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Zuckerman M, Wang S, Kaneoka A, Coster WJ, Leonard R, Langmore SE, Pisegna JM. Conceptualizing Adult Dysphagia in the United States Within the International Classification of Functioning, Disability and Health (ICF). Arch Phys Med Rehabil 2024; 105:1008-1018. [PMID: 38072229 DOI: 10.1016/j.apmr.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/10/2023] [Accepted: 11/28/2023] [Indexed: 02/26/2024]
Abstract
Despite the well-documented safety concerns and effect on quality of life, there does not yet exist a wide-reaching framework that links the etiologies of swallowing disorders to the potential short- and long-term outcomes in the context of International Classification of Functioning, Disability and Health (ICF). This paper introduces an expert-reviewed conceptual framework to highlight common etiologies of dysphagia as well as integrate immediate outcomes of dysphagia with long-term outcomes of dysphagia in terms of medical problems, health-related quality of life, functional effect, and psychosocial features. It also outlines the potential cyclical nature of long-term dysphagia outcomes perpetuating the original dysphagia. This framework serves to inform clinicians of important dysphagic outcomes and to bring awareness to long-term outcomes that should be monitored by health care professionals, caregivers, or people with dysphagia.
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Affiliation(s)
- Melani Zuckerman
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Shawn Wang
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Asako Kaneoka
- The University of Tokyo Hospital Rehabilitation Center, Tokyo, Japan
| | - Wendy J Coster
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA 02215, United States
| | - Rebecca Leonard
- University of California at Davis, Davis, CA 95616, United States
| | - Susan E Langmore
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Jessica M Pisegna
- Boston Medical Center, 800 Harrison Ave, BCD Building, 5th Floor, Boston, MA 02118, United States; Department of Speech Language Pathology, Boston University, Sargent College, 635 Commonwealth Ave, Boston, MA 02215, United States.
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2
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Adams R, Crisp DA, Thomas J. The Psychological Impacts of Pill Dysphagia: A Mixed Methods Study. Dysphagia 2024:10.1007/s00455-024-10703-4. [PMID: 38634944 DOI: 10.1007/s00455-024-10703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024]
Abstract
Pill dysphagia is a common problem amongst older adults, with significant health consequences. Previous research has found that dysphagia can negatively affect an individuals mental health and wellbeing. However, this research has not been extended to pill-specific dysphagia, which presents distinct differences from the challenges posed by swallowing food and liquids. These differences extend to causes, demographics, and physical health ramifications. This study aimed to address this gap in the literature by investigating the effects of pill dysphagia on the wellbeing of older adults. A community sample of 132 Australians aged 65-97 years completed a survey about their wellbeing and difficulty swallowing pills. Thirty-one participants who met the criteria for pill dysphagia completed further open-ended questions detailing the effects of pill dysphagia and how they manage it. Analyses of the quantitative data indicated that difficulty swallowing pills was unrelated to negative affect but negatively related to positive affect, life satisfaction, and eudemonic wellbeing. Supplementary analyses controlling for health-related variables found no significant relationships between difficulty swallowing pills and wellbeing. Responses to the open-ended questions revealed a range of physical, psychological, and practical impacts of pill dysphagia, and successful and unsuccessful methods used to assist in swallowing pills. The findings partially support the hypothesised effects of pill dysphagia on wellbeing. However, further research is required to establish if more severe pill dysphagia predicts wellbeing over and above self-rated health. Future interventions should incorporate wellbeing promotion strategies for older adults with pill dysphagia.
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Affiliation(s)
- Rowan Adams
- Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Dimity A Crisp
- Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia.
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
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3
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Naidoo L, Pillay M, Naidoo U. Who really decides? Feeding decisions 'made' by caregivers of children with cerebral palsy. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e14. [PMID: 38572900 PMCID: PMC11019338 DOI: 10.4102/sajcd.v71i1.1001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic 'doctor knows best' approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically. OBJECTIVES This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector. METHOD A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis. RESULTS Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers' families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation. CONCLUSION Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.Contribution: This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.
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Affiliation(s)
- Lavanya Naidoo
- Discipline of Speech-Language Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and Department of Speech Language Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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4
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Santos SVP, Araújo BCL, Sordi C, Cesar CPHAR, de Andrade DDCM, Batista TSC, Schneiberg S. Swallowing capacity and gravity of the laryngotracheal aspiration risk in atypical cerebellar stroke: case report. Codas 2023; 35:e20210220. [PMID: 37909490 PMCID: PMC10688292 DOI: 10.1590/2317-1782/20232021220pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/04/2022] [Indexed: 11/03/2023] Open
Abstract
This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.
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Affiliation(s)
- Sara Virgínia Paiva Santos
- Programa de Pós-graduação de Ciências Aplicadas a Saúde - PPGCAS, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
| | - Brenda Carla Lima Araújo
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - São Cristóvão (SE), Brasil.
| | - Claudia Sordi
- Departamento de Fonoaudiologia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
| | | | | | | | - Sheila Schneiberg
- Programa de Pós-graduação de Ciências Aplicadas a Saúde - PPGCAS, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
- Departamento de Fisioterapia, Universidade Federal de Sergipe - UFS - Lagarto (SE), Brasil.
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5
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Faulks D, Scambler S, Daly B, Jamieson L, Hennequin M, Tsakos G. Measuring oral health-How can the International Classification of Functioning help? Community Dent Oral Epidemiol 2023; 51:153-164. [PMID: 35112389 DOI: 10.1111/cdoe.12732] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
There is a need for a theoretically informed, contextualized approach to measuring oral health from a multidisciplinary perspective that goes beyond the commonly used clinical indices and sociodental measures. This commentary aims to discuss the potential for the WHO's International Classification of Functioning, Disability and Health (ICF) to provide a model for the development of indicators for oral health. It is suggested that the ICF might provide both a theoretical model and an operational classification for indicators of oral health. The ICF model states that human experience of physical, cognitive and social functioning is universal and, thus, can be described and qualified. Human function is given social and environmental context within the model at both an individual and population level. The ICF can not only capture data regarding oral health and function at the physiological level (e.g. chewing) but also at the social level (e.g. sharing meals). It is able not only to capture aspects of preventive behaviour (e.g. caring for teeth) but also aspects of social facilitation (e.g. economic self-sufficiency) or ability to fulfil a social role (e.g. remunerative employment). It also includes aspects of social environment, such as healthcare services or political, economic and legal systems. Case studies are given as examples of the potential use of the ICF in the oral health domain. Examples are also given of the first steps that have been made towards operationalization of the ICF in data collection and oral health research. The challenges of encompassing such a comprehensive model into a practical oral health measure are discussed.
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Affiliation(s)
- Denise Faulks
- Service d'Odontologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Centre de Recherche en Odontologie Clinique (CROC) EA4847, Université Clermont Auvergne, UFR d'Odontologie, Clermont-Ferrand, France
| | - Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, Tower Wing, Guy's Campus, London, UK
| | - Blánaid Daly
- Trinity College Dublin, School of Dental Sciences and Dublin Dental University Hospital, Dublin 2, Ireland
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Martine Hennequin
- Service d'Odontologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Centre de Recherche en Odontologie Clinique (CROC) EA4847, Université Clermont Auvergne, UFR d'Odontologie, Clermont-Ferrand, France
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, UCL, London, UK
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6
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Coutts K, Sayed B. Third party disability of family members of adults with dysphagia. Afr J Disabil 2023; 12:1040. [PMID: 36756460 PMCID: PMC9900314 DOI: 10.4102/ajod.v12i0.1040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/30/2022] [Indexed: 02/05/2023] Open
Abstract
Background Third-party disability (TPD) has been studied in multiple patients including those with aphasia and hearing loss. Only one study has been done in relation to caregivers of adults with dysphagia. Third-party disability has been analysed using the International Classification of Function and Disability (ICF) framework. This study, therefore, used the ICF model to explore TPD of caregivers of adults with dysphagia for the context of Johannesburg in South Africa. Objectives To describe how caregivers experience TPD when caring for adults with a dysphagia in Johannesburg. Methods Data were collected from five primary adult caregivers, who were all family members, from government clinics in Johannesburg. This article reports the findings from the interviews that were analysed thematically using a top-down analysis approach. Results Caregivers experienced challenges related to TPD mostly related to difficulties of being able to do activities of daily living for themselves, their household chores and attending social engagements. The use of body structure and function from the ICF model was not overtly applicable to the caregiver population. A new visual representation has been suggested to highlight the key themes to augment the social and psychological changes as seen on the ICF framework and demonstrated the specific interaction that these factors had on one another. Conclusion Third-party disability is present in caregivers of patients with dysphagia. Healthcare workers need to be aware of the impact that this can have when preparing home management strategies. This newly devised representation can assist in creating a locally relevant patient-centred care approach but requires future input. Contribution This article has provided greater insight into TPD in caregivers of adult patients with dysphagia in an urban African context. It has led to new information that can be used as an adjunct to the ICF model when understanding this phenomenon.
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Affiliation(s)
- Kim Coutts
- Department of Speech Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Bibi Sayed
- Department of Speech Pathology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
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Lowe SM, Nobriga CV. Head and Neck Cancer in a Rural U.S. Population: Quality of Life, Coping, Health Care Literacy, and Access to Services. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1116-1133. [PMID: 33970685 DOI: 10.1044/2021_ajslp-20-00223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to explore the beliefs, access, and motivations of individuals with head and neck cancer (HNC) living in a rural community in the United States, regarding their speech and swallowing deficits. Method A convenience sample of nine patient participants with HNC and nine caregiver participants completed in-depth, semistructured interviews regarding their experiences with HNC diagnosis and treatment. The researchers utilized a thematic networks approach to analyze the qualitative data obtained. Results Primary results of the study were a set of common themes emerging from 735 units for analysis, arranged into 34 basic themes, nine organizing themes, and four global themes. The resulting networks centered around quality of life impact, coping, health literacy, and access. Direct quotes from the participants are utilized to illustrate response categories. Conclusions Individuals with HNC and their caregivers living in rural communities in the United States appear to represent a unique subset of the HNC population. While they present similarly in most areas, they display unique tendencies in the areas of psychological coping, health literacy, and access. Provision of practical, pertinent information that can be accessed by patients and caregivers alike outside the hospital is suggested to better serve this community.
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Affiliation(s)
- Shawn M Lowe
- Department of Communication Sciences and Disorders, Loma Linda University, CA
| | - Christina V Nobriga
- Department of Communication Sciences and Disorders, Loma Linda University, CA
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8
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Davis C, Namasivayam-MacDonald AM, Shune SE. Contributors to Poststroke Dysphagia-Related Caregiver Burden. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1061-1073. [PMID: 33789060 DOI: 10.1044/2021_ajslp-20-00250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Caregiver burden negatively impacts both stroke survivor and caregiver well-being. Thus, it is important to better understand the individual- and dyadic-level variables that may contribute to dysphagia-related caregiver burden. The aim of this preliminary study was to identify survivor-, caregiver-, and dyadic-specific factors associated with burden in couples experiencing poststroke dysphagia. Method Twenty-eight stroke survivors ("care recipients") with dysphagia and their spouses ("caregivers") participated. Care recipients and caregivers completed a survey from which scores for the following variables were derived: dysphagia-related caregiver burden, survivor- and spouse-perceived impact of dysphagia on mealtimes (social, mealtime logistics), dyadic congruence on perceived impact, International Dysphagia Diet Standardisation Initiative Functional Diet Scale, Swallowing-Related Quality of Life Scale, and Stroke Impact Scale (cognitive, emotional, physical, and social domains). Spearman's rho and point biserial correlation coefficients were calculated to determine the factors related to caregiver burden. Results Increased burden was significantly associated with greater care recipient- and spouse-perceived impact of dysphagia on mealtime logistics; however, burden was not associated with measures of dyadic congruence of perceived impact. Notably, increased burden was also associated with increased diet restrictiveness and decreased swallow-specific quality of life. Dysphagia-related caregiver burden was not associated with measures of stroke impact/severity across any domain. Conclusions Factors related to dysphagia-related caregiver burden are multifactorial and include both care recipient (e.g., International Dysphagia Diet Standardisation Initiative Functional Diet Scale, Swallowing-Related Quality of Life Scale, perceived impact of dysphagia on mealtime logistics) and caregiver (e.g., perceived impact of dysphagia on mealtime logistics) variables. The results of this preliminary investigation support the need to incorporate aspects of counseling and family-centered care into our management practices, a growing area of interest for speech-language pathologists.
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Affiliation(s)
- Cameron Davis
- Communication Disorders and Sciences Program, University of Oregon, Eugene
| | | | - Samantha E Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene
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9
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Coutts KA, Solomon M. The use of diet modifications and third-party disability in adult dysphagia: The unforeseen burden of caregivers in an economically developing country. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2020; 67:e1-e8. [PMID: 33314953 PMCID: PMC7736647 DOI: 10.4102/sajcd.v67i1.777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND One of the interventions for dysphagia is diet modifications, involving a variety of resources and consumables. In South Africa, where 49% of the population live below the poverty line, the necessities for it are not always feasible for the patient and their family. This coupled with the responsibility of caring for a loved one with disability can culminate into caregivers experiencing third-party disability (TPD). OBJECTIVE To describe the experiences of TPD of caregivers when implementing dysphagia management strategies at home within an economically developing country context. METHODS This was a qualitative study using phenomenological principles. Data were collected using a semi-structured self-developed interview tool at three tertiary level public sector hospitals. Seven participants and six caregivers were interviewed. Rigour was obtained through credibility, triangulation, transferability, dependability and confirmability. The data were analysed using a thematic content analysis technique following a top-down approach to coding. RESULTS The use of diet modification is an appropriate management strategy if the patients' access and contextual limitations have been taken into consideration. It was evident that the caregivers had multiple International Classification of Functioning, Disability and Health domains affected, which restricted their daily functioning including activities, participation and environmental and personal factors. CONCLUSION The management of dysphagia needs to be family centred and the caregiver's role and needs have to be considered by all team members when determining long-term management plans. The specific area of how the caregiver's quality of life was experienced also required further exploration.
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Affiliation(s)
- Kim A Coutts
- Department of Speech Pathology and Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg.
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10
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Shune SE, Namasivayam-MacDonald A. Dysphagia-Related Caregiver Burden: Moving Beyond the Physiological Impairment. ACTA ACUST UNITED AC 2020. [DOI: 10.1044/2020_persp-20-00067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Purpose
The biopsychosocial ramifications of dysphagia are widespread. However, its influence on informal caregivers and families is often overlooked. Ultimately, the health and well-being of an entire family is central to care provision. This tutorial introduces readers to the current literature on dysphagia-related caregiver burden and third-party disability, illustrates the consequences of such burden on both caregivers and patients, and suggests strategies for better supporting patients' informal caregivers.
Conclusions
It is essential that speech-language pathologists recognize that the consequences of dysphagia are not limited to the impairment itself and acknowledge dysphagia's substantial impact on the entire family system. More general health care literature suggests that asking caregivers individual questions, modifying the language used to talk with them, providing them with targeted education and resources, and organizing support groups may all be beneficial for increased perceived support and self-efficacy. Ultimately, in order to best meet the needs of our patients with dysphagia, we must also better meet the needs of their families and other informal caregivers.
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Howells SR, Cornwell PL, Ward EC, Kuipers P. Living with Dysphagia in the Community: Caregivers "do whatever it takes.". Dysphagia 2020; 36:108-119. [PMID: 32333212 DOI: 10.1007/s00455-020-10117-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/15/2020] [Indexed: 11/24/2022]
Abstract
The psychological and psychosocial impacts of dysphagia on patients are well documented, however, caregiver perspectives have received limited attention and findings have been predominantly in the head and neck cancer population. The aim of this study was to understand the experience of supporting a person with dysphagia of varying aetiologies in the community from the caregiver perspective. Using a qualitative descriptive approach grounded in phenomenology, caregivers of a person with dysphagia living at home were interviewed (n = 15). Thematic analysis revealed an overarching theme of "You do whatever it takes," describing the caregiver experience of supporting a family member/friend with dysphagia at home. This theme was underpinned by three subthemes where caregivers described (1) being a caregiver; (2) support networks; and (3) practicalities of living with dysphagia. Caregivers voiced a range of pertinent issues experienced when caring for a family member/friend with dysphagia including how personal attributes and life experience impact the caregiver role. Demonstrated through the practical and emotional supports caregivers provided, it was apparent they are instrumental in supporting a family member/friend with dysphagia to live at home and in the community successfully. Through understanding the caregiver experience, health professionals will be in a better position to involve and support caregivers who play a vital role in those living with dysphagia in the community. Incorporating caregivers as direct recipients of dysphagia services will ensure the practical and psychosocial needs of caregivers are addressed, enabling optimal care for people with dysphagia living at home.
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Affiliation(s)
- Simone R Howells
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia. .,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Petrea L Cornwell
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
| | - Elizabeth C Ward
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD, 4102, Australia.,School of Health and Rehabilitation Sciences, The University of Queesland, St Lucia Campus, St Lucia, QLD, 4072, Australia
| | - Pim Kuipers
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, PO Box 6053, Buranda, QLD, 4102, Australia
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12
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Lee YH, Goo-Yoshino S, Lew HL, Chi WC, Yen CF, Liao HF, Chen SC, Liou TH. Social participation in head and neck cancer survivors with swallowing disorder: World Health Organization Disability Assessment Schedule 2.0 study. Head Neck 2019; 42:905-912. [PMID: 31886608 DOI: 10.1002/hed.26062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 11/17/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Social function and quality of life were negatively impacted by the sequelae of treatment for the disease in the head and neck cancer survivor with swallowing disorder. METHOD Data from a total of 1023 survivors between July 2012 and November 2017 were collected from the Taiwan Data Bank of Persons with Disability. Nonparametric rank F test was used to analyze the influence of different variables on social participation. RESULTS (a) All WHODAS (World Health Organization Disability Assessment Schedule) 2.0 scores revealed significantly increased difficulty when swallowing impairment increased (P < .001). (b) Unemployment, institutionalization, severity of swallowing impairment, cancer sites, and WHODAS 2.0 score of domains 1 to 4 were negatively related to social participation, while living in rural area is related to increased social participation. CONCLUSIONS Social participation was negatively affected by many variables in this population. Among these variables, cancer sites and WHODAS 2.0 score of domains 1 to 4 were the strongest factors.
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Affiliation(s)
- Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shari Goo-Yoshino
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Henry L Lew
- Department of Communication Sciences and Disorders, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii.,Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Wen-Chou Chi
- School of Occupational Therapy, Chungshan Medical University, Taichung, Taiwan
| | - Chia-Feng Yen
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | - Hua-Fang Liao
- Taiwan Association of Child Development and Early Intervention, Hualien City, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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13
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Pizzorni N, Valentini D, Gilardone M, Borghi E, Corbo M, Schindler A. The Mealtime Assessment Scale (MAS): Part 1 - Development of a Scale for Meal Assessment. Folia Phoniatr Logop 2019; 72:169-181. [PMID: 30999311 DOI: 10.1159/000494135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/26/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS Safety and efficacy of swallowing in instrumental assessment may not overlap safety and efficacy of swallowing during meal, as personal and environmental factors can influence the performance. This study aims to develop a scale to assess the safety and efficacy of swallowing during meal. METHODS A working group discussed the latent construct, target population, and purposes of the scale. Items were generated based on the International Classification of Functioning framework. Thirty-nine items were created and divided into 4 subscales. A pilot test was conducted on 40 patients, assessed by a speech and language therapist (SLT) while consuming a meal. In 10 patients, meal observation was simultaneously conducted by 2 SLTs to assess inter-rater agreement. Criteria for identification of items candidate for exclusion or revision were defined. RESULTS Twelve items were "not assessable" in at least 10% of the patients. An inter-item correlation r >0.7 was found in 2 cases and a discrimination index equal to 0 in 7/22 items. Inter-rater agreement was satisfactory. After item revision, the Mealtime Assessment Scale (MAS) was created, including 26 items divided into 4 subscales. CONCLUSION The MAS was developed to assess the safety and efficacy of swallowing during meal. A validation process should be conducted.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "L. Sacco," Università degli Studi di Milano, Milan, Italy, .,Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy,
| | - Debora Valentini
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Marco Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Elisa Borghi
- Department of Biomedical and Clinical Sciences "L. Sacco," Università degli Studi di Milano, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco," Università degli Studi di Milano, Milan, Italy
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14
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What Are We Really Measuring? A Content Comparison of Swallowing Outcome Measures for Head and Neck Cancer Based on the International Classification of Functioning, Disability and Health (ICF). Dysphagia 2019; 34:575-591. [PMID: 30945002 DOI: 10.1007/s00455-019-10005-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
A combination of outcome measures are required to provide important information on the physiological profile and associated impact of dysphagia in head and neck cancer (HNC). Choosing the most appropriate tool can be a difficult and time-consuming process. The aim of this study was to identify and then compare the content of tools commonly used to assess swallowing post HNC care using the International Classification of Functioning Disability and Health (ICF) as a reference. A literature audit of 11 databases was conducted for relevant articles published between January 2004 and June 2017 and total of 502 papers met the inclusionary criteria. These papers were audited and 27 tools were identified which met the study criteria. The meaningful concepts contained in each tool were mapped to the ICF. Within the 27 tools, 898 meaningful concepts were identified and matched to 60 ICF categories. The most frequently matched ICF categories related to body functions, while comparatively few concepts matched to activity and participation and environmental factors. This study has identified that a large number of tools are currently being used in HNC research to measure swallowing outcomes. The sheer number of tools available to explore dysphagia post HNC highlights the lack of a uniform approach to outcome measurement which limits the potential to compare and combine research studies in order to strengthen treatment evidence. There is a need to develop an international consensus for a core outcome set of swallowing related measures, that capture the holistic impact of dysphagia, for HNC.
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15
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Chan KMK, Chan HKW, Siu JYL, Pu D, Nund RL, Ward EC. Impact of Head and Neck Cancer Treatment on Survivors' Mealtime Experience. Laryngoscope 2018; 129:1572-1578. [DOI: 10.1002/lary.27501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Karen M. K. Chan
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Herman K. W. Chan
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Jerry Y. L. Siu
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Dai Pu
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences; University of Hong Kong; Pokfulam Hong Kong
| | - Rebecca L. Nund
- School of Health and Rehabilitation Sciences; University of Queensland; St. Lucia Queensland Australia
| | - Elizabeth C. Ward
- School of Health and Rehabilitation Sciences; University of Queensland; St. Lucia Queensland Australia
- Centre for Functioning and Health Research; Queensland Health; Brisbane Queensland Australia
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16
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Namasivayam-MacDonald AM, Shune SE. The Burden of Dysphagia on Family Caregivers of the Elderly: A Systematic Review. Geriatrics (Basel) 2018; 3:E30. [PMID: 31011068 PMCID: PMC6319247 DOI: 10.3390/geriatrics3020030] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/02/2018] [Accepted: 06/08/2018] [Indexed: 11/17/2022] Open
Abstract
With the rapid increase in the elderly population, there is a simultaneous increased need for care provided by family caregivers. Research in the field of head and neck cancer has indicated that caring for patients with dysphagia can impact a caregiver's quality of life. Given that many older adults present with dysphagia, one can assume that their caregivers are equally, if not more greatly, affected. The purpose of this systematic review was to examine all relevant literature regarding the caregiver burden in caregivers of community-dwelling older adults with dysphagia. A review of relevant studies published through April 2018 was conducted using search terms related to dysphagia, caregiver burden, and older adults. The search yielded 2331 unique abstracts. Of the 176 abstracts that underwent full review, four were accepted. All reported an increase in caregiver burden due to presence of dysphagia in care recipients. Worsening feeding-related behaviors were associated with burden, and the use of feeding tubes was more frequently associated with "heavy burden". The presence of dysphagia in community-dwelling older adults is a factor leading to an increased burden among caregivers. Although aspects of dysphagia play a role in the caregiver burden, the specific reasons for the increased burden are unknown. Clinicians should be aware of dysphagia as a source of the burden, and future studies should further define the relationship between dysphagia and the caregiver burden in order to develop comprehensive approaches to care.
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Affiliation(s)
| | - Samantha E Shune
- Communication Disorders and Sciences, University of Oregon, Eugene, OR 97403, USA.
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17
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Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes. Curr Opin Otolaryngol Head Neck Surg 2018; 25:101-107. [PMID: 28106661 DOI: 10.1097/moo.0000000000000340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. RECENT FINDINGS Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data. There are suggestions of less swallowing impairment following primary TOS, but the favourable selection of patients to these case series must be considered. SUMMARY Minimizing swallowing impairment following oropharyngeal squamous cell carcinoma treatment, while ensuring oncological efficacy, should be a priority for head and neck healthcare providers. Primary TOS may offer an advantage to patients, but only through a team approach that considers how adjuvant oncological therapy could be tailored to individuals. High-quality clinical trials are in progress that will inform future practice.
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18
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Van den Steen L, Vanderveken O, Vanderwegen J, Van Gestel D, Daisne JF, Allouche J, Delacroix L, Van Rompaey D, Beauvois S, Cvilic S, Mariën S, Desuter G, Vermorken JB, Van den Weyngaert D, Specenier P, Van Laer C, Peeters M, Van de Heyning P, Chantrain G, Lawson G, Lazarus C, De Bodt M, Van Nuffelen G. Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients. Support Care Cancer 2017; 25:3417-3423. [PMID: 28573486 DOI: 10.1007/s00520-017-3761-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of tongue strength measures (TSMs) and the influence of bulb location, sex, and self-perceived pain and mucositis in head and neck cancer (HNC) patients during chemoradiotherapy (CRT). METHODS Twenty-six newly diagnosed HNC patients treated with CRT performed anterior and posterior maximal isometric tongue pressures by means of the Iowa Oral Performance Instrument (IOPI). The Oral Mucositis Weekly Questionnaire (OMWQ) and a Visual Analogue Scale (VAS) for pain during swallowing were completed weekly from baseline to 1 week post CRT. RESULTS Feasibility of TSMs during CRT declines significantly from 96 to 100% at baseline to 46% after 6 weeks of CRT. But post-hoc analyses reveal only significant differences in feasibility between baseline and measurements after 4 weeks of treatment. No effect of gender or bulb location was established, but feasibility is influenced by pain and mucositis. CONCLUSIONS Feasibility of TSMs declines during CRT and is influenced by mucositis and pain. For the majority of subjects, TSMs were feasible within the first 4 weeks, which provides a window of scientific and clinical opportunities in this patient population.
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Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Jan Vanderwegen
- University College Thomas More, Antwerp, Belgium.,CHU Saint-Pierre, Brussels, Belgium
| | - Dirk Van Gestel
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-François Daisne
- Université Catholique de Louvain, CHU-UCL-Namur, Site Sainte-Elisabeth, Namur, Belgium
| | | | - Laurence Delacroix
- Université Catholique de Louvain, CHU-UCL-Namur, Site Godinne, Yvoir, Belgium
| | - Diane Van Rompaey
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Sylvie Beauvois
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Gauthier Desuter
- Cliniques Universitaires St-Luc, Universite Catholique de Louvain, Brussels, Belgium
| | - Jan Baptist Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Georges Lawson
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Cathy Lazarus
- Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Department of Otorhinolaryngology of the Albert Einstein College of Medicine, Department of Otorhinolaryngology, New York, NY, USA
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, Ghent, Belgium
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19
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Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery. Curr Opin Otolaryngol Head Neck Surg 2017; 25:182-187. [PMID: 28306585 DOI: 10.1097/moo.0000000000000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). RECENT FINDINGS Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. SUMMARY Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.
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20
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21
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Dong Y, Zhang CJ, Shi J, Deng J, Lan CN. Clinical application of ICF key codes to evaluate patients with dysphagia following stroke. Medicine (Baltimore) 2016; 95:e4479. [PMID: 27661012 PMCID: PMC5044882 DOI: 10.1097/md.0000000000004479] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study was aimed to identify and evaluate the International Classification of Functioning (ICF) key codes for dysphagia in stroke patients. Thirty patients with dysphagia after stroke were enrolled in our study. To evaluate the ICF dysphagia scale, 6 scales were used as comparisons, namely the Barthel Index (BI), Repetitive Saliva Swallowing Test (RSST), Kubota Water Swallowing Test (KWST), Frenchay Dysarthria Assessment, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Multiple regression analysis was performed to quantitate the relationship between the ICF scale and the other 7 scales. In addition, 60 ICF scales were analyzed by the least absolute shrinkage and selection operator (LASSO) method. A total of 21 ICF codes were identified, which were closely related with the other scales. These included 13 codes from Body Function, 1 from Body Structure, 3 from Activities and Participation, and 4 from Environmental Factors. A topographic network map with 30 ICF key codes was also generated to visualize their relationships. The number of ICF codes identified is in line with other well-established evaluation methods. The network topographic map generated here could be used as an instruction tool in future evaluations. We also found that attention functions and biting were critical codes of these scales, and could be used as treatment targets.
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Affiliation(s)
- Yi Dong
- Mawangdui Hospital of Hunan Province
| | - Chang-Jie Zhang
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jie Shi
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
| | | | - Chun-Na Lan
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, China
- Correspondence: Chun-Na Lan, Department of Rehabilitation, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha 410011, China (e-mail: )
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22
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Dawe N, Patterson J, O'Hara J. Functional swallowing outcomes following treatment for oropharyngeal carcinoma: a systematic review of the evidence comparing trans-oral surgeryversusnon-surgical management. Clin Otolaryngol 2016; 41:371-85. [DOI: 10.1111/coa.12526] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 01/22/2023]
Affiliation(s)
- N. Dawe
- Northern Deanery Otolaryngology Specialist Training; Newcastle upon Tyne UK
| | - J. Patterson
- Department of Speech and Language Therapy; City Hospitals Sunderland; Newcastle upon Tyne UK
- Institute for Health and Society; Newcastle University; Newcastle upon Tyne UK
| | - J. O'Hara
- Institute for Health and Society; Newcastle University; Newcastle upon Tyne UK
- Department of Otolaryngology - Head and Neck Surgery; The Freeman Hospital; Newcastle upon Tyne UK
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