Dysphagia Prevalence, Attitudes, and Related Quality of Life in Patients with Multiple Sclerosis

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.

Preliminary Study of the Effects of a Dysphagia Support Group on Quality of Life

PURPOSE

Dysphagia (swallowing difficulties) can greatly decrease quality of life for individuals with dysphagia and can lead to caregiver burden and third-party disability. Support groups have been shown to be effective in improving quality of life in a range of conditions, through allowing individuals to form connections with those with shared experiences and sharing and learning about relevant resources and coping skills. However, no research on the effects of dysphagia support groups on quality of life has been conducted. This preliminary study aimed to determine whether a virtual support group, facilitated by speech-language pathologists, could positively affect quality of life in similar ways for adults with dysphagia and their family caregivers.

METHOD

Pre- and postsupport group surveys were sent to participants to gain information about their dysphagia, demographics, and support group feedback (e.g., access to resources). Questions were mainly multiple choice, with three open-ended questions related to the support group.

RESULTS

Eight individuals participated in the surveys, with four completing both pre- and postsession surveys. Seven of eight individuals reported that they felt a support group could improve their quality of life, with the eighth being unsure. Qualitative data found the support group offered both informational (e.g., resource access) and psychosocial support (e.g., knowledge that they were not alone, emotional support).

CONCLUSION

These initial results suggest that a dysphagia support group could fill a gap in the health care system to offer more holistic support to individuals with dysphagia and their family caregivers.

Prevalence of dysphagia in patients with multiple sclerosis: A systematic review and meta-analysis

BACKGROUND

Dysphagia is a major disorder observed in patients with multiple sclerosis (MS), yet different prevalence rates are reported for it. Therefore, we designed this study to estimate the pooled prevalence of dysphagia in patients with MS.

METHOD

We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, reviews studies, and conference abstracts which were published up to May 2022. Articles that were relevant to our topic and could provide information regarding the prevalence of dysphagia among MS patients were included; however, articles with self-report screening strategies were excluded.

RESULTS

The literature search found 997 articles. After eliminating duplicates, 672 articles remained. Two conference abstracts were included for final analysis. A total of 11,266 MS cases and 5047 MS patients with dysphagia were included in the meta-analysis. The overall prevalence of dysphagia across all 54 studies was 44.8 % (95 % CI: [40.4 %-49.2 %]), with a high level of heterogeneity between countries (Q=; I² = 94.96 %; p < 0.001).

CONCLUSION

The results of this systematic review shows that the prevalence of dysphagia in MS patients is 45% which is greatly higher compared to the general population.

Impact of Swallowing Impairment on Quality of Life of Individuals with Dysphagia

To explore oral intake and quality of life measures among individuals with dysphagia. This cross-sectional study with purposive sampling included 15 individuals with dysphagia. Functional oral intake scale (FOIS) and Dysphagia Quality of Life questionnaire in Marathi (DQOL-QM) were administered on individuals with dysphagia to evaluate oral intake levels and swallow related quality of life respectively. Data was collected using the interview method via tele-mode. Statistical analysis using Spearman's rank correlation revealed significant negative correlation (ρ = - 0.87) between oral intake and overall quality of life of the individuals with dysphagia. This negative impact was observed across all the domains of their quality of life. A considerable negative impact on quality of life was observed with declining oral intake of the individual with dysphagia. As oral intake plays an important role in the quality of life, decisions regarding the mode of feeding must be guided by the preferences of the individual and their family. strategies that enhance oral intake improves quality of life of dysphagic individual.

Validation of the Czech Version of the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS)

Dysphagia is a common symptom of neurological disease, including multiple sclerosis (MS). The DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire was developed as a screening tool for swallowing problems. The purpose of the present study was to validate the Czech version of the DYMUS questionnaire. We validated the questionnaire on a sample of 435 patients with MS and 135 healthy controls (HC) chosen by accidental sampling from larger, long-term studies conducted by the Prague MS Center. For the purposes of this study, we used both electronic (primary method of distribution) and paper-based (backup) versions of the questionnaire. The internal consistency of the whole scale was satisfactory (Cronbach’s α =0.833). The DYMUS mean score in HC was 0.215 (standard deviation [SD] = 0.776). Normative data suggested a cut-off value for dysphagia between 1 and 2 points. Principal component analysis (PCA) showed a two-factor structure of the adapted scale. However, the structure did not completely correspond to the originally proposed dimensions of dysphagia for solids and liquids; our data supported dropout of item Q10. Criterion validity was proved by the difference in dysphagia between HC and patients MS (U = 25,546, p < 0.001) and by a positive correlation with the EDSS (Kendall’s tau-b = 0.169, p < 0.001) and other patient-reported outcomes. The Czech version of the DYMUS questionnaire is a valid and reliable tool for evaluating swallowing impairment in Czech-speaking patients with MS. Moreover, the questionnaire can be administered electronically, with a paper-based backup.

Factors related to dysphagia-specific quality of life in aged patients with neurologic disorders: A cross-sectional study

This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support-a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains-the subscales of dysphagia-specific quality of life-are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.

Experiences and perceptions of stroke patients living with dysphagia: A qualitative meta-synthesis

AIMS

To systematically review and synthesise the findings of qualitative research exploring experiences of dysphagia from stroke patients' perspectives.

BACKGROUND

Poststroke patients with dysphagia are suffering from impaired physical functions and heavy psychological burden, and they are living with compromised quality of life. Through synthesising qualitative studies to fully portrait the experiences of poststroke patients living with dysphagia, we can care better for this population.

DESIGN

A systematic review and synthesis of qualitative studies reported by following ENTREQ.

REVIEW METHODS

Five electronic databases (CINAHL, Embase, PubMed, Web of Science and Cochrane Library) and three Chinese databases (CNKI, VIP and Wanfang) were searched from inception until January 2021. Qualitative studies were included if they were related to the experiences of poststroke patients with dysphagia. The Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to appraise study quality. Data were synthesised using the Thomas and Harden method thematic and content analysis.

RESULTS

Five studies were included in the meta-synthesis. Four analytical themes were identified: life changes after dysphagia, coping with social events, rebuilding a normal life and limited professional services.

CONCLUSIONS

More attention should be given to psychological health and social interaction in poststroke dysphagia patients. Healthcare professionals, especially nurses, should make joint efforts to provide patients with dysphagia-related knowledge and long-term individualised support. To improve the quality of life of dysphagia patients, further research should implement high-quality interventions based on dysphagia experience and clinical treatment.

RELEVANCE TO CLINICAL PRACTICE

These findings outline the changes in poststroke patients with dysphagia. Nurses as the first-line force, should deliver comprehensive and individualised intervention for managing physiological and psychosocial symptoms of patients.

Effects of nasal packing and transseptal suturing on swallowing after septoplasty

PURPOSE

This clinical trial aimed to investigate the effects of different nasal packing methods and transseptal suture technique on swallowing after septoplasty.

METHODS

This randomized prospective study consists of 180 consecutive patients with septal deviation. All the patients underwent septoplasty. All the patients were randomly assigned to three groups. In group A, transseptal sutures were used for septal stabilization. In group B, both nasal passages were packed with Merocel tampons for septal stabilization. In group C, both nasal passages were packed with Doyle silicone splints for septal stabilization. For the evaluation of swallowing, the Eating Assessment Tool (EAT-10) questionnaire and a visual analog scale (VAS) were administered to all the patients preoperatively and on the second and seventh postoperative days.

RESULTS

One hundred and twenty two of the patients (67.7%) were female and 58 of them (32.2%) were male. The mean age was 32.41 ± 12.37 years (range: 18-57 years). Both EAT-10 and VAS scores on the second postoperative day were significantly higher than the preoperative scores in all the groups (p < 0.05). The transseptal suture group had significantly lower EAT-10 and VAS scores on the second postoperative day than the Merocel packing and silicone packing groups (p < 0.05). Both EAT-10 and VAS scores on the postop 7th day significantly decreased in all groups compared to the postop second day (p < 0.05).

CONCLUSIONS

Septoplasty affects swallowing, regardless of whether a tampon is applied. Transeptal suturing has a lesser effect on swallowing than other techniques. Although silicone packing is a less invasive method, it negatively affects swallowing, similar to Merocel packing. The transseptal suture technique is more comfortable than the other techniques in terms of swallowing function in the postoperative period.

Accuracy of the Brazilian version of the DYMUS questionnaire for the screening of oropharyngeal dysphagia in multiple sclerosis

BACKGROUND

Oropharyngeal dysphagia is a common symptom of many neurological diseases, including Multiple Sclerosis (MS). Early identification of the risk of dysphagia in neurological patients is very important for early referral for specialized evaluations of oropharyngeal swallowing and treatments. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire has been translated and validated in different countries over the last 10 years. We aimed to analyze the accuracy of the Brazilian Portuguese version of the DYMUS (DYMUS-BR) questionnaire in identifying dysphagia in patients with MS.

METHODS

The DYMUS questionnaire and a videofluorographic swallowing study (VFSS) were conducted in 30 patients with MS. Dysphagia was identified by at least one abnormal response and was considered alarming when the DYMUS scores were equal to or higher than 3. Patients were considered to have dysphagia in the VFSS when one or more signs of impairment in the efficiency and/or safety of swallowing were detected.

RESULTS

According to the initial self-assessment, 37% (N = 11) of patients with MS self-reported with dysphagia. According to the DYMUS-BR scores, 53% (N = 16) of the patients with MS were classified as having dysphagia. The sensitivity, specificity, and positive and negative predictive values of the DYMUS-BR questionnaire for the detection of dysphagia as measured by the VFSS were 50% [95% confidence interval (CI) 29-71], 78% (95% CI 61-90), 60% (95% CI 42-76), and 70% (95% CI 60-78), respectively. The area under the receiver-operating characteristic curve for detecting dysphagia was 64% (95% CI 49-79).

CONCLUSION

The accuracy of the DYMUS-BR questionnaire is poor to detect mild swallowing impairment in patients with MS. However, we suggest longitudinal follow-up in patients with low DYMUS-BR scores for early detection of oropharyngeal dysphagia.

Prevalence and Risk Factors of Dysphagia in Patients with Multiple Sclerosis

Dysphagia is one of the most common symptoms in multiple sclerosis (MS) patients. It can reduce the quality of life and increase the risk of mortality by developing complications such as aspiration pneumonia. The present study was conducted to estimate the prevalence of dysphagia in MS patients and investigate the associations between dysphagia and disease characteristics. The Persian version of the DYMUS questionnaire was used to assess dysphagia in 865 patients with MS, including 738 (85.3%) relapsing-remitting MS (RRMS), 106 (12.3%) secondary progressive MS (SPMS), and 21 (2.4%) primary progressive MS (PPMS). Also, demographic and clinical data, including age, sex, smoking status, Expanded Disability Status Scale (EDSS) score, disease duration, disease-modifying therapies exposure, initial symptoms of MS, were recorded. The mean (SD) age was 37.95(9.25) years, and 83.1% of the participants were female. The prevalence of dysphagia was estimated to be 25.4% among all patients. According to the DYMUS questionnaire results, the prevalence of dysphagia in RRMS, SPMS, and PPMS patients was 22.2%, 44.3%, and 42.9%, respectively. After multivariate analysis the current EDSS score (OR = 1.197, CI: 1.062, 1.350, p = 0.003), cerebellar impairment (OR = 1.335, CI: 1.450, 4.716, p = 0.004) and motor dysfunction (OR = 1.651, CI: 1.004, 2.715, p = 0.048) emerged as the risk factors for dysphagia. Since dysphagia, as previously mentioned, is a common symptom in multiple sclerosis, particularly in SPMS and PPMS courses, active screening for this condition is recommended in all patients, particularly those with identified risk factors.