Hand Manometry to Assess Overall Muscle Strength (Frailty) in Dysphagic Patients

Abstract

Objectives: (1) Evaluate whether patients with symptoms of aspiration as assessed by fiberoptic endoscopic evaluation of swallowing (FEES) demonstrate reduced overall muscle weakness, or frailty, as seen by handgrip strength. (2) Determine whether tools such as the Eating Assessment Tool (EAT-20) and Penetration-Aspiration Scale (PAS) correlate with muscle strength as seen by handgrip strength. Methods: Prospective, single-blind study on patients with chief complaints of dysphagia who presented to a tertiary referral center over a 4-month period. Participants completed the EAT-20 dysphagia questionnaire. FEES was performed by administering standardized boluses of 4 different consistencies (thin liquid, nectar, puree, mechanical soft food) and assessing for spillage, penetration, pharyngeal residue, aspiration, and reflux. Patients were additionally scored using the Penetration-Aspiration Scale. Aspirators had a score >5. Overall muscle strength was assessed using handgrip strength measured by hand dynamometry. Results: Twenty-seven patients with chief complaints of dysphagia were eligible for enrollment. Average grip strength was 25.9 kg, average EAT-20 score was 35, and average PAS score was 3. Six out of 27 patients (22%) were found to be aspirators with PAS >5. Average grip strength for nonaspirators and aspirators was 25.9 kg and 25.6 kg, respectively ( P > .05). Controlling for weight, age, and sex, EAT-20 showed no correlation with grip strength ( P > .05). EAT-20 demonstrated significance with PAS score ( P < .01). Conclusions: Grip strength does not demonstrate association with dysphagia and risk of aspiration. Frailty may not be strongly predicted by grip strength. Other measures of frailty should be investigated with risk of aspiration.