Discriminant Ability of the Eating Assessment Tool-10 to Detect Swallowing Safety and Efficiency Impairments

Nutritional Status, Dietary Intake, Quality of Life, and Dysphagia in Women With Fibromyalgia

BACKGROUND

Fibromyalgia syndrome (FMS) is an idiopathic chronic disease characterized by widespread musculoskeletal pain, hyperalgesia, and allodynia that has been recently associated with risk of dysphagia.

OBJECTIVE

We aimed to analyze the association between nutritional status, micro- and macronutrient intake, and quality of life (QoL) in a cohort of women with FMS and risk of dysphagia compared to women with FMS without risk of dysphagia.

METHODS

A cross-sectional study was conducted in 46 women with FMS. Risk of dysphagia was assessed by the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST). The Food Frequency Questionnaire and the Swallowing Quality of Life Questionnaire were used to assess dietary intake and QoL, respectively.

RESULTS

Thirty women with FMS were at risk for dysphagia (65.21%), assessed by the EAT-10. Based on the V-VST, the frequency of risk of dysphagia was 63.04%. Significant differences in body mass index (BMI) were found between women at risk for dysphagia and those without risk. Women at risk for dysphagia had significantly lower overall QoL scores than those women without risk. No significant differences were found for dietary intake and dysphagia risk.

DISCUSSION

Women with FMS at risk for dysphagia have significantly lower BMI values and worse QoL than women without dysphagia risk, supporting the importance of assessing dysphagia in clinical practice in persons with FMS.

Orofacial Pain and Risk of Dysphagia in Women With Fibromyalgia: A Cross-Sectional Observational Study

OBJECTIVE

This study aims to analyze the frequency of dysphagia risk and swallowing-associated quality of life (QoL) in a sample of women with fibromyalgia syndrome (FMS) and examine the potential relationship between risk of dysphagia and chronic orofacial pain (COP) in a sample of women with FMS.

METHOD

A cross-sectional observational study was conducted in 46 women with FMS. COP was assessed by mouth opening, the orofacial visual analog scale (VAS), and the craniofacial pain and disability inventory (CF-PDI). Risk of dysphagia was assessed using the Eating Assessment Tool (EAT-10) and the volume-viscosity swallowing test (V-VST). Swallowing-associated QoL was determined using the Swallowing Quality of Life (SWAL-QOL) questionnaire.

RESULTS

Thirty patients were identified as being at risk for dysphagia (65.21%) using the EAT-10 and, according to the SWAL-QOL, 41.30% of patients had alterations in QoL associated with swallowing. The EAT-10 correlated positively with orofacial VAS, CF-PDI-total, CF-PDI-pain and disability, and CF-PDI-jaw-functional status. In relation to SWAL-QOL, negative correlations were observed for orofacial VAS, CF-PDI-total, CF-PDI-pain and disability, and CF-PDI-jaw-functional status. Patients at risk of dysphagia (EAT-10 and V-VST) had significantly higher scores in orofacial VAS (p = .002 and p = .015), CF-PDI-total (p = .006 and p = .014), and CF-PDI-pain and disability (p = .004 and p = .013).

CONCLUSIONS

In this sample of women with FMS, we identified a high rate of dysphagia risk. Also, a high percentage of these women presented alterations in QoL associated with swallowing. Patients at risk for dysphagia had significantly higher orofacial VAS and CF-PDI-total scores, supporting the relationship between dysphagia risk and COP in FMS. Further research to establish the need for appropriate assessment referrals in clinical practice to determine whether dysphagia is present in this population is needed.

Eating Assessment Tool (EAT-10) Scores to Detect Self-Reported Dysphagia in Brazilians

The Eating Assessment Tool (EAT-10) detects swallowing impairments (dysphagia) self-reported by patients according to their perception. This noninvasive, inexpensive, self-administered instrument is quickly and easily filled out. The objective of this investigation was to evaluate the scores, sensitivity, and specificity of the method to define self-reported dysphagia in Brazilians. EAT-10 scores were evaluated in 443 healthy individuals (273 women and 170 men), aged 20 to 84 years, with no swallowing difficulties or diseases, and 72 patients with diseases that cause dysphagia (35 women and 37 men), aged 29 to 88 years. Each of the 10 instrument items has a 0-4 rating scale, in which 0 indicates no problem and 4, a severe problem; total results range from 0 to 40. The median EAT-10 score of healthy subjects was 0 (range: 0-20), and that of patients was 14.5 (range: 1-40). Considering a ≥ 3 cutoff score to define dysphagia risk, it was self-reported by 97.2% of patients with dysphagia and 9.5% of no-disease individuals (97.2% sensitivity and 90.7% specificity). The positive predictive value of the test was 63% and the negative predictive value was 99.5%. Healthy women had higher scores (median 0, range: 0-20) than healthy men (median 0, range: 0-8, p < 0.01) and more results indicative of self-reported dysphagia (11.7%) than healthy men (5.9%). The EAT-10 cutoff score to detect self-reported dysphagia in Brazilians should be 3, as previously considered. Healthy women complain more of self-reported dysphagia than healthy men. The test has high sensitivity and specificity.

Diagnostic utility of different dysphagia screening tools to detect dysphagia in individuals with amyotrophic lateral sclerosis

OBJECTIVE

Dysphagia is a common and serious clinical symptom of amyotrophic lateral sclerosis (ALS). The study aimed to evaluate the diagnostic utility of four dysphagia screening tools in ALS, including the ALS Functional Rating Scale-Revised (ALSFRS-R) bulbar subscale, water-swallowing test (WST), Eating Assessment Tool-10 (EAT-10) and Sydney Swallow Questionnaire (SSQ).

METHODS

A total of 68 individuals from First Hospital, Shanxi medical university, were recruited in the study. The ALSFRS-R, WST, EAT-10, SSQ and the gold standard video fluoroscopic swallowing study (VFSS) were performed. The Penetration Aspiration Scale (PAS) during VFSS was assessed to identify unsafe swallowing (PAS ≥ 3) and aspiration (PAS ≥ 6). Receiver operator characteristic curve (ROC) analyses were performed to evaluate the accuracy of the 4 tools. Youden index was used to determine the ideal cut-off value for each tool.

RESULTS

Of the patients, 20.59% (14/68) presented unsafety swallowing and 16.18% (11/68) had aspiration. The four tools could effectively identify patients with unsafe swallowing and aspiration. The EAT-10 had the maximum AUC (0.873 and 0.963, respectively) among the tools in the diagnosis of unsafe swallowing and aspiration. To detect unsafe swallowing and aspiration, an EAT-10 score of 6 (sensitivity: 78.6%, specificity: 87.0%) and an EAT-10 score of 8 (sensitivity: 90.9%, specificity: 91.2%), were the most appropriate cut-off points, respectively.

CONCLUSIONS

The ALSFRS-R bulbar subscale, WST, EAT-10, and SSQ could effectively identify unsafe swallowing and aspiration in patients with ALS. Of the four tools, the EAT-10 was relatively accurate, safe, and convenient. Further studies including more patients should be conducted to verify the conclusions.

The discriminant ability of the eating assessment tool-10 questionnaire to detect residue and aspiration in patients with mixed etiology of dysphagia

PURPOSE

To investigate the discriminant ability of the eating assessment tool-10 (EAT-10) to detect postswallow residue and aspiration for different consistencies.

METHODS

Seventy-two consecutive patients with mixed etiology of dysphagia (42 males and 30 females, mean ± sd age of 60.42 ± 15.82) were included. After completing the EAT-10, Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed to assess the efficiency and safety of swallowing for the following consistencies: thin liquid, nectar thick, yogurt, and solid. While swallowing efficiency was evaluated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the Penetration-Aspiration Scale (PAS) was used to evaluate swallowing safety.

RESULTS

The EAT-10 questionnaire significantly identified the patients with residue from those without residue for the following consistencies and anatomic locations: thin liquid residue in the pyriform sinus (cutoff score ≥ 10, p = 0.009), nectar thick residue in the vallecula (cutoff score ≥ 15, p = 0.001), yogurt residue in the vallecula (cutoff score ≥ 15, p = 0.009), yogurt residue in the pyriform sinus (cutoff score ≥ 9, p = 0.015), and solid residue in the vallecula (cutoff score ≥ 13, p = 0.016). However, the same discriminant ability of EAT-10 was not found for detecting aspiration in any consistency.

CONCLUSIONS

The EAT-10 questionnaire can be used as an assessment tool to judge swallowing efficiency in patients with mixed etiology of dysphagia, but the same is not evident for swallowing safety.

History and Science behind the Eating Assessment Tool-10 (Eat-10): Lessons Learned

INTRODUCTION

Oropharyngeal dysphagia (OD) is an underdiagnosed medical condition with a high prevalence in populations such as patients with frailty, neurological disease, or head and neck pathology. Potential barriers to its diagnosis include lack of (or low) awareness of the existence and severity of the condition, the hidden nature of the condition within the 'normal ageing' process, clinical limitations, and socioeconomic reasons. Consequently, an effective treatment is not systematically offered in a timely manner, and complications, such as dehydration and respiratory infections or aspiration pneumonia, can arise. To overcome this issue, the early use of screening questionnaires to identify people at risk of swallowing disorders represents the cornerstone of preventive medicine. Several screening tools have been created but few are widely used in clinical practice. The Eating Assessment Tool-10 (EAT-10) was developed as a quick, easy-to-understand, and self-administered screening tool for OD.

METHODS

A literature review was conducted in five databases with no restrictions on the language, date of publication, or design of the study to identify aspects of the validation, applicability, and usefulness of EAT-10.

RESULTS AND CONCLUSIONS

Transcultural adaptation and translation studies, as well as studies involving various types of patients with dysphagia in different settings have shown the validity and reliability of EAT-10 in relation to the gold standard and other validation tools. The use of this standardised screening tool could be used as a primary screening instrument of dysphagia in routine clinical practice across a wide range of diseases and settings and thereby increase the likelihood of early diagnosis and management of a condition that lead to serious complications and impaired quality of life.

Prevalence and management of dysphagia in nursing home residents in Europe and Israel: the SHELTER Project

Background

Dysphagia is a frequent condition in older nursing home residents (NHRs) which may cause malnutrition and death. Nevertheless, its prevalence is still underestimated and there is still debate about the appropriateness and efficacy of artificial nutrition (AN) in subjects with severe dysphagia. The aim is to assess the prevalence of dysphagia in European and Israeli NHRs, its association with mortality, and the relationship of different nutritional interventions, i.e. texture modified diets and AN—with weight loss and mortality.

Methods

A prospective observational study of 3451 European and Israeli NHRs older than 65 years, participating in the SHELTER study from 2009 to 2011, at baseline and after 12 months. All residents underwent a standardized comprehensive evaluation using the interRAI Long Term Care Facility (LTCF). Cognitive status was assessed using the Cognitive Performance Scale (CPS), functional status using Activities of Daily Living (ADL) Hierarchy scale. Trained staff assessed dysphagia at baseline by clinical observation. Data on weight loss were collected for all participants at baseline and after 12 months. Deaths were registered by NH staff.

Results

The prevalence of dysphagia was 30.3%. During the one-year follow-up, the mortality rate in subjects with dysphagia was significantly higher compared with that of non-dysphagic subjects (31.3% vs 17.0%,p = 0,001). The multivariate analysis showed that NHRs with dysphagia had 58.0% higher risk of death within 1 year compared with non-dysphagic subjects (OR 1.58, 95% CI, 1.31–1.91). The majority of NHRs with dysphagia were prescribed texture modified diets (90.6%), while AN was used in less than 10% of subjects. No statistically significant difference was found concerning weight loss and mortality after 12 months following the two different nutritional treatments.

Conclusions

Dysphagia is prevalent among NHRs and it is associated with increased mortality, independent of the nutritional intervention used. Noticeably, after 12 months of nutritional intervention, NHRs treated with AN had similar mortality and weight loss compared to those who were treated with texture modified diets, despite the clinical conditions of patients on AN were more compromised.

Pilot Study of Respiratory-Swallow Coordination in Amyotrophic Lateral Sclerosis

PURPOSE

Amyotrophic lateral sclerosis (ALS) impacts bulbar and respiratory musculature, which may contribute to impaired swallow function (dysphagia) and respiratory-swallow coordination. The purpose of this pilot study was to examine if respiratory-swallow coordination in individuals with ALS was perturbed compared to healthy controls. We further explored relationships between measures of respiratory function and self-reported swallowing outcomes on respiratory-swallow coordination.

METHOD

We employed a cross-sectional design with eight participants with ALS and eight age- and sex-matched healthy participants. Respiratory inductance plethysmography and a nasal cannula were used to capture respiratory-swallow phase patterns during a standardized clinical swallow examination. The advantageous respiratory-swallow phase pattern was defined if exhalation surrounded the swallow (E-E). Spirometry was used to capture indices of respiratory function (forced vital capacity % predicted, peak cough flow [PCF]). Validated questionnaires were used to collect information regarding ALS-related bulbar functional status and swallowing-related concerns.

RESULTS

Compared to the matched healthy cohort, individuals with ALS demonstrated higher rates of non-E-E respiratory-swallow phase patterning and worse bulbar/swallow dysfunction. Group (ALS), swallow tasks, and PCF were significantly associated with respiratory-swallow phase pattern.

CONCLUSIONS

These preliminary findings support altered respiratory-swallow phase patterning in ALS. Future work should employ an instrumental assessment to quantify swallowing physiology and elucidate the relationship between perturbed respiratory-swallow coordination and swallowing function.