Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables
Kaori Nishiwaki A1, Tetsuya Tsuji A2, Meigen Liu A1, Kimitaka Hase A1, Naofumi Tanaka A1, Toshiyuki Fujiwara A1
A1 From the Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo
A2 Department of Rehabilitation Medicine, Shizuoka Cancer Center Hospital and Research Institute, Shizuoka, Japan
Objective: To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke.Design: Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test.Patients: Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan.Methods: Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study.Results: Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61–83%) and a specificity of 67% (CI: 55–79%) as a predictor of aspiration (p<0.05).Conclusion: We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration.
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