Psychometric validation of the Center for Epidemiological Studies Depression Scale in Head and Neck Cancer patients.

OBJECTIVE: The Center for Epidemiological Studies Depression Scale (CES-D) is a 20-item tool developed to screen for depression in the general population. To psychometrically evaluate and validate the CES-D scale for use in head and neck cancer (HNC) patients. METHODS: The CES-D was applied to 130 subjects at onset of radiation treatment and 3-months following treatment. Analysis was conducted via face and content validity using two expert raters, internal consistency was applied using Cronbach's alpha, test retest reliability comparing baseline to 3-month application, concurrent validity was performed against the FACT-H&N and Pain Disability Index, construct validity was conducted via exploratory factor analysis. RESULTS: The sample was predominantly male receiving chemo radiation. Face validity was strong (α = 0.85). Significant difference was found in the mean score between depressed (CES-D cut point ≥ 16) vs. non-depressed (t = -15.84, p = .00) (95% CI = -17.18, -13.33). Internal consistency of the scale was high (α = 0.84). Test retest reliability (p < .001) showed moderate-strong correlations (0.51), however was not sensitive to change in this sample across the study time period. Concurrent validity was strong (r = -0.77, 0.51). Factor analysis at baseline explained 54.92% of variance, with 3 distinct factors; depressed affect, somatic/retarded activity, and positive affect. In contrast to general populations, the factor 'disturbed interpersonal skill' was not retained. CONCLUSION: Results confirm the reliability and validity of the CES-D as a measure of depression in HNC populations. Proposed cut off scores remain stable but scale responsiveness suggests caution when evaluating change over time in this population.

Prevalence of and Risk Factors for Dysphagia in the Community Dwelling Elderly: A Systematic Review.

OBJECTIVES: This review clarifies current information regarding the prevalence of and risk factors associated with dysphagia (swallowing disorders) in the community dwelling elderly (CDE). A better understanding of prevalence and characteristics of dysphagia in the CDE will help to determine the scope of this problem. Understanding the scope of dysphagia is a critical first step towards early identification, management, and prevention of dysphagia related morbidities in the CDE. METHODS: Studies identified from multiple electronic databases (MEDLINE (Pubmed), PsychInfo, Google Scholar, EBSCO, PROQUEST, Web of Science and WorldCat dissertations and theses) evaluating prevalence and risk factors for dysphagia in the CDE were reviewed. Data from all eligible studies were abstracted by the first author and independently reviewed by two raters, using the Newcastle-Ottawa scale (NOS). RESULTS: 15 studies (n = 9947 participants) were eligible for inclusion. Studies included were all observational: 14 cross-sectional and 1 prospective cohort. Significant heterogeneity was observed in methodology among studies of dysphagia in the CDE. The average NOS study quality rating was 4.54 points (SD: 0.9), with a mode of 4 points (range 3-6). Only 6 of the 15 studies were identified as high quality research studies, with a mean of 5.33 points (SD: 0.47). Among reviewed studies, the prevalence of swallowing difficulty in the CDE ranged from 5% to 72%. However, the average prevalence of dysphagia estimated from the 6 high quality studies was 15%. Reported risk factors associated with dysphagia include advancing age; history of clinical disease; and physical frailty, including reduced ability to carry out activities of daily living. CONCLUSION: Research on dysphagia in CDE is modest and consists mostly of observational studies with diverse methodology. However, prevalence rate of 15% from the high quality research suggests a significant public health impact of this impairment. Identification of specific risk factors that cause dysphagia in the CDE is premature, given the rigor of published studies. Future research efforts should focus on developing a valid definition and assessment of dysphagia in this population before clarifying causative risk factors.

Hyoid and laryngeal excursion kinematics - magnitude, duration and velocity - changes following successful exercise-based dysphagia rehabilitation: MDTP.

Variability in magnitude of deglutitional hyolaryngeal excursion in patients with dysphagia suggests that it does not adequately represent the kinematics of swallowing difficulties or recovery following rehabilitation. On the other hand, reduced hyolaryngeal excursion velocity has been reported in patients with dysphagia. While increased movement velocity often accompanies clinical and functional recovery in many diseases, velocity changes in swallowing-related movement following dysphagia therapy have not been well studied. This study evaluated changes in hyoid and laryngeal excursion (magnitude, duration and velocity) before and following successful dysphagia therapy to provide a more comprehensive representation of improvement to swallowing kinematics in patients who have experienced successful rehabilitation. A secondary analysis of case series data was completed. Eight patients with severe, chronic dysphagia completed a standard course of an exercise-based dysphagia treatment programme (McNeill dysphagia therapy program, MDTP). Pre- and post-treatment, kinematic aspects of swallowing were evaluated for thin liquid, thick liquid and pudding swallows. Maximum hyoid and laryngeal excursion magnitude and excursion duration were measured. Excursion velocities were calculated from excursion magnitude and duration measures. Successful treatment for dysphagia facilitated increased hyolaryngeal excursion magnitude, duration and velocity. These changes were most prominent for the hyoid and most often observed with thin liquids. By examining hyoid and laryngeal excursion velocity in patients who have experienced successful dysphagia rehabilitation, this study demonstrated the value of evaluating spatial and temporal aspects of swallowing kinematics in a single measure for a more comprehensive representation of positive changes underlying functional recovery.