Jornal Internacional de Neurorreabilitação

Comparing Subjective Scales for Rating Drooling: A Pilot, Bicentric, Study

Abstract

Martina Giorgia Perinelli, Antonella Riva, Camilla Federici, Elisabetta Amadori, Emilia Viscardi, Gaetano Terrone, Laura Siri, Alberto Verrotti and Pasquale Striano*

Purpose: To evaluate the differences among the major subjective scales used to rate drooling in children with neurological disorders.

Patient and Methods: Children with neurological disorders of broad aetiologies were recruited and three different subjective scales were administered: the Drooling Impact Scale (DIS), the modified Teachers' Drooling Scale (mTDS), and the Drooling Severity and Frequency Scale (DSFS). Participants were then divided into 2 groups (A and B) according to the score obtained on the DSFS scale. The Mann-Whitney U test was applied to verify and quantify the difference between the DIS scores obtained in the two groups. The Pearson's correlation was used to verify the correlation between the DSFS score and the DIS total (DIS-tot) score, the DSFS score and DIS (domain 1 to 5) score, and the DSFS score and the mTDS score. Moreover, we analyzed the correlation between age and DSFS/DIS-tot scores, and age and the mTDS score.

Results: 31 children (mean age: 7.3 ± 4.5 years) were enrolled. Group A included 11 (35%) patients with a DSFS score of 2-5; group B included 20 (65%) patients with a DSFS score of 6-9. The Mann-Whitney test highlighted a significant difference between group A and group B with a DIS-tot score of p = 5 × 10−5. We obtained a strong correlation between DSFS and DIS-tot (r = 0.86), between DSFS and mTDS (r = 0.88), and between DIS-tot and mTDS (r = 0.87). No correlation was found between age and DSFS (r = 0.12).

Conclusion: The DIS, DSFS, and mTDS scales are effective in rating drooling, both in terms of severity and frequency. A subjective illustrative approach should, however, include an adequate assessment of the patient as a whole. In light of the impact that drooling has on the quality of life of these patients, the development of a comprehensive method to assess this condition is essential in the future.

What is known?

Drooling recognition and therapeutic management represent a fundamental step in the care of both the patient and his/her caregivers.

The application of subjective scales to measure drooling is suggested in the literature. However, to date, these methods are currently non-validated.

Existing objective approaches do not consider the overall patient’s quality of life, which is a fundamental parameter in evaluating treatments’ effectiveness.

What is new?

Subjective scales (DIS, mTDS, and DSFS) were effective in the diagnosis of drooling, both in terms of rating its severity and its frequency.

The DIS scale has some defects in its method of administration and interpretation in a language different from English.