Eating Assessment Tool Research Articles

İNMELİ HASTALARDA EKSPİRATUAR KAS EĞİTİMİNİN STOMATOGNATİK SİSTEME ETKİSİ

Objective: The aim of this study was to assess the effect of expiratory muscle training on the stomatognathic system in patients with stroke.
 Method: A total of 31 patients with stroke were included in the study: 16 patients with stroke (age=66.63±8.38, height=166.38±8.59, BMI=28.09±4.81) as the control group and 15 patients with stroke (age=65.60±7.62, height=168.20±8.78, BMI=28.95±6.92) as the study group. Temporomandibular joint range of motion and dysfunction, pressure pain threshold of masticatory muscles, facial asymmetry existence, head posture, oral hygiene, oral hygiene habit, masticatory performance, intraoral pH, deglutition, and deep neck flexor muscle endurance of the patients with stroke were assessed. Assessment methods were in order by digital caliper, the Fonseca Questionnaire, algometry, labial commissure and craniocervical angle measurement, general oral health assessment index, and questionnaire, sieve test, digital pH gauge, repetitive saliva swallow test, Eating Assessment Tool, and deep neck flexor endurance test. Patients with stroke in the study group were enrolled in an expiratory muscle training program consisting of 5 sets of 10 repetitions daily for three weeks in addition to conventional physiotherapy; the control group enrolled in the conventional physiotherapy program. Patients with stroke in the study group were called twice a week to assess their compliance with the expiratory muscle training.
 Results: In intragroup comparison significant increase was found in the inferior portion of the left masseter, mandibular protrusion, and a decrease in labial commissure angle and Fonseca Questionnaire score of the control group (p

Ultrasonographic Evaluation of Upper Esophageal Sphincter for Dysphagia During the Acute Postoperative Phase of Anterior Cervical Surgery.

A retrospective study. To verify the pathophysiology of dysphagia during the acute postoperative phase of anterior cervical surgery and to identify its predictive features, using ultrasonographic (US) examination for upper esophageal sphincter (UES). There are no clinical studies investigating dysphagia after anterior cervical surgery, using US examination for UES. We enrolled patients who underwent anterior cervical spine surgery between August 2018 and March 2022. Dysphagia was evaluated using the Eating Assessment Tool-10 (EAT-10) questionnaires. The US examination was performed preoperatively and 2 weeks postoperatively. Three US parameters for morphologic measurements (outer diameter, inner diameter, and muscle thickness) and 4 for functional measurements (displacement, time to relax, passing duration, and time to contract) were assessed. To verify the pathophysiology of postoperative dysphagia, we examined the change in the ratios of US parameters (=US parameter 2 weeks postoperatively /US parameter at baseline ) and the existence of significant correlations with change in the EAT-10 score (=EAT-10 2 weeks postoperatively -EAT-10 at baseline ). To identify the predictive features, the baseline US parameters were compared between dysphagia (+) and dysphagia (-) groups. A total of 46 patients (mean age, 61.3y; 78.3% male) were included for analysis. A greater increase of the EAT-10 score after surgery was positively correlated with change ratios of the muscle thickness and time to contract and negatively with change ratio of the inner diameter. The dysphagia (+) group exhibited significantly greater inner diameter and smaller muscle thickness at baseline than the dysphagia (-) group. Dysphagia during the acute postoperative phase of anterior cervical surgery is caused by the physical narrowing of the inner lumen due to muscle thickening of the UES and sphincter contractile dysfunction. In addition, a baseline UES morphology characterized by a greater inner diameter and a thinner muscle layer is predictive of postoperative dysphagia.

PRESENCE OF DYSPHAGIA IN A COHORT OF PERSONS LIVING WITH DEMENTIA: OUTCOMES FROM A MULTIDISCIPLINARY CLINIC

Abstract The Cognitive Care Clinic (CCC) provides evaluation for Veterans living with dementia. Speech-language pathology (SLP) is incorporated to facilitate early identification and proactive management of dysphagia. This project sought to describe dysphagia frequency in persons living with dementia (PWD) in CCC. Multidisciplinary assessments led to consensus diagnosis of dementia subtype. Stage was determined using the Functional Assessment Staging Tool (FAST). Validated dysphagia screening tools included Eating Assessment Tool (EAT-10), water swallow test (WST), and Test of Mastication and Swallowing Solids (TOMASS). Penetration-Aspiration Scale (PAS) scores were determined following videofluoroscopic swallow studies (VFSS); scores were classified as “safe” (PAS< 3) or “unsafe” (PAS>=3). Descriptive statistics were calculated for dementia subtype, stage, and dysphagia measures. 78 Veterans were diagnosed with dementia between 2017 and 2023 (mean age=77 years; 5% female) and completed dysphagia screening. The majority had Alzheimer’s disease (43%) and were in the mild disease stage (61%). 37% failed the WST, suggesting impaired safety. 49% failed the TOMASS, indicating masticatory inefficiency. 26% scored 3 or higher on EAT-10, indicating increased dysphagia risk. 22 patients completed VFSS; 55% exhibited unsafe swallows. No significant differences in EAT-10 total scores were observed between those with safe and unsafe PAS scores. Nearly half of this cohort demonstrated signs of swallowing impairment based on clinical testing and/or VFSS. Additionally, EAT-10 scores were low overall with no differences based on dysphagia status on VFSS, which suggests underreporting of dysphagia. These findings highlight the necessity of SLPs in dementia care teams to support early identification and management of dysphagia.

Exploring the Feasibility of a Comprehensive Screening for Voice and Swallowing Function in Post-Extubation Patients: A Pilot Study

Objectives. This pilot study aimed to identify and test a battery of time-efficient and cost-effective voice and swallowing screening tools for post-extubated patients in Chile. Methods. A panel of four experts selected and rated voice and swallowing screening tools. Seven measures were selected: smoothed cepstral peak prominence (CPPS) and maximum phonation time (MPT) for voice assessment, Volume-Viscosity Swallow Test (V-VST) for swallowing, voluntary and reflex peak cough flow for cough assessment, Eating Assessment Tool-10 (EAT-10), and Vocal Symptom Scale (VoiSS) for patient-reported outcomes. These tools were applied to four post-extubation patients within 48-72 hours post-hospital discharge, alongside the assessment of 17 matched controls. Results. Post-extubation patients showed significantly shorter MPT, lower CPPS values, increased V-VST dysphagia signs, reduced voluntary peak cough flow, and more pronounced symptoms on both the VoiSS and EAT-10 compared to controls. Limitations. The study had a modest sample size and relied solely on clinical screening tools.Value. This pilot study suggests a feasible and cost-effective approach to voice and swallowing screening for post-extubation patients, valuable in resource-constrained settings.Conclusion. While these accessible tools are not gold-standard assessments, they offer valuable insights and can guide future research. This study underscores the potential of selected tools in facilitating early detection of voice and swallowing disorders in post-extubation patients.

Prevalence of oropharyngeal dysphagia symptoms in community-dwelling older adults: A community survey.

Dysphagia is a common clinical condition in older adults with significant implications for health and quality of life(QOL). However, its prevalence and associated factors in the Indian community-dwelling older adults remain understudied. The present study aims at identifying the prevalence of oropharyngeal dysphagia symptoms in Indian community-dwelling older adults and identifying the age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia in this population. Total 384 community-dwelling older adults (60years of age or older) who were independent in performing daily activities were included in the present study. The Malayalam version of the Eating Assessment Tool-10 (EAT-10) questionnaire was used to assess individuals at risk for dysphagia. Additionally, they also completed a self-report questionnaire addressing age-related comorbid variables associated with an increased risk of oropharyngeal dysphagia. Using the Malayalam version of the EAT-10, the present study identified the prevalence of oropharyngeal dysphagia symptoms in 9.9% of community-dwelling older adults. Among the EAT-10 symptoms, cough while/after swallowing, difficulty swallowing solids and difficulty swallowing liquids were the most prevalent symptoms reported by participants. Increase in age and age-related comorbidities such as tooth loss, history of heart failure and digestive diseases were found to be significantly associated with the reporting of risk for dysphagia symptoms. As dysphagia symptoms significantly impact the social, psychological and QOL of community-dwelling older adults, it is important to develop awareness about these symptoms among older adults, caretakers and physicians. Early detection and appropriate management of community-dwelling older adults at risk for dysphagia can contribute to better health outcomes and improved QOL.

An Evaluation of Psychometric Properties of EAT-10: A Malayalam Version.

The Eating Assessment Tool (EAT-10) is a 10-item self-administered questionnaire that assesses the severity of dysphagia symptoms, the impact of dysphagia on quality of life and treatment efficacy. EAT-10 has been adapted into several languages, including Malayalam. However, the information on the psychometric properties of EAT-10 MALAYALAM is not known. Therefore, the study aimed to evaluate the psychometric properties of the EAT-10 MALAYALAM. EAT-10 MALAYALAM questionnaire was administered to two groups of native Malayalam-speaking participants. Group 1 consisted of a total of 110 participants (76 males and 34 females) with a mean age of 52.9 ± 13.5years diagnosed with oropharyngeal dysphagia. Group 2 consisted of 110 age and gender-matched healthy participants with normal swallow function and no history and symptoms of swallowing disorders. The test-retest reliability was assessed using Spearman's rank correlation coefficient between the test and the retest scores; internal consistency was assessed using Cronbach's alpha, and Known groups validity was evaluated by comparing the EAT-10 MALAYALAM scores between the participants of both groups. The results of Spearman's correlation coefficient showed 0.99, indicating that the EAT-10-MALAYALAM has excellent test-retest reliability. The Cronbach's alpha was 0.94, indicating strong internal consistency. Mann-Whitney U test showed significant differences in the scores of EAT-10-MALAYALAM between the participants of both groups. Therefore, it was inferred that EAT-10-MALAYALAM had good known groups validity. The EAT-10-MALAYALAM is a valid and reliable tool for screening Malayalam-speaking dysphagia patients.

Prevalence of Voice and Swallow Problems in Individuals Living with Sickle Cell Disease

Introduction: Sickle Cell Disease (SCD) is an inherited blood disorder with profound implications on a wide variety of tissue types (Kavanagh et al., 2022). As many as 37% of patients with SCD experience silent cerebral infarction by age 14 (DeBaun et al., 2012). Neurological insults can increase risk for voice and swallow disorders which compromise physical health and diminish quality of life for many individuals (Aronson & Bless, 2009). In fact, voice disorders (dysphonia) affect 6% of adults (Roy et al., 2005), and swallowing difficulties (dysphagia) impact as many as 16% (Adkins et al., 2020). Since both phonation and deglutition require the coordination of multiple muscles and nerves (Kendall, 2008), diseases such as SCD may be associated with elevated risk for dysphonia and dysphagia. Unfortunately, the frequency of these symptoms in individuals with SCD has rarely been considered. This study examined the prevalence and nature of dysphonia and dysphagia in individuals with SCD. Methods: Adults (age >18) diagnosed with SCD were surveyed regarding the presence of voice and swallow complaints, symptomology, voice-use patterns, voice and swallow-related quality of life, demographic information, and medical history. Additionally, participants completed the Voice Handicap Index-10 (VHI-10), Eating Assessment Tool (EAT-10), and Reflux Severity Index (RSI). To enable comparisons with previous epidemiological studies of voice and swallow disorder prevalence, survey questions were adapted from previously published investigations (Roy et al., 2004, 2005). Participants were recruited from an outpatient hematology clinic during routine visits and completed the survey online using Redcap. Univariate and multivariate analyses were used to identify dysphonia and dysphagia risk. Results: Twenty-four patients have completed this study (males=16, females=8; mean age=35.2 years; genotype: SS=8, S/β thalassemia zero=3, SC=6, S/β thalassemia plus=7) with recruitment ongoing. Forty-five percent of patients reported a voice complaint within the last 4 years with symptoms lasting longer than 4 weeks in all cases (Table 1). Sixty-six percent of patients presented with VHI scores indicating a voice problem. Dysphonia was described as episodic, with 83.3% of cases becoming more severe during sickle cell crises. Voice problems resulted in exclusion from social activities (37.5%), missed days of work (12.5%), inability to perform daily tasks (12.5%), inability to sing (27.2%), and difficulty performing one's occupation (12.5%). Individuals who vaped were 8% more likely to report dysphonia ( p=.04), and those who drank more than 3 alcoholic beverages a week were 25% more likely to report dysphonia ( p=.03). Patients with dysphonia presented with significantly more severe VHI scores ( p=.019, dysphonia=15.1, normophonic=10.0) and RSI scores ( p=.036, dysphonia=10.5, normophonic=6.8) than those with no voice complaint. No voice use pattern predicted voice disorder risk. One third of participants reported a swallow complaint, with 75% of cases occurring within the last 2 years (Table 1). Forty-one percent of patients presented with EAT-10 scores indicating dysphagia. Swallowing problems were evident with meats (8.3%), bread-like consistencies (20.8%), pills (29.2%), and thin liquids (4.2%). Dysphagia symptoms were episodic in 87.5% of cases, becoming more severe during sickle cell crisis in 37.5% of cases. Patients with dysphagia symptoms presented with significantly more severe EAT-10 scores than those without swallow symptoms ( p<.001, dysphagia group=6.12, no dysphagia=2.06). No patients reported seeing a medical professional for dysphonia or dysphagia symptoms. Conclusions: Dysphonia and dysphagia were markedly elevated in patients with SCD when compared with the general population. Although these symptoms diminished quality of life, no patient had received treatment or even evaluation of these symptoms. Given the medical complexity of patients with SCD, diagnostic overshadowing might have precluded thorough workups of symptoms. This is unfortunate as impairments in voice and swallow function greatly impact quality of life and, in some cases, can be life-threatening. If the current findings are confirmed by future large-scale studies, individuals with SCD may benefit from proactive systematic monitoring and treatment of the subsystems responsible for voice and swallow.

Association between oral condition and subjective psychological well-being among older adults attending a university hospital dental clinic: A cross-sectional study.

Positive psychological well-being has a favorable impact on survival rates in both healthy and unhealthy populations. Oral health is also associated with psychological well-being, is multidimensional in nature, and includes physical, psychological, emotional, and social domains that are integral to overall health and well-being. This study aimed to identify the associations between individual and environmental characteristics, oral condition and nutritional status in relation to subjective well-being among older adults using the Wilson and Cleary conceptual model. The participants were older adults (age ≥ 60 years) attending a university hospital. Subjective well-being was assessed using the World Health Organization-5 Well-Being Index, oral condition was assessed based on the number of bacteria in the tongue coating, oral wettability, tongue pressure, occlusal force, oral diadochokinesis, and masticatory ability, and subjective swallowing function was assessed using the Eating Assessment Tool, number of remaining teeth, and number of functional teeth. In addition, factors related to well-being, including social networks, life-space mobility, nutritional status, smoking history, drinking history, and medical history were assessed. In the analysis, structural equation modeling was used to investigate the association between oral condition and subjective well-being. Confirmatory factor analysis revealed oral condition as a latent variable, including tongue pressure, oral diadochokinesis /pa/, /ta/, /ka/, occlusal force, masticatory ability, subjective swallowing function, and number of functional teeth. Structural Equation Modeling revealed that oral condition was positively correlated with nutritional status, and nutritional status was positively correlated with the World Health Organization-5 Well-Being Index. These findings suggest that oral condition may influence subjective well-being via nutritional status or social environmental factors.

Validation and cross-cultural adaptation of the Italian version of the paediatric eating assessment tool (I-PEDI-EAT-10) in genetic syndromes.

The Pediatric Eating Assessment Tool (PEDI-EAT-10) is a reliable and valid tool for rapid identification of dysphagia in patients aged 18 months to 18 years. To translate and adapt the PEDI-EAT-10 into the Italian language and evaluate its validity and reliability. The translation and cross-cultural adaptation of the tool consisted of five stages: initial translation, synthesis of the translations, back translation, expert committee evaluation and test of the prefinal version. The internal consistency of the translated tool was analysed in a clinical group composed of 200 patients with special healthcare needs aged between 18 months and 18 years. They were consecutively enrolled at the Rare Disease Unit, Paediatrics Department, Fondazione Policlinico Agostino Gemelli-IRCCS, Rome. For test-retest reliability, 50 caregivers filled in the PEDI-EAT-10 questionnaire for a second time after a 2-week period. Construct validity was established by comparing data obtained from patients with data from healthy participants (n = 200). The study was approved by the local ethics committee. Psychometric data obtained from patients (104 M; mean age = 8.08 ± 4.85 years; median age = 7 years) showed satisfactory internal consistency (Cronbach's α = 0.89) and test-retest reliability (Pearson r = 0.99; Spearman r = 0.96). A total of 30% of children were classified as having a high risk of penetration/aspiration. The Italian PEDI-EAT-10 mean total score of the clinical group was significantly different from that resulting from healthy participants. The PEDI-EAT-10 was successfully translated into Italian, validated and found to be a reliable one-page rapid screening tool to identify dysphagia in children and adolescents with special needs. What is already known on the subject The PEDI-EAT-10 is a valid and reliable quick discriminative paediatric tool for identifying penetration/aspiration risks. What this paper adds to the existing knowledge In the present study we successfully translated and adapted the PEDI-EAT-10 into the Italian language. What are the potential or actual clinical implications of this work? This translation and adaptation increase access to valid feeding and swallowing assessment for children of Italian-speaking families. In addition, the I-PEDI-EAT-10 can suggest further assessment of patients' swallowing abilities.

Influence of Nutritional Status and Physical Fitness on Cognitive Domains among Older Adults: A Cross-Sectional Study.

The health issues presented by the aging population can result in reduced muscle mass, poorer physical function, and cognitive impairment. The goal of this study was to determine how nutritional status and physical fitness relate to cognitive impairment in older adults. A cross-sectional descriptive and analytical study involving 100 participants was carried out to analyze the impact of nutritional status and physical fitness on cognitive impairment. Nutritional status was assessed with the Eating Assessment Tool (EAT-10) and The Mini Nutritional Assessment-Short Form (MNA-SF); physical fitness via the implementation of manual grip evaluation, the 4-m walking test (4-MWT), and the Timed Up and Go (TUG) test; and cognitive impairment evaluation was conducted using the Mini-Mental State Examination (MMSE), the Boston Naming Test (BNT) and the Controlled Oral Word Association Test (COWAT). Data analysis revealed that higher malnutrition status was associated with fewer correct responses in the COWAT (R2 = 0.421), while a correlation between higher MMSE and BNT scores, faster completion times for the 4-m walking and TUG tests, and an increase in handgrip strength load was also observed. The analysis of the data revealed that those individuals with superior nutritional status and greater levels of physical fitness outperformed others on the cognitive evaluation.

A comprehensive assessment of oral health, swallowing difficulty, and nutritional status in older nursing home residents

Declines in oral consumption and swallowing function are common reasons which may elevate the risk of malnutrition in the older adults. This study aimed to provide valuable information and contribute to the existing body of knowledge in this field as well as highlight the importance of a comprehensive assessment of oral health, swallowing function, and nutritional status in long-term care residents. This was a cross-sectional study. Thirty-nine participants were recruited from a nursing home. The comprehensive assessment was evaluated in participants, including oral health (Oral Health Assessment Tool (OHAT)), swallowing function (Functional Oral Intake Scale (FOIS) and Eating Assessment Tool (EAT)-10), and nutritional status (Mini Nutritional Assessment-Short Form (MNA-SF). The average age of participants was 80.4 ± 11.7 years, and 46% of these older adults were found to be at the risk of malnutrition. There was a negative correlation between the OHAT and MNA-SF scores. In addition, subjects with poor oral health (OHAT score = 5~8), oral consumption of a modified diet (FOIS score = 4~6), and reduced swallowing function (EAT-10 score ≥ 3) were more likely to be at risk of malnutrition. A comprehensive evaluation of oral health and swallowing function was closely connected with the nutritional status of older nursing home dwellers.

Correlations Between Anxiety and/or Depression Diagnoses and Dysphagia Severity.

An increased prevalence of mood and anxiety disorders in patients with dysphagia has been noted previously, but whether dysphagia severity may be exacerbated by anxiety and depression has never been studied before. The purpose of this study is to identify the effect of pre-existing diagnosis of anxiety and/or depression (anxiety/depression) on the Eating Assessment Tool (EAT-10), a validated patient-reported outcome measure for dysphagia. We hypothesized that patients with dysphagia and normal instrumental evaluation have higher EAT-10 score in the presence of pre-existing anxiety and depression. A retrospective chart review was conducted of patients seen at the multi-disciplinary dysphagia clinic of an urban academic institution. EAT-10 scores and pre-existing diagnoses of anxiety/depression were collected at the first visit with laryngologists. The two-sample t-test was used to compare mean EAT-10 scores between the anxiety/depression and no anxiety/depression groups, stratified by swallowing dysfunction etiology. The study included 290 consecutive patients seen starting in January 2018. In this cohort, 60 (21%) had pre-existing anxiety, 49 (17%) depression, and 36 (12%) both. Overall, 59 patients had normal swallowing based on instrumental swallowing testing (flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, esophagram, or esophagoscopy). Among those, mean EAT-10 score was significantly higher in patients with anxiety and/or depression (n = 30) (14.63, SD = 11.42) compared to those with no anxiety and/or depression (n = 29) (8.93, SD = 6.59) (p = 0.023). While anxiety/depression may aggravate dysphagia in patients with normal swallowing function, this correlation may not hold in those with objective swallowing dysfunction. 4 Laryngoscope, 134:2115-2120, 2024.

Reply to the Letter to the Editor: Reply to the Letter to the Editor: Eating assessment tool (EAT-10) Has Been Validated as a Screening Tool for Dysphagia, Not for Oropharingeal Dysphagia.

Reply to the Letter to the Editor: Reply to the Letter to the Editor: Eating assessment tool (EAT-10) Has Been Validated as a Screening Tool for Dysphagia, Not for Oropharingeal Dysphagia.

Multi-Domain Screening: Identification of Patient's Risk Profile Prior to Head-and-Neck Cancer Treatment.

Head-and-neck cancer (HNC) can give rise to oropharyngeal dysphagia (OD), malnutrition, sarcopenia, and frailty. Early identification of these phenomena in newly diagnosed HNC patients is important to reduce the risk of complications and to improve treatment outcomes. The aim of this study was (1) to determine the prevalence of the risk of OD, malnutrition, sarcopenia, and frailty; and (2) to investigate the relation between these phenomena and patients' age, performance status, and cancer group staging. Patients (N = 128) underwent multi-domain screening consisting of the Eating Assessment Tool-10 for OD, Short Nutritional Assessment Questionnaire and BMI for malnutrition, Short Physical Performance Battery and Hand Grip Strength for sarcopenia, and Distress Thermometer and Maastricht Frailty Screening Tool for frailty. 26.2%, 31.0%, 73.0%, and 46.4% of the patients were at risk for OD, malnutrition, sarcopenia, or frailty, respectively. Patients with an advanced cancer stage had a significantly higher risk of OD and high levels of distress prior to cancer treatment. This study identified the risk profile of newly diagnosed HNC patients using a standardized 'quick and easy' multi-domain screening prior to cancer treatment.

Letter to the Editor: Eating assessment tool (EAT-10) Has Been Validated as a Screening Tool for Dysphagia, Not for Oropharingeal Dysphagia.

Letter to the Editor: Eating assessment tool (EAT-10) Has Been Validated as a Screening Tool for Dysphagia, Not for Oropharingeal Dysphagia.

Cross-sectional study on dysphagia evaluation in community-dwelling older adults using the Eating Assessment Tool (EAT) -10, EAT-2, and Water Swallow Test

BackgroundDysphagia is a health concern that causes severe complications and affects the life quality of the older population. This study aimed to determine the diagnostic performance of the Eating Assessment Tool (EAT)-2 compared with the EAT-10 and the Water Swallow Test (WST) in screening for dysphagia. MethodsA cross-sectional study was conducted among 5,090 community-dwelling older adults. Dysphagia was evaluated using both a subjective measure, the 10-item EAT (EAT-10) and an objective measure, the WST. The kappa index in pairs were analyzed. The validity and reliability of EAT-2 were also assessed. ResultsThe sensitivity and specificity of the EAT-2 were 96.3 % and 94.8 %, respectively. The kappa index between the EAT-2 and EAT-10 was 0.64, whereas it was 0.11 between the EAT-10 and WST. ConclusionsThe EAT-2 was a simpler screening tool for dysphagia. Combining the subjective questionnaire (EAT-10 or EAT-2) and the objective test (WST) is recommended.

Posterior cervical foraminotomy versus anterior cervical discectomy for Cervical Brachialgia: the FORVAD RCT.

Posterior cervical foraminotomy and anterior cervical discectomy are routinely used operations to treat cervical brachialgia, although definitive evidence supporting superiority of either is lacking. The primary objective was to investigate whether or not posterior cervical foraminotomy is superior to anterior cervical discectomy in improving clinical outcome. This was a Phase III, unblinded, prospective, United Kingdom multicentre, parallel-group, individually randomised controlled superiority trial comparing posterior cervical foraminotomy with anterior cervical discectomy. A rapid qualitative study was conducted during the close-down phase, involving remote semistructured interviews with trial participants and health-care professionals. National Health Service trusts. Patients with symptomatic unilateral cervical brachialgia for at least 6 weeks. Participants were randomised to receive posterior cervical foraminotomy or anterior cervical discectomy. Allocation was not blinded to participants, medical staff or trial staff. Health-care use from providing the initial surgical intervention to hospital discharge was measured and valued using national cost data. The primary outcome measure was clinical outcome, as measured by patient-reported Neck Disability Index score 52 weeks post operation. Secondary outcome measures included complications, reoperations and restricted American Spinal Injury Association score over 6 weeks post operation, and patient-reported Eating Assessment Tool-10 items, Glasgow-Edinburgh Throat Scale, Voice Handicap Index-10 items, PainDETECT and Numerical Rating Scales for neck and upper-limb pain over 52 weeks post operation. The target recruitment was 252 participants. Owing to slow accrual, the trial closed after randomising 23 participants from 11 hospitals. The qualitative substudy found that there was support and enthusiasm for the posterior cervical FORaminotomy Versus Anterior cervical Discectomy in the treatment of cervical brachialgia trial and randomised clinical trials in this area. However, clinical equipoise appears to have been an issue for sites and individual surgeons. Randomisation on the day of surgery and processes for screening and approaching participants were also crucial factors in some centres. The median Neck Disability Index scores at baseline (pre surgery) and at 52 weeks was 44.0 (interquartile range 36.0-62.0 weeks) and 25.3 weeks (interquartile range 20.0-42.0 weeks), respectively, in the posterior cervical foraminotomy group (n = 14), and 35.6 weeks (interquartile range 34.0-44.0 weeks) and 45.0 weeks (interquartile range 20.0-57.0 weeks), respectively, in the anterior cervical discectomy group (n = 9). Scores appeared to reduce (i.e. improve) in the posterior cervical foraminotomy group, but not in the anterior cervical discectomy group. The median Eating Assessment Tool-10 items score for swallowing was higher (worse) after anterior cervical discectomy (13.5) than after posterior cervical foraminotomy (0) on day 1, but not at other time points, whereas the median Glasgow-Edinburgh Throat Scale score for globus was higher (worse) after anterior cervical discectomy (15, 7, 6, 6, 2, 2.5) than after posterior cervical foraminotomy (3, 0, 0, 0.5, 0, 0) at all postoperative time points. Five postoperative complications occurred within 6 weeks of surgery, all after anterior cervical discectomy. Neck pain was more severe on day 1 following posterior cervical foraminotomy (Numerical Rating Scale - Neck Pain score 8.5) than at the same time point after anterior cervical discectomy (Numerical Rating Scale - Neck Pain score 7.0). The median health-care costs of providing initial surgical intervention were £2610 for posterior cervical foraminotomy and £4411 for anterior cervical discectomy. The data suggest that posterior cervical foraminotomy is associated with better outcomes, fewer complications and lower costs, but the trial recruited slowly and closed early. Consequently, the trial is underpowered and definitive conclusions cannot be drawn. Recruitment was impaired by lack of individual equipoise and by concern about randomising on the day of surgery. A large prospective multicentre trial comparing anterior cervical discectomy and posterior cervical foraminotomy in the treatment of cervical brachialgia is still required. This trial is registered as ISRCTN10133661. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 21. See the NIHR Journals Library website for further project information.

The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye.

The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Consensus for voice quality assessment in clinical practice: guidelines of the European Laryngological Society and Union of the European Phoniatricians.

To update the European guidelines for the assessment of voice quality (VQ) in clinical practice. Nineteen laryngologists-phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60-80% of experts were improved and resubmitted to voting until they were validated or rejected. Of the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases. The ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach.

The Water Swallow Test and EAT-10 as Screening Tools for Referral to Videofluoroscopy.

Videofluoroscopy (VFS) is the gold standard in evaluating dysphagia. Water swallow tests (WST) and the Eating Assessment Tool (EAT-10) are commonly used in dysphagia screening. We aimed to determine the feasibility of WST and EAT-10 as screening tools for referral to VFS. Patients (n = 150, median age: 70.0 years, range: 19-92 years, 58.7% female) referred to VFS completed the WST and EAT-10 before the examination. In the WST, we evaluated both the qualitative parameters (coughing, possible change in voice) and quantitative parameters (average drinking bolus size, swallowing speed). Correlations of EAT-10 total scores and WST parameters to the VFS findings were analyzed both individually and combined. In the WST, the most specific (89.7%) predictor of normal VFS findings was the absence of coughing, and the most sensitive (79.1%) parameter to predict abnormal findings was a bolus size of ≤20 mL. Using a combination of coughing and a bolus size ≤20 mL (simplified WST), the sensitivity of predicting abnormal findings increased to 83.5%. The most sensitive (84.6%) predictor of penetration/aspiration was failing any parameter in the WST. Lack of coughing indicated an absence of penetration/aspiration with an 82.5% specificity. Swallowing speed or combining the EAT-10 results with the WST results did not enhance the sensitivity or specificity of the WST for predicting the VFS results. Coughing and average drinking bolus size are the most important parameters in WST when screening for referral to VFS, whereas the swallowing speed does not seem to be useful. The WST is superior to EAT-10 in predicting VFS findings. 4 Laryngoscope, 134:1349-1355, 2024.