Translation, Cross-Cultural Adaptation, Validation and Reliability of the Northwestern Dysphagia Patient Check Sheet (NDPCS) in Iran

Document Type : Original


1 Neuromuscular Rehabilitation Research Center, Semnan University of Medical Science, Semnan, Iran.

2 Department of Neurology, School of Medicine, Iranian Center of Neurological Researches, Tehran University of Medical Sciences. Tehran, Iran.

3 Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

4 Research Center of Physiology and Department of Community Medicine, Semnan University of Medical Science, Semnan, Iran.


Speech and language therapists (SLTs) require proper tools to detect dysphagia in the early stages. One of these screening tools is the Northwestern Dysphagia Patient Check Sheet (NDPCS). However, this tool needs to be adapted, validated, and shown to be reliable for the Persian culture. The aim of the present study was to report the validity and reliability of the Persian NDPCS (P-NDPCS).
Materials and Methods:
The NDPCS has 28 items and five sections. Beaton’s guidelines were followed in terms of the translation process. To report the content validity index (CVI) and the content validity ratio (CVR), eight SLTs experienced in swallowing disorders examined the content and face validities of the P-NDPCS in terms of the quality of translation, fluency, understandability, and the cultural context. In total, 140 patients with neurogenic and mechanical dysphagia were evaluated using the P-NDPCS. Internal consistency reliability was investigated using the Kuder–Richardson formula 20. The interclass correlation coefficient (ICC) was used for test-retest reliability.
The P-NDPCS preserved the 28 items and the five categories of the original version. However, semantic and food adjustments were applied due to cultural differences. The scoring system was changed from safe/unsafe to yes/no for four subsections and to normal/abnormal for the oromotor section. Food requirements were also changed. The CVR and CVI were both 75%. The P-NDPCS was shown to have good content validity. The internal reliability was 0.95, indicating excellent reliability.
The equivalence between the original version of the NDPCS and the P-NDPCS was preserved. Our findings indicate that the P-NDPCSis a valid and reliable screening tool for the diagnosis of dysphagia in the early phase.


Main Subjects

1. Logemann JA. Evaluation and Treatment of Swallowing Disorders. Edition S, editor. London, UK: College-Hill Press; 1998.
2. Murry T, Carrau RL. Clinical Management of Swallowing. edition t, editor. US: Plural Publishing, Inc; 2016.
3. Ekberg O. Dysphagia: Diagnosis and Treatment. Berlin/Heidelberg, Germany: Springer Science & Business Media; 2012.
4. Logemann JA, Veis S, Colangelo L. A Screening Procedure for Oropharyngeal Dysphagia. Dysphagia. 1999;14(1):44–51.
5. DePippo KL, Holas MA, Reding MJ. The Burke dysphagia screening test: validation of its use in patients with stroke. Arch Phys Med Rehabil. 1994;75(12):1284–6.
6. Nathadwarawala K, Nicklin J, Wiles C. A Timed Test of Swallowing Capacity for Neurological Patients. J Neurol Neurosurg Psychiatry. 1992;55(9):822–5.
7. DePippo KL, Hollas MA, Reding MJ. Validation of the 3-Oz Water Swallow Test for Aspiration following Stroke. Arch Neurol. 1992;49(12):
8.Trapl M, Enderle P, Nowotny M, Teuschl Y, Matz K, Dachenhausen A, et al. Dysphagia bedside screening for acute-stroke patients: The Gugging Swallowing Screen. Stroke. 2007;38:2948–52.
9. Martino R, Silver F, Teasell R, Bayley M, Nicholson G, Streiner D, et al. The Toronto bedside swallowing screening test (TOR-BSST) development and validation of a dysphagia screening tool for patients with stroke. Stroke. 2009;40:555–61.
10. Junior M, Virgílio H, Pernambuco L, Souza L, Ferrerira M, Lima K. Translation and cross-cultural adaptation of the Northwestern Dysphagia Patient Check Sheet to Brazilian Portuguese. CoDAS. 2013;25(4):369–74.
11. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine 2000;25:3186–91.
12. Wynd CA, Schmidt B, Schaefer MA. Two Quantitative Approaches for Estimating Content Validity. West J Nurs Res 2005;25:508–18.
13. Polit DF, Beck CT. The Content Validity Index: Are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29:489–97.
14. Etges CL, Scheeren B, Gomes E, Barbosa LDR. Screening Tools for Dysphagia: A Systematic Review. CoDAS. 2014;26(5).
15. Butler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The Effects of Aspiration Status, Liquid Type, and Bolus Volume on Pharyngeal Peak Pressure in Healthy Older Adults. In: Services DoHaH, editor. USA2011.