Patient Reported Outcomes and Objective Swallowing Assessments in a Multidisciplinary Dysphagia Clinic

Abstract

Objectives/Hypothesis Dysphagia encompasses a complex compilation of symptoms which often differ from findings of objective swallowing evaluations. The purpose of this investigation was to compare the results of subjective dysphagia measures to objective measures of swallowing in patients evaluated in a multidisciplinary dysphagia clinic. Study Design Prospective cohort study. Methods The study cohort included all patients evaluated in the multidisciplinary dysphagia clinic over 24 months. Participants were evaluated by a multidisciplinary team including a laryngologist, gastroenterologist, and speech‐language pathologist. Evaluation included a videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), and transnasal esophagoscopy (TNE). Data collected included diet (FOIS), Eating Assessment Tool (EAT‐10) score, Reflux symptom index (RSI) score, and the findings of the VFSS exam. Results A total of 75 patients were included in the analysis. The average EAT‐10 score was 16.3 ± 2.1, RSI was 21.4 ± 0.6, and FOIS score was 6.0 ± 1.33. VFSS revealed impairments in the oral phase in 40% of the cohort, pharyngeal in 59%, and esophageal in 49%. Abnormalities were noted in one phase for 32%, in 2 phases in 32%, and three phases in 18%. Patients with abnormal pharyngeal findings on VFSS had significantly higher EAT‐10 scores (P = .04). Patients with abnormal oral findings on VFSS were noted to have significantly lower FOIS scores (P = .03). Conclusions Data presented here demonstrate a relationship between patient reported symptoms and objective VFSS findings in a cohort of patients referred for multidisciplinary swallowing assessment suggesting such surveys are helpful screening tools but inadequate to fully characterize swallowing impairment. Level of Evidence 3 Laryngoscope, 131:1088–1094, 2021

The Stanford Multidisciplinary Swallowing Disorders Center

“…The SLP scores VFSS findings using the Modified Barium Swallow Impairment Profile (MBSImP) to evaluate the oral, pharyngeal, and esophageal phases of swallowing. 7 We do not repeat the VFSS if it has been previously done and results are sufficient to inform decision-making. VFSS images and results, referral information, and relevant patient history are then discussed by the team before seeing the patient.…”

“…The SLP also scores the patient's diet level using the Functional Oral Intake Scale (FOIS) based on information gathered during the patients' history. 7 At the end of the visit, findings of diagnostic testing are reviewed, and an overall impression is shared with the patient by the multidisciplinary team. A combined plan is discussed and depending on recommendations, a follow-up visit with the appropriate provider…”

Relating Physiologic Swallowing Impairment, Functional Swallowing Ability, and Swallow-Specific Quality of Life

“…Another study conducted by Arrese et al [13] comparing FOIS scores to only five of the 17 MBSImP physiologic components found no significant relationships in a small, heterogeneous group of patients with head and neck cancer [13]. Dewan et al [14] studied a cohort of patients with various dysphagia-related etiologies and found patients with impaired MBSImP total scores had significantly lower FOIS scores and significantly higher EAT-10 total scores than those without impairment [14]. They concluded that, despite these relationships, patient reports alone did not offer sufficient information to adequately describe the full relationship between physiologic swallowing impairment and swallow-specific quality of life [14].…”

“…This relationship is also shown in the swallowing literature. Studies relating physiologic swallowing impairment and functional swallowing ability, as measured by the Functional Oral Intake Scale (FOIS), and swallow-specific quality of life, as measured by the Eating Assessment Tool-10 (EAT-10), report varied results [10][11][12][13][14][15][16][17].…”

“…Dewan et al [14] studied a cohort of patients with various dysphagia-related etiologies and found patients with impaired MBSImP total scores had significantly lower FOIS scores and significantly higher EAT-10 total scores than those without impairment [14]. They concluded that, despite these relationships, patient reports alone did not offer sufficient information to adequately describe the full relationship between physiologic swallowing impairment and swallow-specific quality of life [14]. The findings of these studies were focused on utilizing total scores of the measurement tools; however, the specific factors (item-level scores) that may have contributed to the overall relationships were not accounted for.…”