title: Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation.
abstract: OBJECTIVE
  Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies. A systematic review of the literature on dysphagia-related PRO measures was performed to (1) identify all currently available measures and (2) to evaluate each for the presence of important measurement properties that would affect their applicability.
  
  
  METHODS
  MEDLINE via the PubMed interface, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument database were searched using relevant vocabulary terms and key terms related to PRO measures and dysphagia. Three independent investigators performed abstract and full text reviews. Each study meeting criteria was evaluated using an 18-item checklist developed a priori that assessed multiple domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (6) scoring and interpretation, and (7) burden and presentation.
  
  
  RESULTS
  Of 4950 abstracts reviewed, a total of 34 dysphagia-related PRO measures (publication year 1987-2014) met criteria for extraction and analysis. Several PRO measures were of high quality (MADS for achalasia, SWAL-QOL and SSQ for oropharyngeal dysphagia, PROMIS-GI for general dysphagia, EORTC-QLQ-OG25 for esophageal cancer, ROMP-swallowing for Parkinson's Disease, DSQ-EoE for eosinophilic esophagitis, and SOAL for total laryngectomy-related dysphagia). In all, 17 met at least one criterion per domain. Thematic deficiencies in current measures were evident including: (1) direct patient involvement in content development, (2) empirically justified dimensionality, (3) demonstrable responsiveness to change, (4) plan for interpreting missing responses, and (5) literacy level assessment.
  
  
  CONCLUSIONS
  This is the first comprehensive systematic review assessing developmental properties of all available dysphagia-related PRO measures. We identified several instruments with robust measurement properties in multiple diseases including achalasia, oropharyngeal dysphagia, post-surgical dysphagia, esophageal cancer, and dysphagia related to neurological diseases. Findings herein can assist clinicians and researchers in making more informed decisions in selecting the most fundamentally sound PRO measure for a given clinical, research, or quality initiative.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition.
authors.forename: D A
authors.initials: DA
authors.lastname: Patel
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition.
authors.forename: R
authors.initials: R
authors.lastname: Sharda
authors.affiliation: Vanderbilt University School of Medicine.
authors.forename: K L
authors.initials: KL
authors.lastname: Hovis
authors.affiliation: Vanderbilt University School of Medicine.
authors.forename: E E
authors.initials: EE
authors.lastname: Nichols
authors.affiliation: Department of Health Policy and the Evidence-Based Practice Center.
authors.forename: N
authors.initials: N
authors.lastname: Sathe
authors.affiliation: Departments of Urological Surgery, Health Policy, and Medicine and the Center for Surgical Quality and Outcomes Research.
authors.forename: D F
authors.initials: DF
authors.lastname: Penson
authors.affiliation: Departments of Biostatistics and Surgery and the Center for Surgical Quality and Outcomes Research.
authors.forename: I D
authors.initials: ID
authors.lastname: Feurer
authors.affiliation: Department of Health Policy and the Evidence-Based Practice Center.
authors.forename: M L
authors.initials: ML
authors.lastname: McPheeters
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition.
authors.forename: M F
authors.initials: MF
authors.lastname: Vaezi
authors.affiliation: Department of Otolaryngology and the Evidence-Based Practice Center and the Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: David O
authors.initials: DO
authors.lastname: Francis
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006306:Health Surveys / Q000379:methods / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: dysphagia; patient-reported outcome measures; systematic review