The Dysphagia Handicap Index (DHI)-Normative Values. Systematic Review and Meta-Analysis

Risk factors and nomogram model for recurrence of benign paroxysmal positional vertigo in postmenopausal women: a multicenter cross-sectional study

Objective

To explore the risk factors for recurrent benign paroxysmal positional vertigo (BPPV) in postmenopausal women within 1 year of canalith repositioning procedure (CRP), and develops a risk model based on serum 25-hydroxyvitamin D (25(OH)D), estradiol, and calcium levels to provide early identification of high-risk groups and guide prevention and treatment strategies.

Methods

Data from postmenopausal women with BPPV, diagnosed and successfully treated with CRP at five hospitals in Sichuan Province between January 2019 and January 2024, were retrospectively analyzed. Participants were divided into BPPV validation and training sets in a 3:7 ratio. Clinical data were categorized into recurrence and non-recurrence subgroups based on whether BPPV recurred after treatment. LASSO regression identified factors influencing recurrence within 1 year after CRP, and multivariate logistic regression (MLR) analysis was used to develop a risk nomogram prediction model (NPM).

Results

A total of 490 patients were enrolled, with 147 in the validation set and 343 in the training sets. Among them, 151 patients (30.82%) experienced recurrenced, including 58 (30.61%) in the validation set and 106 (30.90%) in the training sets. LASSO and MLR analyses identified migraine (OR = 2.208, 95% CI = 1.278-3.817), serum calcium (OR = 0.601, 95% CI = 0.447-0.81), 25(OH)D (OR = 0.785, 95% CI = 0.713-0.864), and serum estradiol (OR = 0.820, 95% CI = 0.752-0.894) as significant factors influencing recurrence within 1 year after CRP treatment in postmenopausal women with BPPV.

Conclusion

The recurrence rate of BPPV within 1 year after CRP treatment in postmenopausal women is high. Migraine, 25(OH)D, calcium, and estradiol are associated with recurrence. The risk prediction model, developed using these factors, demonstrates good discrimination and calibration. It effectively predicts the recurrence risk within 1 year after successful CRP treatment, offering practical clinical value.

Risk factors and a nomogram model for recurrence of benign paroxysmal positional vertigo: a multicenter cross-sectional study

Objective

To explore factors influencing the recurrence of benign paroxysmal positional vertigo (BPPV) within 1 year after treatment with canalith repositioning procedure (CRP) and to construct a risk prediction model with a nomogram. This model aims to offer a scientific basis for of high-risk groups' early identification and to support the development of prevention strategies.

Methods

Data of BPPV patients diagnosed and successfully treated with CRP of 5 hospitals in Sichuan Province from Jan 2020 to Mar 2024 were retrospectively analyzed. The patients were divided into a training set of BPPV and a set of validation with a 7:3 ratio. After organizing the clinical data, the training set's patients were arranged into recurrent and non-recurrent subgroups based on the recurrence of BPPV within one-year post-treatment. Factors affecting BPPV recurrence were found using LASSO regression; then, multivariate logistic regression (MLR) analysis was used to build a nomogram-style risk prediction model. The "receiver operating characteristic" (ROC) curve, Hosmer-Lemeshow calibration curve, clinical "decision curve analysis" (DCA), and clinical impact curve were employed to assess the model's discrimination, accuracy, and clinical applicability.

Results

600 patients in all were involved; 180 were in the validation set and 420 in the training set, following a 7:3 split. The overall recurrence rate of BPPV within 1 year was 39.17% (235/600 cases). The recurrence rates in the validation and training sets were 39.44% (71/180 cases) and 39.05% (164/420 cases), respectively. LASSO regression and logistic regression analyses identified hypertension, hyperglycemia, migraine, HADS-A, and 25(OH)D as significant factors for recurrence. On the basis of these factors, a nomogram prediction model for recurrence was established. The validation and training sets had an area under the ROC curve of 0.723 (95%CI: 0.645-0.801) and 0.728 (95%CI: 0.679-0.777), respectively. The "Hosmer-Lemeshow goodness-of-fit (HLGOF) test" indicated satisfactory calibration (training set: chi-square = 8.708, p = 0.368; validation set: chi-square = 13.303, p = 0.102). The analysis exhibited an excellent consistency between the model's predicted probabilities and actual outcomes. DCA and clinical impact curve analyses indicated a positive net clinical benefit at various threshold probability levels, affirming the clinical value of the nomogram model in forecasting BPPV recurrence.

Conclusion

BPPV patients treated with CRP exhibit a high recurrence rate within one-year post-treatment. Hypertension, hyperglycemia, migraine, HADS-A, and 25(OH)D levels were related with increased recurrence risk. The risk prediction model, presented as a nomogram, demonstrated good discrimination and calibration, effectively predicting the BPPV's recurrence risk within 1 year and offering significant clinical utility.

Prevalence of Self-Reported Swallowing Difficulties and Swallowing-Related Quality of Life Among Community-Dwelling Older Adults in India

Self-reported swallowing difficulties are highly prevalent but underreported among older adults. The aging population in India is increasing, yet there is a lack of empirical data on self-reported swallowing difficulties in older adults. In the present study, we aimed to estimate the prevalence of self-reported swallowing difficulties and assess the swallowing-related quality of life (QOL) among community-dwelling older adults in India. We recruited 361 older adults (60-91 years) from the community. Participants completed the Eating Assessment Tool-10 (EAT-10) to assess self-reported swallowing difficulties and the Dysphagia Handicap Index (DHI) to assess swallowing-related QOL. Participants rated the EAT-10 from 0 for 'no problem' to 4 for 'severe problem'. The DHI rating included 0 for 'never', 2 for 'sometimes', and 4 for 'always'. The total scores of EAT-10 and DHI were summarised using descriptive statistics. Statistically significant differences between pass-fail groups of EAT-10 and DHI were evaluated using an independent t-test and multivariate analysis of variance test, respectively. The overall mean score for EAT-10 was 3.34, and 7.56 for DHI, with higher scores observed among females. 36.6% of older adults self-reported experiencing swallowing difficulties, while 47.4% self-reported having poor swallowing-related QOL at p < 0.05. A strong positive correlation (r = 0.86) was found between EAT-10 and total DHI scores at p < 0.001. The present study sheds light on the widespread yet underreported issue of self-reported swallowing difficulties and the impact on swallowing-related QOL among older adults in India. These findings emphasize the urgent need for early swallowing screening programs among older adults.

Impact of Modified Diet, Swallowing Exercises, and Electrostimulation on Quality of Life of Older Patients Suffering from Oropharyngeal Dysphagia

Background and Objectives: Oropharyngeal dysphagia is defined as a swallowing disorder in which it becomes difficult to form a bolus and move food from the mouth to the proximal part of the esophagus. Several factors can cause this disorder in geriatric patients. With oropharyngeal dysphagia, the patient's social isolation and the risk of depression increase, while the quality of life deteriorates. Materials and Methods: In this study, oropharyngeal dysphagia was suspected based on the EAT-10 questionnaire and diagnosed with the water drink test and endoscopic swallowing evaluation, which assesses the aspiration risk by using an eight-point Penetration-Aspiration scale. Patients with oropharyngeal dysphagia received complex treatment: exercises to strengthen the swallowing muscles, electrostimulation of the swallowing muscles, and a modified diet. The quality of life of 64 patients was assessed by using the DHI, SWAL-QoL, and EAT-10 questionnaires before complex treatment and after treatment. The results show that the quality of life improved after the complex treatment of oropharyngeal dysphagia. Results: The mean age of patients was 77.8 (9.1) years, and 56.3% of patients were women. At baseline, mild oropharyngeal dysphagia was found in 18.8% of patients; moderate-in 51.6%; and severe-in 29.7%. Aspiration risk was low in 28.1% of patients; medium-in 39.1%; and high-in 32.8%. The severity of oropharyngeal dysphagia and aspiration risk significantly decreased after treatment (p = 0.002). The EAT-10 score mean was 15.23 (8.92) points before treatment and decreased to 11.50 (6.12) points after treatment (p < 0.001). Before treatment, the DHI physical score was 15.75 (6.813), the DHI functional score was 14.56 (8.659), and the DHI emotional score was 11.06 (7.848) (p < 0.001), and after complex treatment, the DHI physical score was 14.56 (8.659), the DHI functional score was 9.74 (7.165), and the DHI emotional score was 7.94 (6.588) (p < 0.001). The total SWAL-QoL score mean was 132.71 (34.392) points before treatment and increased to 152.42 (30.547) points after treatment (p < 0.001). Conclusions: Complex treatment of oropharyngeal dysphagia plays an important role in improving the quality of life and reducing aspiration risk in older people affected by this condition.

Assessing Swallowing and Mastication Using the Swallowing Proficiency for Eating and Drinking Protocol Among Healthy Adults

BACKGROUND

Objective evaluation of swallowing using single bolus consistency are popular among Speech-Language Pathologists (SLPs) but has limited generalization to other bolus consistencies. The Swallowing Proficiency for Eating and Drinking (SPEAD) test assesses the oral and pharyngeal phases of swallowing using three different consistencies.

OBJECTIVES

The aim of this study was to establish normative data for the SPEAD test among healthy individuals aged 20-79 years.

METHOD AND MATERIALS

One hundred and twelve healthy adults recruited from the community were divided into three age groups (20-39.11, 40-59.11, & 60-79.11 years). Participants swallowing 100 g of water and thickened Electral, and 6.67 g of Parle Monaco was video recorded for data analysis.

RESULTS

Cronbachs Alpha test indicated good to excellent internal consistency and inter-class correlation test revealed a high level of inter-rater reliability for all SPEAD parameters. Older adults exhibited a higher number of bites, chews, and swallows, and required more time to swallow compared to younger and middle adults. Similarly, speed of ingestion and SPEAD rate were lowest in older adults. SPEAD indices also showed significant differences across the three consistencies at p < 0.01.

CONCLUSION

In summary, the SPEAD test was found to be feasible, reliable, and valid in healthy adults of India between 20 and 79 years of age. The age and sex based normative data established in this study will enable SLPs in assessing the presence and / or absence of swallowing difficulties in the oral and pharyngeal phases across different consistencies using one test.

Screening Oropharyngeal Dysphagia in Diabetic Patients and Its Potential Impact on Quality of Life

Background: Diabetes mellitus is a common chronic disease that affects the entire body, but some of its complications are less recognized. There are underlying mechanisms that suggest a possible co-occurrence of oropharyngeal dysphagia with diabetes. Objectives: The primary goal of this study was to assess the symptoms of oropharyngeal dysphagia resulting from diabetes and explore potential relationships between oropharyngeal dysphagia, sex, age, duration of diabetes, and types of interventions. Additionally, we aimed to investigate how dysphagia might impact the quality of life of individuals with diabetes mellitus. Methods: A total of 268 diabetic patients aged 18 - 65 years participated in this recent cross-sectional study. Participants were specifically selected from individuals with type 2 diabetes mellitus based on inclusion criteria. We collected brief medical histories and demographic information from each patient. Following the medical history, patients were questioned about their swallowing condition, and self-reported signs of dysphagia were recorded. Patients were also asked to complete a Persian version of the Dysphagia Handicap Index (P-DHI) questionnaire, which is used to assess dysphagic patients' self-assessments. Swallowing function was evaluated using the Mann Assessment of Swallowing Ability (MASA) test. Statistical analyses were performed using SPSS version 16, and Pearson and Spearman correlation coefficients were employed to assess relationships among variables. Results: Our findings revealed that women experienced more severe dysphagia compared to men. Furthermore, the impact of dysphagia on the quality of life was more significant among individuals treated with insulin than among diabetic patients not on insulin therapy (P-value = 0.001). Conversely, there was no significant difference in the quality of life among individuals with varying levels of education (P-value = 0.069). The most commonly reported symptom by patients on the self-report survey was "food sticking to the throat during swallowing." Additionally, patients faced considerable difficulties with the dry mouth subscale of P-DHI and the voice subscale of MASA. Conclusions: Our results suggest that patients with diabetes may exhibit various symptoms of oropharyngeal dysphagia. Detecting different signs of dysphagia associated with diabetes can guide researchers in developing new screening tools for dysphagia in these patients. Furthermore, our study identified relationships between various variables, aiding therapists in predicting potential signs of dysphagia. For instance, we found a relationship between the duration of diabetes and the occurrence of dysphagia, which can assist therapists in predicting dysphagia in patients with a longer history of diabetes.

Convergent and discriminant validity of the Minimal Eating Observation Form - version II: a cross-sectional study

BACKGROUND

The Minimal Eating Observation Form - Version II (MEOF-II) is a brief and easy to use screening tool for eating difficulties, that is psychometrically robust. The aim of this study was to explore convergent (measuring similar constructs) and discriminant (measuring somewhat different constructs) validity of the MEOF-II to other validated dysphagia specific, activity and participation related instruments.

METHODS

In this cross-sectional study, participants (n = 100, mean age 72, n = 42 women), diagnosed with either chronic pulmonary disease, Parkinson´s disease, Multiple Sclerosis, or stroke were recruited from rehabilitation centres. Patient-reported outcomes and clinical-rated assessments, capturing eating ability in general and swallowing in specific, included: The Dysphagia Handicap Index (DHI), the 4-question test (4QT), the Minimal Eating Observation Form - II, the Volume - Viscosity Swallow Test (V-VST), Flexible Endoscopic Evaluation of Swallowing (FEES) documented according to the Penetration-Aspiration Scale (PAS). Type of oral intake was documented using the Functional Oral Intake Scale (FOIS). Activities in daily living was assessed with Barthel index (BI). Spearman's correlation coefficient was used to analyze associations. The MEOF-II total score was hypothesised to have moderate correlations (r ≥ 0.3) with the other assessments, besides with PAS and FOIS (weak correlations, r < 0.3).

RESULTS

In total 78 participants had any type of eating difficulties (MEOF-II), 69 reported dysphagia (4QT), 62 had dysphagia according to V-VST, 29 showed evidence of penetration/aspiration (PAS), and 31 participants had decreased oral intake ability (FOIS). The MEOF-II total score had moderate correlations with DHI, BI, 4QT, V-VST volume, and weak correlations with V-VST dysphagia and viscosity, PAS, and FOIS. Comparing a prior hypothesised correlation strengths against empirical findings showed that 83% of the hypothesised correlations were correct.

CONCLUSIONS

The MEOF-II is a holistic and objective screening tool that can indicate the need for further assessment and corresponds well with the persons' subjective experiences. MEOF-II does not specifically assess the risk for penetration/aspiration.

Nutritional Status and Frailty Improvement through Senior-Friendly Diet among Community-Dwelling Older Adults in South Korea

Considering that Korea’s aging population is rapidly increasing, health serves as an indicator of older adults’ quality of life, and dietary life directly affects their health. For health maintenance and improvement, preventive healthcare measures including safe food selection and nutritional supply are needed. This study aimed to evaluate the effect of senior-friendly diet on nutrition and health status improvement in older adults receiving community care. A total of 180 older adults were analyzed, with 154 and 26 in the senior-friendly diet intervention group and the general diet group, respectively. Surveys, blood tests, and frailty evaluations were conducted before and after the study. After 5 months of intervention, the blood status, nutrient intake, and frailty level were evaluated. The participants’ mean age was 82.7 years, and 89.4% of them were living alone. In both groups, energy, protein, vitamin A, vitamin D, vitamin C, calcium, and magnesium intake were insufficient initially but generally improved after the intervention. Especially in the intervention group, energy, protein, vitamin D, vitamin C, and folic acid intake significantly increased. The frailty level also slightly improved, and the malnutrition rate was reduced. Even after the passage of time, the improvement effect size significantly differed between the groups. Therefore, resolving and supporting meals corresponding to the physiological needs of the older adults has a great impact on improving their quality of life, and such special consideration is a reasonable way to respond to a super-aged society.

Associations of Trunk Muscle Mass and Muscle Quality Indicators with Self-Reported Dysphagia in Older Inpatients

Recent studies have correlated dysphagia with ultrasound-measured quadriceps muscle mass and quality. Computed tomography (CT) is more precise than ultrasound for estimating muscle mass and quality. We aimed to investigate the possible associations of chest CT-determined trunk muscle mass and quality with dysphagia. A cross-sectional study. Older inpatients in a geriatric department of a university hospital. Self-reported dysphagia was determined by the Dysphagia Handicap Index. Unenhanced chest CT images were segmented to calculate skeletal muscle area (SMA) and intermuscular adipose tissue (IMAT). Skeletal muscle index (SMI) was calculated via SMA/ height squared. The percentage of IMAT (IMAT%) was calculated by IMAT% = IMAT/ (SMA + IMAT) × 100%. Mimics software was applied to calculate the mean skeletal muscle radio density (SMD).The semiquantitative food frequency method, the Barthel Index (BI), and the Mini Nutritional Assessment Short-Form (MNA-SF) were used to evaluate energy intake, activities of daily living, and nutrition status, respectively. Among the 212 participants (mean age: 84 years), 89 (42%) had self-reported dysphagia. After adjustment for age, nutrition status, energy intake, and other confounders, the SMI (adjusted OR 0.91, 95% CI 0.86, 0.96) was negatively associated with dysphagia, whereas the IMAT (adjusted OR 1.08, 95% CI 1.01, 1.16) and the IMAT% (adjusted OR 1.10, 95% CI 1.04,1.17) were positively associated with dysphagia. However, the SMD (adjusted OR 0.99, 95% CI 0.94, 1.05) was not significantly associated with dysphagia. The subgroup analyses indicated that only the SMI (adjusted OR 0.92, 95% CI 0.86, 0.97) and the IMAT% (adjusted OR 1.08, 95% CI 1.01, 1.17) were significantly associated with dysphagia in men. None of these indicators was significantly associated with dysphagia in women. Trunk muscle mass and quality (estimated by chest CT-derived SMI and IMAT%, respectively) were significantly associated with self-reported dysphagia in older inpatients, especially in men. IMAT% might be a more sensitive muscle quality indicator than IMAT (or SMD). These results merit further investigation in prospective studies.

Translation and Validation of the Dysphagia Handicap Index in Polish-Speaking Patients

Dysphagia Handicap Index (DHI) is a self-assessment questionnaire which consists of 25 statements to examine three aspects of dysphagia patients’ quality of life (QoL): functional, physical, and emotional. The patient can get a maximum score of 100 points. The study goal was to validate and translate the Polish version of the DHI (PL-DHI). One hundred and seventy-eight (178) individuals with oropharyngeal dysphagia with different etiology and 35 (thirty-five) asymptomatic adults with no history of swallowing disorders filled out the PL-DHI. Internal consistency was determined using Cronbach alpha coefficient, which was high for the total PL-DHI score (0.962). The reproducibility was high (r-Spearman correlation coefficient was 0.97 for total PL-DHI score). The PL-DHI’s total score and its subscales were significantly higher in the dysphagia patients study group (SG) than in the healthy controls group (CG) (SG median: 36; CG median: 4). A strong correlation was observed between the PL-DHI score and the self-reported dysphagia severity measure (Spearman’s correlation coefficient was 0.859, p < 0.001). The Polish DHI is a reliable and valid questionnaire for assessing dysphagia patients’ QoL.

Pilot Study of Respiratory-Swallow Coordination in Amyotrophic Lateral Sclerosis

PURPOSE

Amyotrophic lateral sclerosis (ALS) impacts bulbar and respiratory musculature, which may contribute to impaired swallow function (dysphagia) and respiratory-swallow coordination. The purpose of this pilot study was to examine if respiratory-swallow coordination in individuals with ALS was perturbed compared to healthy controls. We further explored relationships between measures of respiratory function and self-reported swallowing outcomes on respiratory-swallow coordination.

METHOD

We employed a cross-sectional design with eight participants with ALS and eight age- and sex-matched healthy participants. Respiratory inductance plethysmography and a nasal cannula were used to capture respiratory-swallow phase patterns during a standardized clinical swallow examination. The advantageous respiratory-swallow phase pattern was defined if exhalation surrounded the swallow (E-E). Spirometry was used to capture indices of respiratory function (forced vital capacity % predicted, peak cough flow [PCF]). Validated questionnaires were used to collect information regarding ALS-related bulbar functional status and swallowing-related concerns.

RESULTS

Compared to the matched healthy cohort, individuals with ALS demonstrated higher rates of non-E-E respiratory-swallow phase patterning and worse bulbar/swallow dysfunction. Group (ALS), swallow tasks, and PCF were significantly associated with respiratory-swallow phase pattern.

CONCLUSIONS

These preliminary findings support altered respiratory-swallow phase patterning in ALS. Future work should employ an instrumental assessment to quantify swallowing physiology and elucidate the relationship between perturbed respiratory-swallow coordination and swallowing function.

Cross-Cultural Adaptation and Validation of the Italian Version of the Dysphagia Handicap Index (I-DHI)

The Dysphagia Handicap Index (DHI) is a valid Health-related Quality of Life (HRQOL) questionnaire for patients with oropharyngeal dysphagia (OD) of heterogeneous etiologies. The study aimed at crossculturally translating and adapting the DHI into Italian (I-DHI) and analyzing I-DHI reliability, validity, and interpretability. The I-DHI was developed according to Beaton et al. 5-stage process and completed by 75 adult OD patients and 166 healthy adults. Twenty-six patients filled out the I-DHI twice, 2 weeks apart, for test–retest reliability purposes. Sixty-two patients completed the Italian-Swallowing Quality of Life Questionnaire (I-SWAL-QoL) for criterion validity analysis. Construct validity was tested comparing I-DHI scores among patients with different instrumentally assessed and self-rated OD severity, comparing patients and healthy participants and testing Spearman’s correlations among I-DHI subscales. I-DHI interpretability was assessed and normative data were generated. Participants autonomously completed the I-DHI in maximum 10 min. Reliability proved satisfactory for all I-DHI subscales (internal consistency: α > .76; test–retest reliability: intraclass correlation coefficient > .96, k = .81). Mild to moderate correlations (− .26 ≤ ρ ≤ − .72) were found between I-DHI and I-SWAL-QoL subscales. Construct validity proved satisfactory as (i) moderate to strong correlations (.51 ≤ ρ ≤ .90) were found among I-DHI subscales; (ii) patients with more severe instrumentally or self-assessed OD reported higher I-DHI scores (p < .05); and (iii) OD patients scored higher at I-DHI compared to healthy participants (p < .05). Interpretability analyses revealed a floor effect for the Emotional subscale only and higher I-DHI scores (p < .05) for healthy participants > 65 years. In conclusion, the I-DHI is a reliable and valid HRQOL tool for Italian adults with OD.