The validity and reliability of the Thai version of M.D. Anderson dysphagia inventory and correlation between quality of life and dysphagia severity in patients with head and neck cancer

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Tiraya Phuengtrakul
Phuanjai Rattakorn
Peesit leelasawatsuk


Background: Dysphagia is one of the most significant side effects of head and neck cancer (HNC) treatments, which increases the symptom rate after treatments. This has negative effects on patient quality of life (QoL); therefore, the evaluation of quality of life by standardized instruments is essential to patient-reported outcomes.

Objectives: The purpose of this study was to translate and validate the M.D. Anderson Dysphagia Inventory (MDADI), which is a specific QoL instrument that evaluates the impact of dysphagia on QoL in HNC patients, into the Thai language by a cross-cultural adaptation process. This subsequently determines the reliability of the Thai version of MDADI (MDADI-TH), and to verify a correlation between dysphagia severity and QoL in HNC patients.

Materials and methodsThe six steps for a cross-cultural adaptation process, which include: forward translation, translation synthesis, backward translation, expert committee review, pretesting, and final proof reading were performed. Sixty-five HNC patients with dysphagia were included in this study. The patients completed the same questionnaires two weeks after first enrollment, to determine the reliability. The Reliability was determined by internal consistency (Cronbach’s alpha) and test-retest reliability. The correlation was verified between the total score of MDADI-TH and Penetration-aspiration scale, from a video-fluoroscopy swallowing study (VFSS) by independent t-test.

Results: Validation was achieved by a cross-cultural adaptation process, except for one question (E7), which was not equivalent to the original version in semantic proposition. A total of twenty-nine patients completed the same questionnaires two weeks later. The MDADI-TH subscale and total scores showed acceptable internal consistency reliability (ranging from 0.71-0.94), and test-retest reliability (ranging from 0.86-0.99). For the correlation study, a total of sixty patients were able to be examined by VFSS. The results showed that correlation between dysphagia severity and QoL was significant in total scores, the emotional subscale, and the functional subscale (p<0.05).

Conclusion: The MDADI-TH showed good reliability; therefore, the MDADI-TH can be a useful dysphagia-specific QoL instrument, for measuring QoL in Thai patients with HNC. Patients with more severity of dysphagia showed it had a compromising effect on the quality of life, especially in the emotional and functional domains.


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Phuengtrakul, T., Rattakorn, P., & leelasawatsuk, P. (2020). The validity and reliability of the Thai version of M.D. Anderson dysphagia inventory and correlation between quality of life and dysphagia severity in patients with head and neck cancer. Journal of Associated Medical Sciences, 54(1), 47–57. Retrieved from
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