ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2021 February;57(1):131-6

DOI: 10.23736/S1973-9087.20.06321-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Screening dysphagia risk in 534 older patients undergoing rehabilitation after total joint replacement: a cross-sectional study

Alessandro de SIRE ^{1, 2} ✉, Alice GIACHERO ², Shara DE SANTI ², Katia INGLESE ², Claudio SOLARO ²

¹ Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy; ² Unit of Rehabilitation, “Mons. L. Novarese” Hospital, Moncrivello, Vercelli, Italy

BACKGROUND: Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this postacute phase, they might suffer from other symptoms, including dysphagia, defined as a dysfunction of the digestive system, characterized by an objective difficulty or a sensation of difficulty in swallowing. It is considered as a very challenging problem in older people and early detection is fundamental for a prompt and effective management. However, up to date, there is a lack of data on dysphagia risk screening in orthopedic rehabilitation inpatients.
AIM: The aim of this study was to evaluate dysphagia risk through Eating Assessment Tool (EAT-10) in older people undergoing rehabilitation after total hip or knee arthroplasty.
DESIGN: Cross-sectional study.
SETTING: Rehabilitation Unit.
POPULATION: All consecutive patients undergone total hip or knee arthroplasty, aged ≥65 years, referring to Orthopedics Rehabilitation Unit “Mons. Luigi Novarese” Hospital, Moncrivello, Italy, for a 24-month period (from 1^st January 2018 to 31^st December 2019). We excluded patients with: 1) diagnosis of neurological diseases; 2) pharyngeal or esophageal cancer; 3) maxillofacial cancer; 4) tracheotomy.
METHODS: Dysphagia risk was assessed through EAT-10. The cohort was divided into two groups, according to water swallowing test (WST), in order to evaluate differences in terms of different EAT-10 scores. Furthermore, based on pathological WST, we have stratified study participants by the American Speech-Language-Hearing Association (ASHA)’s National Outcomes Measurement System (NOMS) swallowing scale in order to evaluate differences in terms of the different EAT-10 scores.
RESULTS: We included 534 participants (180 men, 357 women), mean aged 74.8±5.6 years. Thirty-one patients (5.8%) had pathological WST and 34 (6.4%) reported EAT-10 ≥3. There were significant differences (P<0.001) between groups (pathological WST vs. normal WST) in terms of all EAT-10 total scores. EAT-10 reported a high specificity (96.8% if ≥3 and 98.4% if ≥4), but a low sensitivity (58.1% if ≥3 and 54.8% if ≥4).
CONCLUSIONS: EAT-10 might be considered as useful screening tools for dysphagia in older people, considering the high specificity of EAT-10≥4.
CLINICAL REHABILITATION IMPACT: Screening dysphagia risk should be recommended also in patients undergoing rehabilitation in order to set up an early diagnosis and management.

KEY WORDS: Deglutition disorders; Arthroplasty; Aging; Osteoarthritis