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European Journal of Physical and Rehabilitation Medicine 2020 Jun 26

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 “A. Avogadro”, Novara, Italy; 2 Rehabilitation Unit, ‘Mons. L. Novarese’ Hospital, Moncrivello, Vercelli, Italy


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BACKGROUND: Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this post-acute 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 Orthopaedic Rehabilitation inpatients.
AIM: 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 Orthopaedics Rehabilitation Unit “Mons. Luigi Novarese” Hospital, Moncrivello, Italy, for a 24-month period (from 1st January 2018 to 31th December 2019). We excluded patients with: a) diagnosis of neurological diseases; b) pharyngeal or esophageal cancer; c) maxillofacial cancer; d) 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; Dysphagia; Arthroplasty, Replacement; Aging; Osteoarthritis

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