SWAL-QOL Scores Research Articles

Relationship between Quality of Life and Swallowing in Hypertensive Individuals with Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is closely associated with resistant hypertension (RHTN). Individuals with OSA may have sensory and muscular alterations in pharyngolaryngeal structures, potentially resulting in oropharyngeal dysphagia. One objective of this study was to assess and compare the quality of life (QoL) and swallowing ability of resistant hypertensive patients with and without OSA. Another objective was to evaluate the relationship between QoL and changes in swallowing in patients with RHTN and OSA. This work was an analytical observational study with a cross-sectional design that included resistant hypertensive patients who were undergoing polysomnography (the gold standard exam for the diagnosis of OSA), fiberoptic endoscopic evaluation of swallowing (FEES), dysphagia risk assessment (Eating Assessment Tool - EAT-10) and QoL assessment in swallowing (Swal-Qol). Of the 65 participants, 13 (20%) did not have OSA, 13 (20%) had mild OSA, 18 (27.7%) had moderate OSA, and 21 (32.2%) had severe OSA. Compared with those without OSA, patients with OSA had lower swallowing QoL scores ("burden", "symptoms", and "mental health"). Furthermore, pre premature leakage, onset of the pharyngeal phase in the pyriform sinus, laryngeal penetration, pharyngeal residue and oropharyngeal dysphagia were more prevalent among patients with OSA. Resistant hypertensive patients with OSA have a greater prevalence of changes in swallowing and worse Swal-QoL scores than those without OSA, although such changes were not shown in the EAT-10. In addition, Swal-Qol is related to swallowing safety impairments among these individuals.

Comparison of clinical and patient-reported outcomes in patients with benign euthyroid solitary nodules after ultrasound-guided percutaneous microwave ablation and endoscopic thyroidectomy.

Percutaneous ultrasound-guided microwave ablation (MWA) for benign solid thyroid nodules is the newest modality for treatment. However, the differences in treatment outcomes between MWA and endoscopic thyroidectomy vestibular approach (TOETVA) for patients with benign euthyroid solitary nodules remain unknown. We are sharing initial results from our prospective study. Prospective study between January 2022 and December 2023 was conducted and data were noted at 3 time points in patients planned for treatment (Preoperative, 1week, and 12months). Main outcome measures were clinical outcome and comparison of thyroid-related quality of life using the ThyPRO-39hin and swallowing-related quality of life using the SWAL-QoL. Of the 36 included patients, 20 patients underwent TOETVA and 16 underwent MWA. Both the groups were comparable in terms of demographic and clinicopathological profiles. The nodule volume reduction rate of patients at 12months after MWA was 75.10% and 100% for TOETVA. The mean preoperative ThyPRO-39hin and SWAL-QoL scores were comparable in all domains between the two groups. Mean ThyPRO-39hin and SWAL-QoL scores on postoperative day 7 were significantly better in the MWA group in domains impaired social life (p<0.0001) and impaired daily life (p=0.0002). However, at the end of 12months, mean ThyPRO-39hin and SWAL-QoL scores became significantly better in the TOETVA group as compared to the MWA group. Our findings suggest that transoral endoscopic thyroidectomy results in significant superior clinical outcome, thyroid-related quality of life, and swallowing-related quality of life in the long term.

The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery.

Retrospective cohort. To investigate the impact of evolving Enhanced Recovery After Surgery (ERAS) protocols on outcomes after cervical deformity (CD) surgery. ERAS can help accelerate patient recovery and assist hospitals in maximizing the incentives of bundled payment models while maintaining high-quality patient care. However, there remains a paucity of literature assessing how developments have impacted outcomes after adult CD surgery. Patients with operative CD 18 years or older with pre-baseline and 2 years (2Y) postoperative data, who underwent ERAS protocols, were stratified by increasing implantation of ERAS components: (1) early (multimodal pain program), (2) intermediate (early protocol + paraspinal blocks, early ambulation), and (3) late (early/intermediate protocols + comprehensive prehabilitation). Differences in demographics, clinical outcomes, radiographic alignment targets, perioperative factors, and complication rates were assessed through Bonferroni-adjusted means comparison analysis. A total of 131 patients were included (59.4 ± 11.7 y, 45% females, 28.8 ± 6.0 kg/m 2 ). Of these patients, 38.9% were considered "early," 36.6% were "intermediate," and 24.4% were "late." Perioperatively, rates of intraoperative complications were lower in the late group ( P = 0.036). Postoperatively, discharge disposition differed significantly between cohorts, with late patients more likely to be discharged to home versus early or intermediate cohorts [χ 2 (2) = 37.973, P < 0.001]. In terms of postoperative disability recovery, intermediate and late patients demonstrated incrementally improved 6 W modified Japanese Orthopedic Association scores ( P = 0.004), and late patients maintained significantly higher mean Euro-QOL 5-Dimension Questionnaire and modified Japanese Orthopedic Association scores by 1 year ( P < 0.001, P = 0.026). By 2Y, cohorts demonstrated incrementally increasing SWAL-QOL scores (all domains P < 0.028) domain scores versus early or intermediate cohorts. By 2Y, incrementally decreasing reoperation was observed in early versus intermediate versus late cohorts ( P = 0.034). The present study demonstrates that patients enrolled in an evolving ERAS program demonstrate incremental improvement in preoperative optimization and candidate selection, greater likelihood of discharge to home, decreased postoperative disability and dysphasia burden, and decreased likelihood of intraoperative complications and reoperation rates.

A comparison of swallowing related quality of life in patients undergoing transoral endoscopic versus open thyroid surgery.

It is important for the endoscopic thyroid surgeon to understand the pros and cons of trans-oral endoscopic thyroidectomy-vestibular approach (TOETVA) vis-à-vis, open conventional thyroidectomy (OTx) so he/she can help patients in making informed choices regarding the type of procedure to opt for. Swallowing related quality of life (SWAL-QoL) has not been compared between the two approaches. Using a rigorous qualitative methodology and validated reliable tool, this study set out to compare the swallowing related quality of life in patients undergoing TOETVA versus OTx. Prospective study at 3 time points in patients planned for hemithyroidectomy (Preoperative, 1week and 12weeks). Data were collected on patients at a tertiary teaching institute in India. Participants ranged from age 18-60years with a diagnosis of benign euthyroid nodule undergoing hemithyroidectomy. Exclusion criteria were-(1) pre-existing vocal cord abnormalities, (2) undergoing surgery for recurrent nodules, and (3) any neuro-muscular disease affecting swallowing ability. Main outcome measure was comparison of swallowing related quality of life domain scores between patients undergoing hemithyroidectomy via either endoscopic trans-oral or open approach. Of the 82 included patients, 40 underwent TOETVA and 42 OTx. Both the groups were comparable in terms of demographic and clinicopathological profile. The mean preoperative SWAL-QOL scores were comparable in all domains. Mean SWAL-QoL scores for all domains on postoperative day 7 were significantly better in TOETVA group with domains burden, eating desire, mental health and communication having medium effect sizes. Physical symptom domain was better in the OTx group but had a small effect size. The difference in SWAL-QoL domains between the two groups persisted for 3months also. Swallowing related quality of life after trans-oral endoscopic thyroidectomy compared to conventional open surgery has not been reported in the literature. Our findings suggest that trans-oral endoscopic thyroidectomy results in significant superior swallowing related quality of life in the majority of domains.

Effectiveness of smart health-based rehabilitation on patients with poststroke dysphagia: A brief research report.

This study aimed to evaluate the effectiveness of smart health-based rehabilitation on patients with poststroke dysphagia (PSD). We recruited 60 PSD patients and randomly allocated them to the intervention (n = 30) and control (n = 30) groups. The former received the smart health-based rehabilitation for 12 weeks, whereas the latter received routine rehabilitation. Water swallow test (WST), standardized swallowing assessment (SSA), swallow quality-of-life questionnaire (SWAL-QOL), stroke self-efficacy questionnaire (SSEQ), perceived social support scale (PSSS) and nutritional measurements including body weight, triceps skinfold thickness (TSF), total protein (TP), serum albumin (ALB) and serum prealbumin (PA) in both groups were measured. When the baseline WST, SSA, SWAL-QOL, SSEQ, PSSS and nutritional measurements were examined, there was no significant difference between the intervention group and the control group (P > 0.05). After rehabilitation interventions, the WST and SSA scores in the intervention group were significantly lower than those in the control group (P < 0.01). The SWAL-QOL, SSEQ and PSSS scores in the intervention group were significantly higher than in the control group (P < 0.01). Compared with the control group, the intervention group showed an increase in the serum levels of PA (P < 0.01). However, no statistically significant difference existed between the intervention group and the control group in terms of body weight, TSF, TP or ALB (P > 0.05). Overall, our data revealed that smart health-based rehabilitation is significantly beneficial to the swallowing function, quality of life, self-efficacy, and social support for PSD patients when compared with routine rehabilitation. However, nutritional measurements were not significantly improved in such patients under the smart health-based rehabilitation when compared the routine rehabilitation. In the future, it is necessary to extend the intervention time to further evaluate the long-term efficacy of smart health-based rehabilitation on nutritional measurements of PSD patients.

Impact of local steroid application on dysphagia after anterior cervical spine surgery: a meta-analysis.

Dysphagia is one of the most common complications of anterior cervical spine surgery. Local steroid was widely used to reduce the postoperative swallowing pain. However, the effect of local steroid application on dysphagia after anterior cervical spine surgery was still uncertain. We searched Medline (PubMed), Embase and the Cochrane Library on July 27, 2021 for studies investigating the effect of local steroid application on dysphagia after anterior cervical spine surgery from their date of inception to 2021. The relative risk or weighted mean difference with 95% confidence interval was recorded as a summary statistic consist of postoperative dysphagia, swallowing VAS scores, SWAL-QOL scores, PSTSI, and steroid related complications. This meta-analysis included 7 RCT studies involving 254 patients in the steroid group and 232 patients in the placebo group. Results showed local steroid group had less patients with dysphagia, lower swallowing VAS scores and less severe of prevertebral soft-tissue edema on the fourth day after surgery. No significant difference in non-fusion rate between the two groups was observed. And all included studies had no serious steroid related complications reported. The use of local steroid in anterior cervical spine surgery could reduce the early postoperative dysphagia without serious steroid related complication. However, the safety of local steroid application still need further studies with larger samples.

Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson's disease.

Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson’s disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD. Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up. Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference –277.3, 95 %CI [–497.8, –56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference –10.1 mm Hg, 95 %CI [–16.3, –3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference –11.3 mm Hg, 95 %CI [–17.2, –5.4], P = 0.003). Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.

The Effect of Capacity Assessment Combined with Staged Target Nursing Intervention on Swallowing Functional Disturbance and Pulmonary Infection in Elderly Stroke Patients

To investigate the effect of capacity assessment combined with staged target nursing intervention on swallowing functional disturbance (SFD) and pulmonary infection in elderly stroke patients. 82 elderly stroke patients treated in the neurological department of our hospital (June 2019-February 2021) were chosen as the study subjects and randomly split into study group (n=41) and control group (n=41). Both groups received basic treatment for cerebrovascular diseases. After that, control group received routine clinical nursing, while study group underwent capacity assessment combined with staged target nursing intervention. The scores of the Burke Lateropulsion scale in both groups after 3-month nursing intervention were obviously lower (P &lt; 0.001), and after 3-month nursing intervention the scores of the Burke Lateropulsion scale in study group were obviously lower compared with control group (P &lt; 0.001). The NIHSS scores in both groups after 3-month nursing intervention were obviously lower (P &lt; 0.001), and the NIHSS scores in study group after 3-month nursing intervention were obviously lower compared with control group (P &lt; 0.001). The total clinical efficacy rate in study group was obviously higher compared with control group (P &lt; 0.05). The SWAL-QOL scores in both groups after 3-month nursing intervention were obviously higher (P &lt; 0.001), and the SWAL-QOL scores in study group after 3-month nursing intervention were obviously higher compared with control group (P &lt; 0.001). The levels of FVC, FEV1 and PEF in both groups after 3-month nursing intervention were obviously higher (P &lt; 0.001), and those after 3-month nursing intervention in study group were obviously higher compared with control group (P &lt; 0.001). Plus, the total incidence of complications in study group was obviously lower compared with control group (P &lt; 0.05). The capacity assessment combined with staged target nursing intervention can effectively improve patients’ swallowing function, neurological function, pulmonary function and life quality, with obvious therapeutic effect, deserving promotion and popularization.

Understanding the Predictors of Swallowing-Related Quality of Life

<h3>Research Objectives</h3> To identify the independent predictors of swallowing-related quality of life (QOL) in stroke survivors. Give that a large proportion of stroke survivors suffer from swallowing difficulties (dysphagia), which negatively impact survival and QOL, it is important pinpoint modifiable factors contributing to reduced quality of life in order to improve treatment outcomes and the overall health of the patient. <h3>Design</h3> Cross-sectional online survey. <h3>Setting</h3> General community. <h3>Participants</h3> A volunteer sample of 31 adult stroke survivors with dysphagia (mean age 62 years; 23 males) and their spouses (mean age 57 years; 7 male). Survivors were >3 months post-stroke and living with their spouse who was providing some degree of caregiving. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Backward regression analysis methods were employed.Dependent variable: dysphagia-related quality of life (SWAL-QOL)Independent variables: age; employment status; receiving dysphagia treatment; number of medical conditions; diet restrictiveness (based on consumption of texture modified food and drink); stroke impact (Stroke Impact Scale; SIS); relationship with spouse; spousal age; spousal employment status; spousal burden; spousal depression. <h3>Results</h3> Number of survivor medical conditions, degree of diet restrictiveness, SIS emotional subscale score, and spousal employment status significantly predicted dysphagia-related QOL, F(3, 21) = 16.423, p < .001, accounting for 75.4% of the variation in SWAL-QOL scores with an adjusted R2 of 70.1%. The model suggested that stroke survivors with more medical conditions and/or a caregiver who worked outside of the home had worse dysphagia-related QOL, and those with fewer feelings of sadness, burden, nervousness, etc. and/or a less restrictive diet had better dysphagia-related QOL. <h3>Conclusions</h3> Factors related to dysphagia-related QOL are multifactorial and include both survivor and spousal variables. Results support the interrelatedness of overall patient health, patient mental health, and family support, particularly for individuals coping with dysphagia-related dietary restrictions. These data highlight the need for speech-language pathologists and other members of the rehabilitation team to consider patient disability and needs more holistically in order to maximize perceived treatment outcomes. <h3>Author(s) Disclosures</h3> Nothing to disclose.

The Effect of Esophageal Temperature Probes on Postoperative Dysphagia Following Primary Anterior Cervical Discectomy and Fusion: A Randomized Prospective Study.

The anterior approach to the cervical spine is associated with postoperative dysphagia. It is difficult to predict which patients are most at risk for dysphagia. The objective of this study was to determine if placing an esophageal temperature probe preoperatively would affect the severity and length of postoperative dysphagia. We hypothesize that use of an esophageal temperature probe would result in worse postoperative dysphagia at all measured time points as measured by the Swallowing-Quality of Life (SQAL-QOL) survey after anterior cervical discectomy and fusion (ACDF). A total of 44 patients were enrolled in a prospective, randomized controlled trial and randomized into groups: 1 with an esophageal temperature probe placed at the time of surgery and 2 without. A total of 39 patients filled out postoperative SWAL-QOL questionnaires at their preoperatives. Using the survey results, the data were analyzed between groups and subanalyzed based on number of operative levels and sex. SWAL-QOL scores for patients undergoing 2-level ACDF with an esophageal temperature probe were significantly better compared with those without a probe at 2 weeks and 6 months postoperatively. These results were not significant at other time points in in the overall analysis, but a trend toward improved dysphagia scores at each time point postoperatively was seen with the probe group. No differences were found between the 2 groups with respect to age at the time of surgery, sex, and preoperative SWAL-QOL score. Placement of an esophageal temperature probe at the time of surgery significantly improved postoperative dysphagia scores in patients undergoing 2-level ACDF at 2 weeks and 6 months postoperatively. 2 CLINICAL RELEVANCE: Placement of a temperature probe is a safe and effective technique that is readily available and easily applicable to the practice of spine surgery and may improve postoperative dysphagia after ACDF.

Combination of acupuncture with rehabilitation training for pseudobulbar paralysis after stroke:A randomized controlled trial吞咽五穴联合康复训练 治疗脑卒中后假性延髓麻痹：随机对照试验

ObjectiveTo compare the clinical effects of needling at “five acupoints for swallow function” combined with rehabilitation training and only rehabilitation training in the treatment of dysphagia due to pseudobulbar paralysis after stroke. MethodsSeventy-six patients were randomized into rehabilitation group and combination group, with 38 cases in each. Both groups were treated with basic treatment of western medicine. The rehabilitation group was treated with routine rehabilitation training, and the combination group was treated with acupuncture at “five acupoints for swallow function” based on treatment in the rehabilitation group. Patients in the two groups were treated once a day, 6 days a week, 1 day for rest, for 3 weeks in succession. The changes in the grades and scores of water swallow test (WST), video fluoroscopic swallowing study (VFSS), and swallowing quality of life questionnaire (SWAL-QOL) in the two groups were observed before and after treatment, and the clinical effects of the two groups were compared. ResultsAfter treatment, the WST grades of the two groups were statistically different from that of before treatment (both P< 0.05), and the WST grade of the combination group was statistically different from that of the rehabilitation group (P< 0.05). After treatment, the VFSS and SWAL-QOL scores of the two groups were increased in comparing with those of before treatment (all P < 0.05), and the VFSS and SWAL-QOL scores of the combination group were higher than those of the rehabilitation group (both P < 0.05). The total effective rate of the combination group was 92.1% (35/38), higher than 60.1% (23/38) of the rehabilitation group. ConclusionThe acupuncture combined with rehabilitation training for pseudobulbar paralysis after stroke is more effective than rehabilitation training only. The combination of the two can significantly relieve the dysphagia and improve the patients’ quality of life.

Comparison of Patient-Reported and Caregiver-Reported Swallowing-Related Quality of Life in Parkinson's Disease.

This pilot study explored agreement on swallowing-related quality-of-life scores reported by individuals with Parkinson's disease (PD) and their caregivers. Thirty-six patient-caregiver pairs completed the Swallowing Quality of Life Questionnaire (SWAL-QOL) using an online survey format. Additional background and clinical information was ascertained. A Wilcoxon signed-rank test was completed to compare the means of scores between individuals with PD and caregivers. Factors potentially influencing SWAL-QOL scores (age, employment status, sex, ethnicity, race, previous history of swallowing evaluation or treatment, caregiver concern about patient cognition, caregiver burden, and time since onset of disease) were explored using Spearman Coefficient Correlation tests. The Holm-Bonferroni method was used to adjust for multiple comparisons. Results did not reveal significant differences in SWAL-QOL scores between individuals with PD and caregiver pairs. There was a moderate degree of reliability and agreement between paired patient and caregiver scores, with the average ICC measures being 0.598 (95% CI [358, 0.748]) (F(71, 72) = 2.451, p < 0.0001). After adjusting for multiple comparisons, caregiver burden was found to be the only significant factor associated with caregivers' reported scores. No significant influential factor on reported scores by individuals with PD was found. These pilot results suggest individuals with PD and their caregivers may report similar swallowing-related quality-of-life scores. Further, caregiver burden appears to be an influential factor for caregiver-reported scores. Future studies should investigate the clinical benefits of including caregiver SWAL-QOL ratings in assessments, either as a supplement to patient scores to identify discrepancies across the dyad or in place of patient scores if needed. Further, caregiver burden and its influence on dysphagia identification and management should be explored, with targeted interventions to manage caregiver burden.

Progressive Decline in Voice and Voice-Related Quality of Life in X-Linked Dystonia Parkinsonism

To characterize the evolution of swallowing and voice in patients with X-linked dystonia parkinsonism (XDP). Retrospective case series. Retrospective review of 59 patients with XDP from January 2016 to January 2018. All patients underwent complete examinations and quality of life (QOL) surveys (Swallowing Quality of Life questionnaire [SWAL-QOL], Voice-Related Quality of Life [V-RQOL], and Voice Handicap Index [VHI]), and functional endoscopic examination of swallowing. We excluded patients with incomplete records or patients lost to follow-up. Univariate analysis was used to compare 2016 to 2018 Penetration-Aspiration Scale (PAS), SWAL-QOL, V-RQOL, and VHI scores. Ten patients met the inclusion criteria. Nine patients had oromandibular dystonia. Voice-related measures significantly worsened with an increase in mean VHI from 81 to 109.9 (P=0.026) and decrease in mean V-RQOL from 58 to 28 (P=0.013). Vocal strain also significantly worsened 0.4 to 1.4 (P=0.001). Mean PAS scores increased from 4.2 to 5.1 (P=0.068) and mean SWAL-QOL decreased from 50.4 to 43.5 (P=0.157). In the SWAL-QOL, the mean Eating Duration score worsened from 0.9 to 0.4 (P=0.052) and Mental Health score declined from 10.1 to 6.1 (P=0.077). Both vocal strain and voice-related QOL measures considerably worsened over the 2-year interval in our limited group of XDP patients with no significant change in PAS scores or swallowing QOL. The findings demonstrated that the pace of disease affecting voice symptoms was different from swallowing symptoms in our study group and that changes in communication ability may be a more sensitive marker for disease progression than swallowing dysfunction.

Oncological and Functional Outcomes of Conservation Surgery for Carcinoma Glottis.

Conservation laryngectomy has gained considerable acceptance as a means of enhancing overall long-term function preservation in the management of glottic cancers. This study aims to evaluate the oncological and functional outcomes of conservation surgery for carcinoma of the glottis. Fifty consecutive conservation laryngectomies from January 2010 to December 2018 were studied. Glottic cancers of stages I to IVa were carefully selected both in the primary and salvage settings after a consensus from the multidisciplinary tumour board (MDT). Oncological outcomes in terms of overall survival and disease-free survival were measured, and the long-term functional outcomes of voice and swallowing were evaluated using the GRBAS vocal scale and SWAL-QOL questionnaire. The median follow-up period was 63.4months. The overall 5-year survival probability was 98% (standard error 2.2%), while median disease-free survival was 23months. The median GRBAS scores in the open and transoral laser microsurgery (TOLMS) group were 1.828 and 1.428, respectively. The median SWAL-QOL scores in majority of quality of life domains were in the mild or no disease impact zone (71-100). Conservative laryngeal surgery plays a crucial role in the treatment of glottic cancers in all stages. It is oncologically safe, and the functional outcomes are favourable.

Fire needling on dysphagia due to pseudobulbar palsy after stroke: a randomized controlled trial

To observe the clinical effect of fire needling on dysphagia due to pseudobulbar paralysis after stroke and to compare the difference in clinical effect between fire needling and swallowing function rehabilitation training. A total of 76 patients with dysphagia due to pseudobulbar paralysis after stroke were randomly divided into an observation group and a control group, 38 cases in each group (1 case dropped out in the control group). The both groups were based on conventional western medication treatment. Fire needle pricking was exerted at Lianquan (CV 23), Fengchi (GB 20), Wangu (GB 12), Shuigou (GV 26), Neiguan (PC 6) and Zusanli (ST 36) without needle retaining every other day in the observation group. The control group was treated with the swallowing function rehabilitation training. In both groups, treatment for 2 weeks was as one course and 2 courses of treatment with 2-day interval were required. After treatment, swallowing scores of Fujishima Ichiro and swallow quality of life questionnaire (SWAL-QOL) scores were observed in both groups, and the clinical effect was compared. Follow-up of swallowing scores of Fujishima Ichiro in 4 weeks after treatment was completed to evaluate the clinical effect. The clinical effective rates after treatment and follow-up were 92.1% (35/38) and 94.7% (36/38) in the observation group, higher than 75.7% (28/37) and 83.8% (31/37) in the control group (P<0.05). After treatment, the swallowing scores of Fujishima Ichiro and SWAL-QOL scores were increased in the two groups (P<0.05), and those in the observation group were higher than the control group (P<0.05). The swallowing scores of Fujishima Ichiro were increased during follow-up in the two groups (P<0.05). Fire needling has a better effect than conventional rehabilitation training in the treatment of dysphagia due to pseudobulbar paralysis after stroke, which can obviously improve the swallowing function and quality of life in patients with dysphagia.

P116. Swallowing function following anterior cervical discectomy and fusion with and without anterior plating

BACKGROUND CONTEXT Anterior cervical plating in anterior cervical discectomy and fusion (ACDF) procedures are associated with improved outcomes compared to stand-alone cages. However, concerns exist regarding increased rates of postoperative dysphagia following an ACDF. PURPOSE To quantify the effect of anterior plating on SWAL-QOL scores and radiographic swelling assessments following a primary, single-level ACDF. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 68 patients who underwent a primary, single-level ACDF from 2014-2017. OUTCOME MEASURES SWAL-QOL scores, radiographic swelling. METHODS Patients were retrospectively reviewed and grouped by those receiving a stand-alone cage (cage) or cage with anterior plating (plate). SWAL-QOL scores were recorded preoperatively and 6-week and 12-week postoperatively. Lateral radiographs were used to create a swelling index with a ratio of the prevertebral swelling distance to the anterior-posterior diameter of each involved vertebral body. A tracheal air index was created using the same methodology. Statistical analysis was performed using chi-square analysis and independent t-tests for categorical and continuous variables. RESULTS A total of 68 primary, single-level ACDF patients were included. Forty-one (60.3%) received a stand-alone cage and 27 (39.7%) received a cage with anterior plating. No differences in demographics, comorbidities, operative time, estimated blood loss, or length of hospital stay were identified between cage and plate cohorts. Additionally, no differences were observed in postoperative SWAL-QOL scores. Swelling index was greater for the plate cohort at 6-weeks but was similar between groups at 12-weeks. The air index was similar at all time points. CONCLUSIONS The results demonstrate that patients undergoing a primary, single-level ACDF with or without anterior plating experience similar operative times and lengths of stay. Patients that receive a cage with anterior plating did not experience significant increases in dysphagia as measured by the SWAL-QOL questionnaire compared to patients that received a stand-alone cage. Furthermore, radiographic assessments of swelling are comparable between cohorts. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

The present study aimed to investigate which swallowing difficulty of food consistency in participants over 65years of age who did not have any disease that might affect swallowing functions, and which symptoms were most likely related to oropharyngeal dysphagia (OD). The cross-sectional and multicenter study was conducted at 12 hospitals including 883 participants aged ≥65years who were fed orally and who were admitted to the physical medicine and rehabilitation outpatient clinics between September 2017 and December 2018. Demographic characteristics were recorded. Katz Daily Living Activities Index (KDLAI), swallowing-related quality of life scale (Swal-QoL) and 10-item Eating Assessment Tool (EAT-10) were used. The participants were asked the "yes" or "no" questions including swallowing difficulty of various types of food consistency with the face-to-face interview. Participants were divided into two groups as normal swallowing (EAT-10 < 3 group) (n = 639) and OD risk groups (EAT-10 ≥ 3 group) (n = 244) according to the EAT-10 scores. While there was no difference related to number of teeth and KDLAI scores between groups (p = 0.327 and p = 0.221, respectively), the significant difference was found between groups in terms of yes/no questions and Swal-QoL scores (p < 0.05). Receiver operating characteristic analysis revealed that eating difficulty of mixed content food provided maximum sensitivity (99%) and eating/drinking difficulty of thick liquid had maximum specificity (77%). The higher area under curve was in eating/drinking difficulty of thick liquid (0.891), and higher positive likelihood ratio (LR) was eating/drinking difficulty of thick liquid (4.26) as well as lower negative LR was eating difficulty of mixed content food (0.01). The higher diagnostic odds ratio was eating difficulty of mixed content food (367.0), and the higher posttest probability was eating/drinking difficulty of thick liquid (0.211). While eating difficulty of hard solid food is the most common symptom in healthy participants over 65years of age, the eating difficulty of thick liquids is the highest predictive value related to oropharyngeal dysphagia risk. Also, the eating difficulty of mixed content food had the highest diagnostic ratio.

Cervical Deformity Patients Have Baseline Swallowing Dysfunction but Surgery Does Not Increase Dysphagia at 3 Months: Results From a Prospective Cohort Study.

Study Design:Prospective cohort study.Objectives:Most studies of dysphagia in the cervical spine have focused on a degenerative patient population; the rate of dysphagia following surgery for cervical deformity (CD) is unknown. This study aims to investigate if surgery for cervical deformity results in postoperative dysphagia.Methods:Patients with CD undergoing surgery from 2013 to 2015 were prospectively enrolled to evaluate dysphagia. Demographic, operative, and radiographic variables were analyzed. The Quality of Life in Swallowing Disorders (SWAL-QoL) was used to measure dysphagia. Paired t test, independent t tests, and bivariate Pearson correlations were performed.Results:A total of 88 CD patients, aged 61.52 ± 10.52 years, were enrolled. All patients (100%) had 3-month SWAL-QoL for analysis. The baseline preoperative SWAL-QoL was 78.35. This is roughly the same level of dysphagia as an anterior cervical discectomy patient that is 3 weeks removed from surgery. Increasing body mass index (BMI) was correlated with decreased SWAL-QoL score (r = −0.30, P = .001). Age, gender, smoking, and Charlson Comorbidity Index (CCI) showed no significant correlations with preoperative SWAL-QoL. Patients with prior cervical surgery had a lower preoperative SWAL-QoL (P = .04). While 11 patients had acute postoperative dysphagia, CD surgery did not result in lower SWAL-QoL at 3 months (77.26 vs 78.35, P = .53). Surgical variables, including estimated blood loss (EBL), anterior or posterior fusion levels, steroid use, preoperative traction, staged surgery, surgical approach, anterior corpectomy, posterior osteotomy, and UIV (upper instrumented vertebrae) location, showed no impact on postoperative SWAL-QoL. Correction of cervical kyphosis was not correlated to 3-month SWAL-QoL scores or the change in SWAL-QoL scores.Conclusions:While patients undergoing surgery for cervical deformity had swallowing dysfunction at baseline, we did not observe a significant decline in SWAL-QoL scores at 3 months. Patients with prior cervical surgery and higher BMI had a lower baseline SWAL-QoL. There were no surgical or radiographic variables correlated to a change in SWAL-QOL score.

Quality of Life Related to Swallowing in Parkinson’s Disease

Swallowing difficulties in Parkinson's disease can result in decreased quality of life. The swallowing quality of life questionnaire (SWAL-QOL) is an instrument for specifically assessing quality of life with respect to swallowing, which has been little explored in patients with Parkinson's disease (PD). The goal of this study was to evaluate the quality of life with respect to swallowing in persons with PD compared to controls and at several stages of the disease using the SWAL-QOL. The experimental group was composed of 62 persons with PD at stages 1-4. Forty-one age-matched healthy subjects constituted the control group. The SWAL-QOL scores were significantly lower for the patients with PD than for the controls in all SWAL-QOL domains. Eating duration had the largest difference in score between persons with PD and the controls and the lowest mean score, followed by communication, fatigue, fear, sleep, and food selection. The scores of most domains were lower at later stages of the disease. The scores for eating duration, symptom frequency, and sleep were significantly lower at stage 4 than stages 1 and 2. In conclusion, patients with PD have significantly lower scores in all domains of the SWAL-QOL than normal controls. This means swallowing difficulties occurring in patients with PD negatively affect their QOL. Progression of the disease worsens swallowing QOL, more specifically in the domains of eating duration, symptom frequency, and sleep. This occurs mostly at later stages of the disease.

Patient-reported symptom questionnaires in laryngeal cancer: Voice, speech and swallowing

To validate questionnaires on voice, speech, and swallowing among laryngeal cancer patients, to assess the need for and use of rehabilitation services, and to determine the association between voice, speech, and swallowing problems, and quality of life and distress. Laryngeal cancer patients at least three months post-treatment completed the VHI (voice), SHI (speech), SWAL-QOL (swallowing), EORTC QLQ-C30, QLQ-HN35, HADS, and study-specific questions on rehabilitation. Eighty-eight patients and 110 healthy controls participated. Cut off scores of 15, 6, and 14 were defined for the VHI, SHI, and SWAL-QOL (sensitivity > 90%; specificity > 80%). Based on these scores, 56% of the patients reported voice, 63% speech, and 54% swallowing problems. VHI, SHI, and SWAL-QOL scores were associated significantly with quality of life (EORTC QLQ-C30 global quality of life scale) (r = .43 (VHI and SHI) and r = .46 (SWAL-QOL)) and distress (r = .50 (VHI and SHI) and r = .58 (SWAL-QOL)). In retrospect, 32% of the patients indicated the need for rehabilitation at time of treatment, and 81% of these patients availed themselves of such services. Post-treatment, 8% of the patients expressed a need for rehabilitation, and 20% of these patients actually made use of such services. Psychometric characteristics of the VHI, SHI, and SWAL-QOL in laryngeal cancer patients are good. The prevalence of voice, speech, and swallowing problems is high, and clearly related to quality of life and distress. Although higher during than after treatment, the perceived need for and use of rehabilitation services is limited.