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BMC Research Notes Dec 2023Swallowing dysfunction (dysphagia) significantly impacts patient and medical outcomes. In Sweden, there is no comprehensive outcome measure for dysphagia that...
BACKGROUND
Swallowing dysfunction (dysphagia) significantly impacts patient and medical outcomes. In Sweden, there is no comprehensive outcome measure for dysphagia that incorporates holistic assessment and dysphagia impact on a person's impairment, function and participation. The Dysphagia Outcome and Severity Scale (DOSS) was developed and validated (in English) and incorporates the World Health Organisation's (WHO) aforementioned, International Classification of Functioning (ICF) aspects. This study translated then evaluated the validity and reliability of the Swedish version, DOSS-S.
METHOD
Translation occurred based on WHO recommendations. The Content Validity Index (CVI) of the translated version (DOSS-S) was assessed twice by 11 (multi-professional) dysphagia experts. Criterion validity and rater reliability was calculated using 18 Speech Pathologists assessing patient cases from International Dysphagia Diet Standardization Initiative-Functional Diet Scale (IDDS-FDS) research.
RESULTS
Very high CVI values (0.96-0.99) for the linguistic correlation, and high CVI values (0.84-0.94) for applicability correlation were achieved. High criterion validity of DOSS-S with IDDSI-FDS was demonstrated (r = 0.89, p < 0.01), with very high inter and intra rater reliabilities (ICC > 0.90).
CONCLUSION
The DOSS-S demonstrated very high validity values, and very high inter and intra rater reliability. This research contributes to improved dysphagia management by providing interprofessional dysphagia clinicians with a validated scale to identify patient progression, communicate dysphagia status between regions and countries, and document patient outcomes using an ICF framework.
Topics: Humans; Deglutition Disorders; Sweden; Reproducibility of Results; Deglutition; Language
PubMed: 38098056
DOI: 10.1186/s13104-023-06637-z -
Dysphagia Aug 2023The aim of the study was to examine the following: (a) the trajectory of external and internal head and neck lymphoedema (HNL) in patients with head and neck cancer...
The aim of the study was to examine the following: (a) the trajectory of external and internal head and neck lymphoedema (HNL) in patients with head and neck cancer (HNC) up to 12 months post-chemoradiotherapy (CRT) and (b) the relationship between HNL and swallowing function. Using a prospective longitudinal cohort study, external/internal HNL and swallowing were examined in 33 participants at 3, 6 and 12 months post-CRT. External HNL was assessed using the Assessment of Lymphoedema of the Head and Neck and the MD Anderson Cancer Centre Lymphoedema Rating Scale. Internal HNL was rated using Patterson's Radiotherapy Oedema Rating Scale. Swallowing was assessed via clinical, instrumental and patient-reported measures. Associations between HNL and swallowing were examined using multivariable regression models. External HNL was prevalent at 3 months (71%), improved by 6 months (58%) and largely resolved by 12 months (10%). In contrast, moderate/severe internal HNL was prevalent at 3 months (96%), 6 months (84%) and at 12 months (65%). More severe penetration/aspiration and increased diet modification were associated with higher severities of external HNL (p=0.006 and p=0.031, respectively) and internal HNL (p<0.001 and p=0.007, respectively), and more diffuse internal HNL (p=0.043 and p=0.001, respectively). Worse patient-reported swallowing outcomes were associated with a higher severity of external HNL (p=0.001) and more diffuse internal HNL (p=0.002). External HNL largely resolves by 12 months post-CRT, but internal HNL persists. Patients with a higher severity of external and/or internal HNL and those with more diffuse internal HNL can be expected to have more severe dysphagia.
Topics: Humans; Deglutition Disorders; Prospective Studies; Longitudinal Studies; Head and Neck Neoplasms; Deglutition; Chemoradiotherapy; Lymphedema
PubMed: 36309604
DOI: 10.1007/s00455-022-10526-1 -
BMC Palliative Care Oct 2023Although oncological palliative care is increasingly being offered by multidisciplinary teams, there is still a lack of data about some symptoms handled by these teams,...
BACKGROUND
Although oncological palliative care is increasingly being offered by multidisciplinary teams, there is still a lack of data about some symptoms handled by these teams, such as dysphagia, in patients with advanced cancer outside swallow regions. This study aimed to estimate the occurrence of dysphagia in prognosis studies of adults with advanced cancer outside the head, neck, and upper gastrointestinal tract, and to determine if there is an association with mortality.
METHODS
A systematic review of studies that evaluated dysphagia and mortality was conducted (PROSPERO: CRD42021257172).
DATA SOURCES
BVS, PubMed, CINAHL, Web of Science, and Scopus. Data between 2011 and 2023 were selected.
RESULTS
Among the 608 articles screened, only 14 were included, which covered different types of cancer, primarily Lung, and Genitourinary, Skin, Hematological, and Central Nervous System as well. Dysphagia demonstrated a variable frequency, and almost half of the studies found a percentage of dysphagia above 60%, appearing most as a symptom that affects health-related quality of life and prove to be a toxicity of treatment. The association between dysphagia and mortality was only evaluated in three articles that studied advanced lung cancer, in which, after controlling for covariates, swallowing disorders were associated with worse survival, with prevalences of dysphagia and hazard ratios of 78.5% (1.12 [1.04-1.20]), 4% (1.34 [1.28-1.35]), and 3% (1.40 [1.07-1.81]), respectively.
CONCLUSIONS
The occurrence of dysphagia in advanced cancer outside the head, neck, and upper GI tract is common, and there seems to be an association with significantly decreased survival in patients with advanced lung cancer.
Topics: Humans; Adult; Deglutition Disorders; Deglutition; Head and Neck Neoplasms; Quality of Life; Lung Neoplasms; Upper Gastrointestinal Tract
PubMed: 37798715
DOI: 10.1186/s12904-023-01268-4 -
JPMA. the Journal of the Pakistan... Aug 2023A cross sectional study utilising convenience sampling was conducted to determine the co-morbidities and risk factors in post stroke patients with swallowing and...
A cross sectional study utilising convenience sampling was conducted to determine the co-morbidities and risk factors in post stroke patients with swallowing and communication complications. The study recruited 150 diagnosed cases of stroke with no gender and age limitation from Combined Military Hospital, Fatima Memorial Hospital, and Mayo Hospital, Lahore, from January to June 2015. Glasgow coma scale, Modified Massey Bedside Swallow Screener, informal clinical assessment by SLP, and medical history sheet were employed for data collection, while the data was analysed using SPSS -23. Results revealed 103 (68.7%) patients with swallowing and 99 (66%) with communication difficulties. Swallowing issues revealed significant association with age (p=.016); history of stroke (p=.017), smoking (p=.004), alcohol intake (p=.035), diabetes mellitus (p=.003), and GCS (p=.009). Communication difficulties had significant association with hypertension (p=.029), GCS (p=.000). Hence, stroke related dysphagia is associated with diabetes mellitus; level of consciousness, previous history of stroke, smoking, alcohol abuse, and age, while communication issues are associated with hypertension and level of consciousness.
Topics: United States; Humans; Deglutition; Prevalence; Cross-Sectional Studies; Risk Factors; Communication; Stroke; Hospitals, Military; Hypertension
PubMed: 37697764
DOI: 10.47391/JPMA.7596 -
Surgical Endoscopy Dec 2023Esophageal mucosal bridge (EMB) may be diagnosed at the anastomotic site in children operated on for esophageal atresia (EA) but so far only a few cases (n = 4) have...
BACKGROUND AND STUDY AIMS
Esophageal mucosal bridge (EMB) may be diagnosed at the anastomotic site in children operated on for esophageal atresia (EA) but so far only a few cases (n = 4) have been reported. This study aimed to characterize EMB in children with EA, risk factors, and treatment.
PATIENTS AND METHODS
This retrospective multicenter study recorded patient's characteristics, EMB diagnosis circumstances, endoscopic management, follow-up, and EMB recurrence in children with EA aged less than 18 years, compared with paired EA patients without EMB.
RESULTS
Thirty patients were included (60% male, 90% EA/tracheoesophageal fistula, 43% associated malformations). Compared to 44 paired controls, EMB was associated with a history of nasogastric tube feeding (31% vs. 9.1%, p = 0.02) and severe gastroesophageal reflux disease (history of fundoplication: 41.4% vs. 13.6%, p < 0.01). 77% had symptoms (food impaction and/or dysphagia). Endoscopic management was performed in 53% of patients (83% electrocoagulation) with no technical difficulties or complications. 80% of the symptomatic patients with EMB improved after endoscopic treatment, independently of anastomotic stricture dilatation or not.
CONCLUSION
EMB endoscopic management by electrocoagulation is safe and often leads to symptom improvement.
Topics: Child; Humans; Male; Female; Esophageal Atresia; Tracheoesophageal Fistula; Deglutition Disorders; Fundoplication; Endoscopy; Retrospective Studies; Treatment Outcome; Postoperative Complications; Esophageal Stenosis
PubMed: 37831175
DOI: 10.1007/s00464-023-10492-1 -
Journal of Speech, Language, and... Oct 2023It is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for...
PURPOSE
It is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for diagnostic judgments and identifying mechanisms of impairment from videofluoroscopy (VFSS). Establishing VFSS reference values for healthy swallowing would help resolve such discrepancies. Steele et al. (2019) released preliminary reference data for quantitative VFSS measures in healthy adults aged < 60 years. Here, we extend that work to provide reference percentiles for VFSS measures across a larger age span.
METHOD
Data for 16 VFSS parameters were collected from 78 healthy adults aged 21-82 years (39 male). Participants swallowed three comfortable sips each of thin, slightly, mildly, moderately, and extremely thick barium (20% w/v). VFSS recordings were analyzed in duplicate by trained raters, blind to participant and task, using the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) Method. Reference percentiles (p2.5, 5, 25, 50, 75, 95, and 97.5) were determined as per Clinical and Laboratory Standards Institute EP28-A3c guidelines.
RESULTS
We present VFSS reference percentile tables, by consistency, for (a) timing parameters (swallow reaction time; the hyoid burst-to-upper esophageal sphincter (UES)-opening interval; UES opening duration; time-to-laryngeal vestibule closure (LVC); and LVC duration) and (b) anatomically scaled pixel-based measures of maximum UES diameter, pharyngeal area at maximum pharyngeal constriction and rest, residue (vallecular, pyriform, other pharyngeal locations, total), and hyoid kinematics (X, Y, XY coordinates of peak position; speed). Clinical decision limits are proposed to demarcate atypical values of potential clinical concern.
CONCLUSION
These updated reference percentiles and proposed clinical decision limits are intended to support interpretation and reliability for VFSS assessment data.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.24043041.
Topics: Adult; Humans; Male; Deglutition; Deglutition Disorders; Reference Values; Reproducibility of Results; Esophageal Sphincter, Upper; Fluoroscopy
PubMed: 37669617
DOI: 10.1044/2023_JSLHR-23-00246 -
Journal of Speech, Language, and... Oct 2023Our study aims were (a) to examine laryngeal vestibular closure (LVC) temporal measures in healthy adults across tasks used in the Modified Barium Swallow Impairment...
PURPOSE
Our study aims were (a) to examine laryngeal vestibular closure (LVC) temporal measures in healthy adults across tasks used in the Modified Barium Swallow Impairment Profile (MBSImP) protocol to establish normative reference values and (b) to examine influences of age, gender, and swallow task on LVC temporal measures.
METHOD
A retrospective analysis of 195 healthy adults (85 men, 110 women; age range: 21-89 years) who participated in a videofluoroscopic swallowing study was completed. Seven swallow tasks of standardized viscosities and volumes, as per the MBSImP protocol, were analyzed to measure time-to-LVC and LVC duration (LVCd). Descriptive statistics were employed for all measures of interest. Regression modeling was used to explore relationships between LVC temporal measures (time-to-LVC, LVCd) with age, gender, and swallow task. The relationship between time-to-LVC and LVCd was also explored.
RESULTS
Significant findings included an increasing trend in LVCd across age (older individuals had a longer LVCd), with women demonstrating a greater increase. Related to viscosity, LVCd was significantly shorter for pudding compared to thin liquid. Furthermore, when compared to 5-ml tasks, LVCd was significantly longer in cup tasks, while time-to-LVC was significantly shorter. An association was also observed between time-to-LVC and LVCd: As time-to-LVC decreased, LVCd increased.
CONCLUSIONS
LVCd was influenced by age, gender, and swallow task. Longer time-to-LVC was observed in older individuals, particularly older women, and with thin liquids. Study findings contribute to adult normative reference values for LVC temporal measures (time-to-LVC and LVCd) across MBSImP swallowing tasks.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.24126432.
Topics: Male; Adult; Humans; Female; Aged; Young Adult; Middle Aged; Aged, 80 and over; Retrospective Studies; Larynx; Deglutition; Deglutition Disorders; Fluoroscopy
PubMed: 37751725
DOI: 10.1044/2023_JSLHR-22-00741 -
European Archives of... Dec 2023Dysphagia is common after radiotherapy for head and neck cancer (HNC) and can affect health-related quality of life (HRQL). This randomized controlled trial aimed to... (Randomized Controlled Trial)
Randomized Controlled Trial
A randomized controlled study evaluating the head-lift exercise in head and neck cancer patients with radiation-induced dysphagia: effect on swallowing function and health-related quality of life over 12 months.
PURPOSE
Dysphagia is common after radiotherapy for head and neck cancer (HNC) and can affect health-related quality of life (HRQL). This randomized controlled trial aimed to evaluate the effect of the head-lift exercise (HLE) over 12 months in HNC patients with radiation-induced dysphagia.
METHODS
Sixty-one patients with dysphagia were randomized to intervention group (n = 30) and control group (n = 31) at 6-36 months after completion of radiotherapy for HNC. Dysphagia-specific HRQL was measured with the MD Anderson Dysphagia Inventory (MDADI); general and HNC-specific HRQL was measured with the European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30) and QLQ-H&N35. Measurements were made at baseline, and at 8 weeks and 12 months after start of intervention.
RESULTS
Adherence to the intervention was good throughout the year. When comparing change from baseline reports to each follow-up no statistically significant differences between the groups were found in any of the HRQL instruments. There were some statistically significant changes within groups compared to baseline. The intervention group improved self-rated swallowing function on the MDADI at 8 weeks (emotional domain, p = 0.03; functional domain, p = 0.007; total score, p = 0.01) and the control at twelve months (emotional domain, p = 0.03; functional domain, p = 0.02; physical domain, p = 0.004; total score, p = 0.002).
CONCLUSION
In this randomized control study, no effect was observed short term or at 12 months on HRQL after use of the HLE as rehabilitation for radiation-induced dysphagia.
Topics: Humans; Deglutition Disorders; Deglutition; Quality of Life; Head and Neck Neoplasms; Exercise; Surveys and Questionnaires
PubMed: 37584752
DOI: 10.1007/s00405-023-08183-7 -
Nutricion Hospitalaria Nov 2023Introduction: dysphagia is classified under "symptoms and signs involving the digestive system and abdomen" in the International Classification of Diseases (ICD-10, code...
Introduction: dysphagia is classified under "symptoms and signs involving the digestive system and abdomen" in the International Classification of Diseases (ICD-10, code R13). It is defined as obstruction in the region of the pharynx, sternum or xiphoid because of obstruction of the passage of food from the mouth to the stomach or cardia, and has become one of the most important causes affecting the adequate intake of energy and nutrients. An optimal dietary and nutritional approach plays a crucial role in the management of dysphagia. The main goal of such an approach is to ensure safe and sufficient nutrition to prevent malnutrition and complications associated with dysphagia. Objectives: to establish an action protocol for an effective dietary and nutritional approach in patients with dysphagia based on the existing scientific evidence. Methods: a review of the scientific literature on the dietary-nutritional approach to dysphagia was carried out. Results: the dietary and nutritional approach in patients with dysphagia requires a multidisciplinary and personalized approach and is essential to improve the quality of life of patients with dysphagia. Through the implementation of an evidence-based action protocol, it is possible to guarantee preventing aspiration and ensuring safe swallowing and modification of textures of different foods (thus promoting adequate intake of nutrients and fluids to avoid malnutrition and dehydration). Conclusion: adequate and protocolized management, from a dietary and nutritional point of view, can have a significant impact on the quality of life of patients, improving their well-being and preventing complications associated with this condition.
Topics: Humans; Deglutition Disorders; Quality of Life; Diet; Nutritional Status; Malnutrition; Review Literature as Topic
PubMed: 37929911
DOI: 10.20960/nh.04957 -
Dysphagia Feb 2024Tongue function is vital for chewing and swallowing and lingual dysfunction is often associated with dysphagia. Better treatment of dysphagia depends on a better... (Review)
Review
Tongue function is vital for chewing and swallowing and lingual dysfunction is often associated with dysphagia. Better treatment of dysphagia depends on a better understanding of hyolingual morphology, biomechanics, and neural control in humans and animal models. Recent research has revealed significant variation among animal models in morphology of the hyoid chain and suprahyoid muscles which may be associated with variation in swallowing mechanisms. The recent deployment of XROMM (X-ray Reconstruction of Moving Morphology) to quantify 3D hyolingual kinematics has revealed new details on flexion and roll of the tongue during chewing in animal models, movements similar to those used by humans. XROMM-based studies of swallowing in macaques have falsified traditional hypotheses of mechanisms of tongue base retraction during swallowing, and literature review suggests that other animal models may employ a diversity of mechanisms of tongue base retraction. There is variation among animal models in distribution of hyolingual proprioceptors but how that might be related to lingual mechanics is unknown. In macaque monkeys, tongue kinematics-shape and movement-are strongly encoded in neural activity in orofacial primary motor cortex, giving optimism for development of brain-machine interfaces for assisting recovery of lingual function after stroke. However, more research on hyolingual biomechanics and control is needed for technologies interfacing the nervous system with the hyolingual apparatus to become a reality.
Topics: Animals; Humans; Deglutition; Deglutition Disorders; Mastication; Tongue; Hyoid Bone; Biomechanical Phenomena
PubMed: 37326668
DOI: 10.1007/s00455-023-10596-9