A multi-centre prospective study on functional outcomes and post-stroke oropharyngeal dysphagia
1 February 2018
UAntwerp, Campus Drie Eiken, Building Q, Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk (route: UAntwerpen, Campus Drie Eiken
Organization / co-organization:
Faculty of Medicine and Health Sciences
Prof M. De Bodt & Prof G. Van Nuffelen
PhD defence Ingeborg Simpelaere - Faculty of Medicine and Health Sciences
Stroke has been recognized as a leading cause of disability and death. Post-stroke oropharyngeal dysphagia (PSOD) is a common complication. The reported short- and long-term outcomes associated with PSOD are often not consistent among studies. The main aim of this thesis was therefore to study the role of PSOD in predicting short- and long-term functional outcomes and place of residence. This thesis comprised five studies. Study I involved the evaluation of the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech-language pathologists (SLPs). As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. In study II, we performed a multi-centre prospective longitudinal study with a one-year follow-up in 151 acute stroke patients to determine the short- and long-term outcomes associated with PSOD assessed by the Mann Assessment of Swallowing Ability (MASA). This study showed that having PSOD at baseline predicts failure to return home after discharge. Both baseline MASA and OHAT scores were significant predictors of pneumonia during hospitalization and follow-up. The baseline MASA score was a significant predictor of survival following stroke, feeding status, functional independence and place of residence during follow-up, although more information regarding feeding status and functional independence could be obtained by repeating the MASA at the particular time points. Study III involved the development of the adjusted DSWAL-QoL questionnaire (aDSWAL-QoL) to increase self-reporting about dysphagia-related quality of life in dysphagic patients with additional language and/or cognitive impairment (DysLC). The feasibility and classical test theory (CTT)-psychometric properties (i.e., internal consistency, test-retest reliability, and criterion validity) of the aDSWAL-QoL were evaluated. The aDSWAL-QoL is a feasible, reliable and valid tool for use with DysLC patients. In study IV, we evaluated the psychometric properties of the DSWAL-QOL and aDSWAL-QoL using item analysis with the Rasch model. The analysis could not establish the structural validity and objectivity of the scales or their subscales and the statistical sufficiency of the total scores and subscale scores. Despite the implementation of adjustments suggested by the Rasch model, not all weaknesses could be resolved. Study V involved the development of a systematic review protocol to systematically review the clinical utility and psychometric properties of patient- and proxy-reported outcome measures that assess HRQoL among patients receiving enteral feeding.
The findings of this study contribute to our insight in PSOD and improved clinical care in this population.