Dysphagia: clinical evaluation and management

Association between improved dysphagia and increased trunk muscle mass in older patients with stroke undergoing convalescent rehabilitation

OBJECTIVE

The association between dysphagia and activities of daily living in patients with stroke has been reported, but the effect of improved dysphagia on the increase in trunk muscle mass is not clear. The aim of this study was to investigate the relationship between improved dysphagia and increased trunk muscle mass in older patients with stroke.

RESEARCH METHODS & PROCEDURES

This retrospective, case-control study enrolled patients with stroke aged ≥65 years. Dysphagia was evaluated using the Kuchi-Kara Taberu (KT) Index. Patients were classified into two groups according to KT Index at discharge: improved dysphagia group (≥57 scores) and non-improved dysphagia group (<57 scores). The primary outcome of the study was Trunk Muscle Mass Index (TMI) gain from admission to discharge. Multiple regression analysis was performed to investigate the association between trunk muscle mass gain and improved dysphagia.

RESULTS

There were 153 participants with a mean age of 79.8 ± 7.7 years, and 89 (58%) were classified in the improved dysphagia group. The TMI gain was greater in the improved dysphagia group compared to that in the nonimproved group. Multiple regression analysis showed that improved dysphagia (β: 0.776, 95% confidence interval: 0.643 to 0.909, P < 0.001) was independently associated with TMI gain.

CONCLUSION

Improved dysphagia was independently associated with trunk muscle mass gain, suggesting that improved dysphagia is important for trunk muscle mass gain in patients with stroke.

Clinical validation of the nursing outcome "Swallowing status: pharyngeal phase" in patients with laryngeal cancer

AIMS AND OBJECTIVES

This study aimed to clinically validate the nursing outcome "Swallowing status: pharyngeal phase" (1013).

METHODS

A two-stage study was designed: (1) Chinese translation and cultural adaptation and (2) clinical validation. Internal consistency and interrater reliability tests were performed on 285 patients with laryngeal cancer, and an additional 130 patients were randomly selected from the 285 patients as an independent sample. Criterion-related validity tests were performed using the standardized swallowing assessment (SSA). Nursing outcome sensitivity was detected by scoring two time points.

RESULTS

The Cronbach's alpha coefficients were 0.951 for the nursing outcome and 0.942-0.965 for each indicator. The interclass correlation coefficient (ICC) values for each indicator ranged from 0.73 to 0.929. The scores of the nursing outcome were negatively correlated with the SSA scores (r = -0.555, p < 0.01). With the exception of two indicators, there was a significant difference (p < 0.05) between the total scores of the scale and its 11 indicator scores for the two time points. The results indicated that the nursing outcome "Swallowing status: pharyngeal phase" (1013) exhibited satisfactory psychometric properties and high sensitivity to change.

CONCLUSIONS

The nursing outcome "Swallowing status: pharyngeal phase" (1013) demonstrated good reliability, validity, and sensitivity in patients with laryngeal cancer.

IMPLICATIONS FOR NURSING PRACTICE

The nursing outcome "Swallowing status: pharyngeal phase" (1013) can be used to assess swallowing function in patients with laryngeal cancer and provide guidance for the development of rehabilitation intervention plans and nursing care.

Dysphagia in Neurological Disorders

Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with coughing and choking; whereas patients with esophageal dysphagia describe the feeling that swallowed food stops in the chest. Chronic neurologic diseases such stroke, Parkinson's disease, or dementia often have dysphagia as a symptom, particularly oropharyngeal dysphagia, and the term "neurogenic dysphagia" is often used. A disruption of the sophisticated, integrated sensorimotor swallowing system is usually the main reason behind dysphagia. Dysphagia can be associated with aspiration leading to aspiration pneumonia, and chronic dysphagia can lead to weight loss and malnutrition. Patients with dysphagia, when accurately and promptly diagnosed through medical history, physical examination, and diagnostic tests, often can be treated and experience improved quality of life. The pathophysiological mechanisms behind dysphagia, its diagnosis, and potential treatments are discussed in this manuscript.