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ERIC Number: EJ1472181
Record Type: Journal
Publication Date: 2025-May
Pages: 10
Abstractor: As Provided
ISBN: N/A
ISSN: ISSN-1368-2822
EISSN: EISSN-1460-6984
Available Date: 2025-04-21
Translation and Validation of the TOR-BSST into Turkish for Stroke Patients
International Journal of Language & Communication Disorders, v60 n3 e70042 2025
Purpose: The most common cause of death in Turkey is attributed to vascular diseases, including stroke. Dysphagia stands out as one of the prevalent and life-threatening complications that often follow a stroke. Within the Turkish context, the availability of validated bedside screening tests for assessing dysphagia remains limited. The primary objective of this study was to undertake the translation of the TOR-BSST into Turkish and subsequently validate this newly translated Turkish version. Method: Once the translation of the TOR-BSST into Turkish was accomplished, 60 stroke patients were consecutively enroled in the validation process. The enroled patients were evaluated using the TOR-BSST-TR, administered by a speech and language pathologist (SLP) trained in TOR-BSST screener training. On the screening day, each patient underwent a videofluoroscopic swallowing study (VFSS), administered by another SLP blinded to the patient's medical information and TOR-BSST-TR results. The VFSS images were recorded for independent analysis by the second SLP who conducted the VFSS, and a third SLP, also blinded to the TOR-BSST-TR findings, using the Penetration Aspiration Scale (PAS) to measure airway invasion severity, and Dysphagia Severity Rating Scale (DSRS) to measure overall dysphagia severity. The reliability of the gold standard VFSS ratings was assessed using the intra-class correlation coefficient (ICC). The accuracy of the new TOR-BSST-TR was assessed using sensitivity, specificity, predictive values and likelihood ratios. Results: Of all the 60 patients, 35 (58.3%) failed the TOR-BSST-TR, and 33 (55%) were identified with some degree of dysphagia from VFSS imaging scores. The overall inter-rater reliability (in ICC, 95% CI) for the gold standard ratings were as follows: PAS semi-solids (0.98, 0.95-0.99), PAS liquids (0.75, 0.58-0.85) and overall DSRS (0.70, 0.32-0.85). Based on the total screening score of the TOR-BSST-TR, the sensitivity, specificity, positive and negative predictive values along with positive likelihood ratio were as follows: 93.9%, 85.2%, 90.5%, 90.4% and 6.34, respectively. Conclusion: The TOR-BSST was successfully translated into Turkish, and the resulting TOR-BSST-TR demonstrated high accuracy in the acute stroke phase using videofluoroscopy as the gold standard. Specifically, the new TOR-BSST-TR screening tool yielded excellent sensitivity, specificity and predictive values in this patient population. The clinical implementation of this validated screening tool has the potential to enhance early detection of dysphagia, thereby triggering early management and ultimately improving patient outcomes and reducing the burden of complications from vascular diseases, such as stroke. Further research and widespread adoption of the TOR-BSST-TR could contribute to more standardized and effective dysphagia assessment protocols in clinical practice.
Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www-wiley-com.bibliotheek.ehb.be/en-us
Publication Type: Journal Articles; Reports - Research
Education Level: N/A
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A
Identifiers - Location: Turkey
Grant or Contract Numbers: N/A
Author Affiliations: 1Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey; 2BAVIM––Stroke Center, Istinye University Liv Hospital, Istanbul, Turkey; 3Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada; 4Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; 5Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; 6Department of Otolaryngology––Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada