Predictor of rehabilitation outcome for dysphagia

Predicting whether dysphagia will resolve is very difficult, but is obviously important for patients and their families as well as for physicians. This study retrospectively evaluated potential prognostic indicators for dysphagia in order to examine the feasibility of predicting the outcome.

Data on 123 patients who received initial treatment for dysphagia between April 2008 and March 2010 were reviewed. The patient population included 63 men and 60 women, with a mean age of 81.4 years. All the patients underwent physical examination and video-endoscopy (VE) at the initial assessment, and video-fluorography (VF) was also done if necessary. We used the "Food Intake Level Scale" (FILS) to classify the severity of dysphagia as follows: "no oral intake" (FILS score: 1-3), "oral intake and alternative nutrition" (FILS score: 4-6), and "oral intake alone" (FILS score: 7-10). The patient's age, primary disease, cognitive ability, and general condition were evaluated as potential factors associated with the severity of dysphagia. Each patient underwent assessment at every 2 weeks to evaluate the progress of their dysphagia.

Forty-six patients were classified as "no oral intake" (FILS score: 1-3) at the initial examination and subsequently showed improvement to "oral intake and alternative nutrition" (FILS score: 4-6) or "oral intake alone" (FILS score: 7-10). They were compared with 43 patients who were also "no oral intake" at the second examination after training in swallowing. The combination of stroke and cognitive dysfunction showed a sensitivity of 75.9% (22/29) and specificity of 78.3% (18/23) for predicting no improvement of dysphagia, and was a statistically significant parameter. The presence of disuse syndrome showed a sensitivity of 66.0% (31/47) and specificity of 71.4% (30/42) for predicting no improvement of dysphagia, and this was also a significant parameter.

The results of this study suggest that a combination of factors other than stroke, including cognitive dysfunction and a decrease in activity of daily living (ADL) influence the outcome of dysphagia. It is not rare for patients who resume oral intake to be readmitted within a year for symptoms such as fever. Therefore, effective rehabilitation programs should be developed for the impairments of elderly patients and common disabilities such as dysphagia.