Clinical Validity of the SWAL-QOL and SWAL-CARE Outcome Tools with Respect to Bolus Flow Measures

Abstract

The aim of this study was to quantify the association between a dysphagia-specific quality of life (SWAL-QOL) and quality of care (SWAL-CARE) questionnaire and four measures of bolus flow. Three hundred eighty-six people with oropharyngeal dysphagia completed a videofluoroscopic examination of their swallowing structure and physiology. They also completed the SWAL-QOL and SWAL-CARE surveys. Measures of bolus flow patterns for each swallow were analyzed from videofluoroscopic recordings and correlated with the SWAL-QOL and SWAL-CARE scale scores. The SWAL-QOL and SWAL-CARE scales were modestly related to the four measures of the bolus flow. The SWAL-QOL and SWAL-CARE were most related to measures of oral transit duration and total swallow duration. The SWAL-QOL and SWAL-CARE scales were least related to pharyngeal transit duration. Results were stronger for semisolid trials than for liquid trials. Results were generally weak for the Penetration Aspiration Scale. For all of the significant relationships, the greater the bolus flow severity, the worse the quality of life. The observed modest correlations suggest that patient-centered quality-of-life measures and clinician-driven bolus flow measures provide distinct yet complementary information about oropharyngeal dysphagia. Both sets of measures should be used in dysphagia effectiveness and outcomes research.