Correlation between dietary stages and quality of life assessed by SWAL-QOL in patients with dysphagia

재활학과/석사[한글] 본 연구는 삼킴곤란자의 삶의 질 평가를 목적으로 McHorney 등에 의해 2002 년에 개발된 SWAL-QOL을 이용하여 삶의 질의 변화를 알아보았다. 대상은 16개기관에서 삼킴재활치료를 받고있는 58명을 대상으로 실시되었으며 4주 뒤에 삼킴식이 단계가 향상된 21명의 자료를 수집하여 분석하였다. 식이상태 변화 후 SWAL-QOL의 '삼킴곤란에 대한 걱정', ‘먹는데 대한 걱정과 관심’, ‘음식에 대한 욕구’, ‘삼킴능력’, '삼킬 수 있는 음식에 대한 지식', '발음 능력’, ‘삼킴실패로 인한 두려움’, ‘정신건강’, ‘사회생활’, '피로', '수면' 11개 하위항목의 평균점수와 총점이 상승하여 삶의 질이 높아졌으며, 1차 SWAL-QOL과 2차 SWAL-QOL의 설문결과 모든 하위항목 간에 유의한 차이가 있었다. 또한 SWAL-QOL 하위항목인 ‘삼킴능력’은 ‘삼킴곤란에 대한 걱정’, ‘먹는데 대한 걱정과 관심’, ‘발음능력’, '삼킴실패로 인한 두려움‘, ’정신건강‘과 유의한 상관관계가 있었다. 식이단계 향상폭은 ’삼킴 실패로 인한 두려움‘, ’사회생활‘과 양의 상관관계를, 나이와는 음의 상관관계를 보였다. SWAL-QOL 총점은 ’삼킴곤란에 대한 걱정‘, ’먹는데 대한 걱정과 관심‘, ’삼킴 능력‘, ’삼킬 수 있는 음식에 대한 지식‘, ’발음 능력‘, ’삼킴 실패로 인한 두려움‘, ’정신건강‘와 유의한 상관관계를 보였다. 유병기간이 길수록 SWAL-QOL 총점은 음의 상관관계를 보였으며, 유의하였다. 본 연구는 물리적, 생리적인 측면에 초점을 맞추어 실시하던 기존의 삼킴재활치료 방법을 정신사회적인 측면으로 바라보고 환자들의 삶의 질을 제시하였다는 점에서 의의가 있으며, 식이단계가 상승하면서 삼킴곤란자의 삶의 질 또한 향상된다는 것을 알 수 있었다. 이는 임상치료사들이 삼킴곤란자를 치료함에 있어서 환자들의 실질적인 삶의 질 평가를 통해서 환자가 어떤 점에서 더 힘들어하고, 도움이 더 필요한지 알고 치료방향을 수정하거나, 보호자 교육에 대한 기본적인 정보를 마련하는데 도움이 될 수 있을 것이다. [영문]This Study reviews the change of the qualify of life making use of the SWAL-QOL method which was developed in 2002 in order to evaluate the quality of life of the one who has the difficulties in swallowing the food. The object of the study was the 58 patients who were undertaking the Swallowing Rehabilitation treatment at the 16 organizations and the information on the 21 out of the 58 whose swallowing dietary stage was improved after 4 weeks was collected and analyzed. After the dietary status has been changed, the average score of the 11 lower items and the total score were increased to make the life quality enhanced and the 11 items are :- general burden, eating duration, eating desire, symptoms, food selection, communication, fear of eating, mental health, social functioning, fatigue & sleep Meaningful difference was found in all the lower items according to the first and second survey of SWL-QOL. And the lower item of SWAL-QOL, symptoms had meaning interrelationship with the general burden, eating duration, communication, fear of eating and the mental health. And the improved range of the dietary stage showed positive relationship to the general burden, eating duration, communication, fear of eating and the mental health. On the other hand, however, negative relationship to the ages. Total score of SWAL-QOL indicated meaningful interrelationship to the general burden, eating duration, symptoms, food selection, communication, fear of eating and mental health. When the medical treatment period was long, the total score of SWAL-QOL showed the negative relationship and it was meaningful.ope

한국판 swallowing-quality of life questionnaire (K-SWAL-QOL)의 신뢰도 및 타당도 연구

Dept. of Occupational Therapy/박사The purpose of the present study was to examine the usefulness of creating a Korean version of the SWAL-QOL, which measures quality of life related to swallowing, by assessing its reliability and validity. The translation process for this measure involved correcting inappropriate vocabulary through translation, modifying sentences with errors in meaning through back-translation, and completing the final Korean version by assessing the appropriateness of the questions. Reliability was assessed via internal consistency and test-retest reliability analyses, while convergent validity and discriminant validity were also examined. In addition, experts tested the clinical utility of this measure. In order to obtain convergent validity, correlations between the K-WHOQOL-BREF and K-HDRS, which assess quality of life related to health and levels of depression, respectively, were compared. In order to test the discriminant validity, all categories of the K-SWAL-QOL were compared between patients with a swallowing disorder and normal subjects, while all categories of the K-SWAL-QOL were compared and analyzed depending on the diet and feeding type. The Cronbach’s α and Pearson''s correlation coefficients (r) for test-retest reliability ranged between 0.54-0.91 and 0.80-0.98, respectively. For convergent validity, a significant correlation (p < .001) was observed for all categories on comparing the K-WHOQOL-BREF and K-HDRS. Results of discriminant validity showed a significant difference between patients with swallowing disorders and normal subjects for all categories of the K-SWAL-QOL (p < .001) as well as differences based on diet and feeding type (p < .001). A test of clinical utility revealed significant results regarding the use of this measure for clinical assessment and treatment of swallowing disorders. The K-SWAL-QOL is able to assess several aspects of quality of life related to swallowing. The K-SWAL-QOL appears to be a reliable and valid assessment tool. In the future, this measure should be used as a means of providing appropriate intervention for occupational therapy and rehabilitation.ope