臺灣博碩士論文加值系統

本研究目的為中文化吞嚥障礙生活品質問卷（SWAL-QOL），並驗證其信度與效度，建立國內吞嚥障礙生活品質評估工具，以供臨床及學術研究參考使用。
本研究對象為50名年齡20歲以上、性別不拘、經由臨床診斷為吞嚥障礙且吞嚥障礙症狀穩定者。排除條件為疑似失智症患者。研究方法分三步驟，第一步驟為語言治療師評估吞嚥障礙嚴重度並填寫吞嚥障礙嚴重度分級表（Dysphagia Outcome and Severity Scale, DOSS），第二步驟為受試者填寫台灣版吞嚥障礙生活品質問卷（SWAL-QOL Taiwan version），第三步驟為受試者填寫台灣簡明版世界衛生組織生活品質問卷（WHOQOL-BREF Taiwan version）。
本研究以下列方式進行信度與效度分析。信度分析包括：1. 內部一致性：使用Cronbach's α coefficient檢測本研究問卷的信度。2.以Spearman correlation檢驗再測信度。效度分析包括：1.內容效度：以專家審查方式進行，使用內容效度評估指標（content validity index, CVI）量化各題內容效度。2.效標關聯效度：利用Spearman correlation驗證本研究問卷和WHOQOL-BREF Taiwan version及DOSS量表之相關性。
研究結果顯示本研究量表的內部一致性高，總量表之Cronbach’s α值為0.94。本研究量表總量表再測信度良好，Spearman相關係數rs值為1。內容效度良好，CVI值為0.98。本研究與兩個效標之效標關聯效度為中度至高度相關，本研究總量表與WHOQOL-BREF Taiwan version總量表的Spearman相關係數rs值為.745（p < 0.01），本研究與DOSS量表的Spearman相關係數rs值為.611（p < 0.01）。
本研究之量表「台灣版吞嚥障礙生活品質問卷｣可做為臨床及學術研究上評估吞嚥障礙患者生活品質的評估工具。

The purpose of this study was aimed to translate the “swallowing quality of life questionnaire” and verify its reliability and validity, establish SWAL-QOL Taiwan version for clinical and academic research.
The 50 subjects were 20 years pld pr more, regardless of gender; went through the clinical diagnosis of dysphagia and the dysphagia condition is stable. Exclusion criteria are patients with suspected dementia. Research methods include three steps: in the first step the speech therapist evaluate dysphagia severity and complete “Dysphagia Outcome and Severity Scale (DOSS)”. In the second step the subjects fill in “SWAL-QOL Taiwan version”. In the third step the subjects fill in “WHOQOL-BREF Taiwan version”.
This study was analyzed through reliability and validity analyses. Reliability analysis included: 1. the internal consistency by Cronbach's α coefficient. 2. the test-retest reliability analysis by Spearman’s rank-order correlation coefficient. Validity analysis included: 1. the content validity assessed by expert opinions. 2. the criterion related validity between “SWAL-QOL Taiwan version” and “WHOQOL-BREF Taiwan version”, and the criterion related validity between “SWAL-QOL Taiwan version” and “DOSS”.
The results showed that “SWAL-QOL Taiwan version” have a high internal consistency (Cronbach’s α = 0.94). The test-retest reliability was great (r = 1). Content validity was great (CVI=0.98). The criterion related validity between “SWAL-QOL Taiwan version” and two criterions was moderate to high correlation. The Spearman correlation coefficient between “SWAL-QOL Taiwan version” and “WHOQOL-BREF Taiwan version” was 0.745 (p < 0.01).The Spearman correlation coefficient between “SWAL-QOL Taiwan version” and “DOSS” was 0.611 (p < 0.01).
The scale of this study, the “SWAL-QOL Taiwan version”, can be used in clinical and academic research to assess the quality of life in patients with dysphagia.

第一章 緒論........................................................1
第二章 文獻探討....................................................7
第一節 吞嚥障礙的機轉與原因....................................7
第二節 吞嚥障礙的影響..........................................8
第三節 吞嚥障礙臨床常用評估方法及其限制.......................10
第四節 健康相關生活品質評估工具...............................11
第五節 吞嚥障礙生活品質評估工具...............................14
第三章 研究方法...................................................18
第一節 研究架構...............................................18
第二節 研究對象...............................................20
第三節 研究工具...............................................21
第四節 研究步驟...............................................26
第五節 統計方法...............................................34
第六節 預試流程與結果.........................................36
第四章 研究結果...................................................40
第一節 研究對象基本資料.......................................40
第二節 台灣版吞嚥障礙生活品質問卷信度分析.....................43
第三節 台灣版吞嚥障礙生活品質問卷效度分析.....................47
第五章 研究討論...................................................52
第一節 台灣版吞嚥障礙生活品質問卷信度.........................52
第二節 台灣版吞嚥障礙生活品質問卷效度.........................59
第三節 結論...................................................64
第四節 研究限制...............................................66
第五節 未來研究建議...........................................67
參考文獻...........................................................68
附錄...............................................................78
附錄一 WHOQOL-BREF Taiwan version問卷作者授權同意書.........78
附錄二 SWAL-QOL問卷作者授權同意信件........................79
附錄三 吞嚥障礙生活品質問卷（SWAL-QOL）原文版...............80
附錄四 台灣版吞嚥障礙生活品質問卷回覆翻譯專家效度.............87
附錄五 基本資料表.............................................94
附錄六 受試者同意書...........................................95
附錄七 吞嚥障礙嚴重度分級表...................................99
附錄八 台灣版吞嚥障礙生活品質問卷(SWAL-QOL Taiwan version).....101
附錄九 國立臺灣大學醫學院附設醫院研究倫理委員會計畫執行及修正許可書....................................................112
附錄十 台灣版吞嚥障礙生活品質問卷之專家效度...................116
 
圖目錄
頁碼
圖 3-1 研究架構圖........................................................19
圖 3-2 研究流程圖........................................................27
圖 3-3 中文化SWAL-QOL圖.................................................28
 表目錄
頁碼
表 2-5 SWAL-QOL原文版及各國翻譯版本比較表..........................17
表 3-6-1 預試受試者基本資料.............................................37
表 3-6-2 預試總量及表分量表內部一致性信度係數...........................39
表 4-1-1 研究對象性別、年齡.............................................41
表 4-1-2 研究對象教育程度、疾病診斷、是否有管灌.........................42
表 4-2-1 台灣版吞嚥障礙生活品質問卷總量表及分量表內部一致性係數.........44
表 4-2-2 WAL-QOL Taiwan version總量表及分量表再測信度係數..............46
表 4-3-1 台灣版吞嚥障礙生活品質問卷總量表及分量表與台灣簡明版世界衛生組織生活品質問卷總量表及分量表之Spearman相關係數..................50
表 4-3-2 台灣版吞嚥障礙生活品質問卷總量表及分量表與吞嚥障礙嚴重度分級表之Spearman相關係數...............................................51

吳明隆、涂金堂（2006）。SPSS與統計應用分析（2）。台北：五南。
林金定（2008）。WHO國際功能、失能和健康分類：理論架構、範圍、分類與編碼原則。身心障礙研究，6(2)，102-127。
台灣簡明版世界衛生組織生活品質發展小組（2000）。台灣簡明版世界衛生組織生活品質問卷之發展及使用手冊。台北：台灣簡明版世界衛生組織生活品質發展小組。
姚開屏（2000a）。台灣版世界衛生組織生活品質問卷之發展簡介。中華衛誌，19(4)，315-324。
姚開屏（2000b）。簡介與評論常用的一般性健康相關生活品質量表兼談對未來研究的建議。測驗年刊，47(2)，111-138。
姚開屏（2002）。健康相關生活品質概念與測量原理之簡介。台灣醫學會，6(2)，183-192。
郭信霖、許淑卿（1994）。統計學。華立圖書。
陳正昌、張慶勳（2007）。量化研究與統計分析。新學林出版有限公司。
劉弘煌（2003）。社會統計學：理論與應用。雙葉書廊有限公司。
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191.
Bogaardt, H. C. A., Speyer, R. Baijens, L. W. J. & Fokkens, W. J. (2009). Cross-cultural adaptation and validation of the Dutch version of SWAL-QOL. Dysphagia, 24, 66-70. doi:10.1007/s00455-008-9174-z
Barata, L. F., Carvalho, G. B., Angelis, E. C., Faria, J. C. M., & Kowalski, L. P. (2013). Swallowing, speech and quality of life in patients undergoing resection of soft palate. Eur Arch Otorhinolaryngol, 270, 305-312. doi:10.1007/s00405-012-2006-7
Chen, A. Y., Framkowski, R., Bishop-Leone, J., Hebert, T., Leyk, S., Lewin, J., & Goepfert, H. (2001). The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer. Archives Otolaryngol Head and Neck Surgery, 127, 870-876.
Campell, B. H., Spinelli, K., Marbella, A M., Myers, K. B., Kuhn, J. C., & Layde, P. M. (2014). Aspiration, weight loss, and quality of life in head and neck cancer survivors. Archives Otolaryngol Head and Neck Surgery, 130,1100-1103.
Cichero, J., & Murdoch, B. (2010). Dysphagia Foundation, Theory and Practice, Lexington, KY, Wiley.
Chung, L., Valenzuela, A., Fiorentino, D., Stevens, K., Li, S., Harris, J. & Rodriguez‐Reyna, T. S. (2015). Validation of a novel radiographic scoring system for calcinosis affecting the hands of patients with systemic sclerosis. Arthritis care & research, 67(3), 425-430.
Chen, P. H., Golub, J. S., Hapner, E. R., & Johns III, M. M. (2009). Prevalence of perceived dysphagia and quality-of-life impairment in a geriatric population. Dysphagia, 24, 1-6. doi:10.1007/s00455-008-9156-1
Dalton, C., Caples, M., & Marsh, L. (2011). Management of dysphagia. Learning Disability Practice, 14(9), 32-38.
Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: Its impact on diagnosis and treatment. Dysphagia, 17, 139-146. doi:10.1007/s00455-001-0113-5
Finizia, C., Rudberg, I., Bergqvist, H., & Ryden, A. (2012). A cross-sectional validation study of the Swedish version of SWAL-QOL. Dysphagia, 27, 325-335. doi:10.1007/s00455-011-9369-6
Flaherty, J. A., Gaviria, F. M., Pathak, D., Mitchell, T., Wintrob, R., Richman, J. A., & Birz, S. (1988). Developing instruments for cross-cultural psychiatric research. The Journal of nervous and mental disease, 176(5), 260-263.
Gillespie, B. M., Brodsky, M. B. Day, T. A., Lee, F. S., & Martin-Harris, B. (2004). Swallowing-Related quality of life after head and neck cancer treatment. Laryngoscope, 114, 1362-1367.
Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-Cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiolgy, 46(12), 1417-1432.
Gjersing, L., Caplehorn, J. R. M., & Clausen, T. (2010). Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Medical Research Methodology, 10 (13), 1-10.
Govender, R., Lee, M. T., Davies, T. C., Twinn, C. E., Katsoulis, K. L., Payten, C. L., Stephens, R., & Drinnan, M. (2012). Development and preliminary validation of a patient-reported outcome measure for swallowing after total laryngectomy (SOAL questionnaire). Clinical Otolaryngolgy, 37, 452-459.
Gudykunst, W. B. (2001). Asian American ethnicity and communication. Thousand Oaks, CA: Sage.
Gudykunst, W. B., Matsumoto, Y., Ting-Toomey, S., Nishida, T., Kim, K., & Heyman. S. (1996). The influence of cultural individualism-collectivism, self-construals, and individual values on communication styles across styles across cultures. Human Communication Research, 22, 510-543. doi:10.1111/j.1468-2958.1996.tb00377.x
Hall, E. T. (1976). Beyond culture. Garden City, NY: Anchor Bools/ Doubleday.
Hoy, M., Domer, A., Plowman, E. K., Loch, R., & Belafsky, P. (2013). Causes of dysphagia in a tertiary-care swallowing center. Annals of otology, Rhinology & Laryngology, 122(5), 335-338.
Kim, B. S. K., & Atkinson, D. R. (2002). Asian American client adherence to Asian cultural values, counselor expression of cultural values, counselor ethnicity, and career counseling process. Journal of Counseling Psychology, 49, 3-13. doi:10.1037/0022-0167.49.1.3
Khaldoun, E., Woisard, V., & Verin, E. (2009). Validation in French of the SWAL-QOL scale in patients with oropharyngeal dysphagia. Gastroenterologie Clinique et Biologique, 33, 167-171. doi:10.1016/j.gcb.2008.12.012
Körner, S., Hendricks, M., Kollewe, K., Zapf, A., Dengler, R., Silani, V., & Petri, S. (2013). Weight loss, dysphagia and supplement intake in patients with amyotrophic lateral sclerosis (ALS): impact on quality of life and therapeutic options. BMC Neurology, 13, 1-9. doi:10.1186/1471-2377-13-84
Kuo, P., Holloway, R. H., & Nguyen, N. Q. (2012). Current and future techniques in the evaluation of dysphagia. Journal of Gastroenterology and Hepatology, 27, 873-881. doi:10.1111/j.1440-1746.2012.07097.x
Langdon, C., & Blacker D. (2010). Dysphagia in stroke: A new solution. Stroke research and treatment. doi:10.4061/2010/570403
Logemann, J. A. (1998). Evaluation and treatment of swallowing disorder, Austin TX: Pro.Ed.
Logemann J. A., & Larsen, K. (2012). Oropharyngeal dysphagia: pathophysiology and diagnosis for the anniversary issue of Diseases of the Esophagus. Diseases of the Esophagus, 25,299-304. doi:10.1111/j.1442-2050.2011.01210.x
List, M. A., & Stracks, J. (2000). Evaluation of quality of life in patients definitively treated for squamous carcinoma of the head and neck. Current Opinion in Oncology, 12(3), 215-220.
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382-385.
Lam, P. M., & Lai, C. K. Y. (2011). The validation of the Chinese version of the Swallow Quality-of-Life Questionnaire (SWAL-QOL) using exploratory and confirmatory factor analysis. Dysphagia, 26, 117-124. doi:10.1007/s00455-010-9272-6
Lovell, S. J., Wong, H. B. Loh, K. S., Ngo, R. Y. S., & Wilson, J. A. (2005). Impact of dysphagia on quality of life in nasopharyngeal carcinoma. Head and Neck, 27, 864-872. doi:10.1002/hed.20250
Mandaville, A., Ray, A., Robertson, H., Foster, C., & Jesser, C. (2014). A retrospective review of swallow dysfunction in patients with severe traumatic brain injury. Dysphagia, 29(3), 310-318. doi:10.1007/s00455-013-9509-2
Mann, G., Hankey, G. J., & Cameron, D. (1999). Swallowing function after stroke- Prognosis and prognostic factors at 6 months. Stroke, 30, 744-748.
Murphy, B. A., Ridner, S., Wells, N., & Dietrich, M. (2007). Quality of life research in head and neck cancer: A review of the current state of the science. Critical Reviews in Oncology and Hematology, 62, 251-267. doi:10.1016/j.critrevonc.2006.07.005
McHorney, C. A., Bricker, D. E., Robbins, JA., Kramer, A. E., Rosenbek, J. C., Chignell, K. A. (2000a). The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: II. Item Reduation and Preliminary Scaling. Dysphagia, 15, 122-133. doi:10.1007/s004550010013
McHorney, C. A., Bricker, D. E., Kramer, A. E., Rosenbek, J. C., Robbins, J. A., Chignell, K. A., Logemann, J. A., & Clarke, C. (2000b). The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual Foundation and Item Development. Dysphagia, 15, 115-121. doi:10.1007/s004550010012
McHorney, C. A., Martin-Harris, B., Robbins, JA., Rosenbek, J. (2006). Clinical validity of the SWAL-QOL and SWAL-CARE outcome tools with respect to bolus flow measures. Dysphagia, 21, 141-148. doi:10.1007/s00455-005-0026-9
McHorney, C. A., Robbins, JA., Lomax, K., Rosenbek, J. C., Chignell, K., Kramer, A. E., & Bricker, D. E. (2002). The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia, 17, 94-114. doi:10.1007/s00455-001-0109-1
Maclean, J., Cotton, S., & Perry, A. (2009). Dysphagia following a total laryngectomy: The effect on quality of life, functioning, and psychological well-being. Dysphagia, 24, 314-321.
Maclean, J., Szczesniak, M., Cotton, S., Cook, I., & Perry, A. (2011). Impact of a laryngectomy and surgical closure technique on swallow biomechanics and dysphagia severity. Otolaryngology- Head and Neck Surgery, 144, 21-28.
McCrae, R.R., Kurtz, J.E., Yamagata, S., & Terracciano, A. (2011). Internal consistency, retest reliability, and their implications for personality scale validity. Personality and Social Psychology Review, 15(1):28-50. doi:10.1177/1088868310366253
Nacci, A., Ursino, F., Vela, R. La., Matteucci, F., Mallardi, V., & Fattori, B. (2008). Fiberoptic endoscopic evaluation of swallowing (FESS): proposal for informed consent. Acta Otorhinolaryngol Italica, 28(4), 206-211.
Nunnally, J. C. (1978). Psychometric theory (2nd ed.). New York: McGraw-Hill.
Norton, R. (1983). Communicator style: Theory, application, and measures. Beverly Hills, CA: Sage.
O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical Medicine, 2, 196-199.
O’Neil, K. H., Purdy, M., Falk, J., & Gallo, L. (1999). The dysphagia outcome and severity scale. Dysphagia, 14, 139-145.
Pernambuco, L. A., Oliveira, J. H. P., Lima Regis, R.M.F., Lima, L. M., Araujo, A. M. B., Balata, P. M. M., Cunha, D. A., & Silva, H. J. (2012). Quality of life and deglutition after total laryngectomy. Int. Arch. Otorhinolaryngol., 16(4), 460-465.
Sullivan, P., Hind, J. A., & Robbins, J. A. (2001). Lingual exercise protocol for head and neck cancer: a case study. Dysphagia, 16(2), 154.
Singh, S., & Hamdy, S. (2006). Dysphagia in stroke patients. Postgraduate Medical Journal, 82, 383-391. doi: 10.1136/pgmj.2005.043281
Shintani, S., & Shiigau, T. (2004). Sirvival-determining factors in patients with neurologic impairments who received home health care in Japan. Journal of the Neurological Sciences, 225, 117-123.
Vesey, S., (2013). Dysphagia and quality of life. British Journal of Community Nursing, 18(5), s14-s19. doi:10.12968/bjcn.2013.18.sup5.s14
World Health Organization. Division of Mental Health (1996). WHOQOL-BREF : introduction, administration, scoring and generic version of the assessment. Geneva : World Health Organization.
Waltz, C. F., Strickland, O. L., & Lenz, E. R. (1991). Measurement in nursing research (2nd ed.). Philadelphia: A. Davis.
Williams, L. S., Weinberger, M., Harris, L. E., Clark. D. O., & Biller, J. (1999). Development of a stroke-specific quality of life scale. Journal of the American Heart Association, 30, 1362-1369. doi:10.1161/01.STR.30.7.1362