alpha [α]= 0.91-0.96). Additional findings included:<br />
<ul>
<li><span style="color: #333333;">The other included PROMs did not demonstrate both sufficient content validity and sufficient internal structure (α = 0.50-0.99).</span></li>
<li><span style="color: #333333;">Six dysphagia-specific PROMs demonstrated sufficient content validity only: the 5 FACE-Q Head and Neck Cancer scales designed for patients' status-post surgery (i.e., Eating, Eating Distress, Drooling, Oral Competence, Swallowing) and the Head and Neck Cancer Survivors' Assessment of Mealtimes.</span></li>
<li><span style="color: #333333;">Three dysphagia-specific PROMs demonstrated sufficient internal consistency only: the Sydney Swallow Questionnaire (</span><span style="color: #333333;">α</span><span style="color: #333333;"> = 0.95), the Swallowing Quality of Life Questionnaire (</span><span style="color: #333333;">α</span><span style="color: #333333;"> = 0.97; α of subscales = 0.69-0.96), and the Mini M. D. Anderson Dysphagia Inventory (</span><span style="color: #333333;">α</span><span style="color: #333333;"> = 0.90).</span></li>
<li><span style="color: #333333;">Two generic PROMs demonstrated sufficient content validity only: the revised European Organisation for Research and Treatment of Cancer Quality of Life Head and Neck Module (EORTC QLQ-H&N43) and the Nasopharyngeal Subscale from the Functional Assessment of Cancer Therapy.</span></li>
<li><span style="color: #333333;">One generic PROM, the Head and Neck Cancer Inventory, demonstrated sufficient structural validity only.</span></li>
</ul>
<span style="color: #333333;">Of note, 24 of the included measures were unable to be evaluated according to the COSMIN standard. Additional limitations of this review include a lack of high quality evidence and the lack of inclusion of 13 potentially eligible PROMs due to an inability to contact the PROM authors. </span>
