Factors Associated With Compliance With Viscosity-Modified Diet Among Dysphagic Patients

Abstract

ObjectiveTo investigate compliance with a viscosity-modified diet among Korean dysphagic patients and to determine which factors are associated with compliance.MethodsWe retrospectively reviewed medical records of patients who had been recommended to use thickeners in the previous videofluoroscopic swallowing study (VFSS). Among 68 patients, 6 were excluded because tube feeding was required due to deterioration in their medical condition. Finally, 62 patients were included in the study. Patient compliance was assessed using their medical records by checking whether he or she had maintained thickener use until the next VFSS. To determine which factors affect compliance, the relationship between thickener use and patient characteristics, such as sex, age, inpatient/outpatient status, severity of dysphagia, aspiration symptoms, follow-up interval of VFSS, and current swallowing therapy status were assessed. For noncompliers, reasons for not using thickeners were investigated by telephone interview.ResultsAmong 62 patients, 35 (56.5%) were compliers, and 27 (43.5%) were noncompliers. Eighteen (90%) of 20 inpatients had followed previous recommendations; however, only 17 (40.5%) of 42 outpatients had been using thickeners. Of patient characteristics, only admission status was significantly correlated with compliance. When asked about the reason why they had not used thickeners, noncompliers complained about dissatisfaction with texture and taste, greater difficulty in swallowing, and inconvenience of preparing meals.ConclusionAmong Korean dysphagic patients, compliance with a viscosity-modified liquid diet was only about 50%. Betterments of texture and taste along with patient education might be necessary to improve compliance with thickener use.

Patient Adherence to Dysphagia Recommendations: A Systematic Review

“…(24–32) The remaining three studies included patients who were diagnosed with dysphagia of varied etiologies. (17, 33, 34) These etiologies were the following: stroke, hemilaryngectomy, cerebral spinal surgery;(33) Parkinson disease, airway malignancy, Huntington disease, motor neuron disease, Alzheimer’s disease, muscular dystrophy, tetraplegia, poliomyelitis;(17) brain lesion, deconditioning, unspecified neuromuscular or neurodegenerative disease, local structural lesion;(34) and cardiovascular accident. (17, 33) Studies were conducted in various settings, with all but one(17) in a hospital-based setting.…”

“…(17, 33) Studies were conducted in various settings, with all but one(17) in a hospital-based setting. Of these hospital based studies, many were administering outpatient treatments,(24–32)one included both inpatient and outpatients(34), and one with just inpatients. (33) The one study not conducted in a hospital setting incorporated a variety of settings including patients living at home, in institutional or rehab settings and hospital inpatients.…”

“…One study(17) reported an age range and divided mean between two groups, another study(34) only reported mean age, and two others reported mean age and standard deviation rather than range and average age. (31, 32) One study(27) did not report an age range or mean.…”

“…One study(29) used a prospective cohort study design with a JAMA rating of 2. Four studies(17, 25, 27, 34) completed retrospective studies earning a JAMA score of 3. Five studies(24, 26, 28, 30, 33) earned a JAMA quality rating score of 4 and used the following designs: prospective cohort,(24) case-series(26, 28, 33) and pilot study.…”

Abordaje de la disfagia en enfermos de alzhéimer

“…Hay pocos estudios experimentales sobre esta técnica y se necesitan ensayos controlados aleatorizados que exploren los efectos a largo plazo, así como el impacto en el resultado clínico de los pacientes (29). Por último, los cambios de volumen y viscosidad del bolo constituyen la técnica más desarrollada en pacientes neurológicos, causan un importante efecto terapéutico en los signos de eficacia y seguridad y han mostrado una importante mejoría en las penetraciones y aspiraciones (3,4,9,11,29,31,32). Diversos expertos están de acuerdo en que la modificación de la textura de los líquidos es extremadamente importante para asegurarse de que los pacientes con disfagia orofaríngea funcional, asociada a enfermedades neurológicas, estén adecuadamente nutridos e hidratados y no tengan aspiraciones (29).…”