Jiin‑Ling Jianga, Jia‑Lun Yub, Jen‑Hung Wangc, Yao‑Yi Wangd, Wan‑Hsiang Wangb*
aDepartment of Nursing, Tzu Chi University, Hualien, Taiwan, bDepartment of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, cDepartment of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, dDepartment of Rehabilitation Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Objective: The purpose of this study was to validate a Chinese version of the modified Standardized Swallowing Assessment (SSA) instrument used by nurses in stroke patients with dysphagia and explore the feasibility of the simplified instrument. Materials and Methods: This study involved a cross‑sectional design. Nurses independently applied the modified SSA to 127 patients with stroke before a complete dysphagia evaluation conducted by a speech–language pathologist. Factor analysis of eight dysphagia variables in the modified SSA was performed to evaluate construct validity. The accuracy of the screening instrument was assessed through receiver operating characteristic (ROC) analysis. Results: The comprehensive swallowing assessment revealed that 49.6% of the stroke patients had dysphagia. The modified SSA had an acceptable internal consistency coefficient. The inter‑rater agreement between nurses using the modified SSA showed a Kappa coefficient of 0.509. All items had a communality loading of >0.5, and two factors accounted for 73.89% of the response variance. The area under the ROC curve was 0.79 (95% confidence interval: 0.71–0.87). The sensitivity and specificity derived for dysphagia detection were satisfactory according to the results obtained from the original 8‑item and simplified 6‑item scales (sensitivities = 82.50% and 81.00% and specificities = 59.40% and 64.10%, respectively; accuracy = 70.87% and 72.44%, respectively). Conclusion: This preliminary study suggests that the modified SSA is a potentially reliable and valid nurse‑administered screening instrument for dysphagia detection in patients with stroke.
Keywords: Accuracy, Dysphagia, Stroke, Swallowing screen