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Validity and reliability of a novel patient reported outcome tool to evaluate post-operative dysphagia, odynophagia, and voice (DOV) disability after anterior cervical procedures

Joseph A Sclafani, MD,1 Deborah I. Ross, CCC-SLP,2 Brian H. Weeks, MD,3 Michelle Yang, BS,1 Choll W. Kim, MD, PhD1

1Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence, 2San Diego Speech Therapy, San Diego, CA, 3Senta Clinic, San Diego, CA



Existing evaluative instruments for dysphagia, odynophagia, and voice disturbance are cumbersome, focus predominately on dysphagia, and often require administration by a certified Speech Pathologist. This study was conducted to utilize widely accepted instruments such as the American Speech and Hearing Association's National Outcomes Measurement System (NOMS) and VAS pain scales to validate a novel, patient-reported instrument that quantifies the severity of post-operative dysphagia, odynophagia, and voice disabilities (DOV). 


The DOV was developed and subjected to multiple rounds of face and content validation by representative patient cohorts and a panel of clinical experts. An established, prospective clinical registry was utilized to collect pre and post-operative VAS-swallow related pain and DOV measurements for subjects with recent anterior cervical procedures (n=25 content validation, n=20 criterion validation), or recent lumbar decompressions (n=33). NOMS evaluations were performed by a certified Speech Language Pathologist on the first post-operative day after minimally invasive anterior approaches to cervical reconstruction were performed in the criterion validation cohort. 


Content validity: Subjects with a recent anterior cervical procedure reported a significant increase in post-operative dysphagia (pre-op: 0.13±0.35, post-op: 1.08±1.41, p=0.01), odynophagia (pre-op: 0.24±0.69, post-op: 0.84±0.90, p=0.001), and voice (pre-op: 0.10±0.41, post-op: 0.88±0.92, p=0.0004) disturbance. In contrast, subjects with a recent lumbar procedure did not demonstrate a significant increase in post-operative dysphagia, odynophagia, or voice disturbance (p>0.05). 
Criterion validity: Chi-squared contingency testing for independence between converted NOMS and DOV instrument scores accepted linkage between the two instruments for dysphagia X2(DF: 12, n=20, Expected: 21.03, Observed: 24.4, p: 0.02) and voice X2(DF: 6, n=20, Expected: 12.60, Observed: 21.28, p: 0.002) dimensions. Similarly, converted swallow related VAS and DOV odynophagia instruments demonstrated linkage X2(DF: 9, n=20, Expected: 16.92, Observed: 24.21, p: 0.004).
Internal Reliability: Chronbach's alpha coefficient of reliability was 0.74 between all DOV survey dimensions.


The DOV survey is a valid patient-reported instrument to rapidly and reliably detect post-operative swallow and voice dysfunction. 

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Minimally Invasive Cervical Surgery, Dysphagia, Odynophagia, Voice disturbance, Swallow dysfunction, Patient Reported Outcome, Instrument Validation
Volume 11 Issue 5
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