Swan Katina, Speyer Renée, Heijnen Bas J, Wagg Bethany, Cordier Reinie
Discipline of Speech Pathology, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD, 4811, Australia.
Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Qual Life Res. 2015 Oct;24(10):2447-56. doi: 10.1007/s11136-015-0990-y. Epub 2015 Apr 14.
Difficulty swallowing, oropharyngeal dysphagia, is widespread among many patient populations (such as stroke and cancer groups) and aged community-dwelling individuals. It is commonly managed with bolus modification: altering food (usually cutting, mashing or puréeing) or fluids (typically thickening) to make them easier or safer to swallow. Although this treatment is ubiquitous, anecdotal evidence suggests patients dislike this management, and this may affect compliance and well-being. This review aimed to examine the impact of bolus modification on health-related quality of life.
A systematic review of the literature was conducted by speech pathologists with experience in oropharyngeal dysphagia. The literature search was completed with electronic databases, PubMed and Embase, and all available exclusion dates up to September 2012 were used. The search was limited to English-language publications which were full text and appeared in peer-reviewed journals.
Eight studies met the inclusion criteria. Generally, bolus modification was typically associated with worse quality of life. Modifications to foods appeared to be more detrimental than modifications to fluids, but this may be due to the increased severity of dysfunction that is implied by the necessity for significant alterations to foods. The number of studies retrieved was quite small. The diverse nature of methodologies, terminologies and assessment procedures found in the studies makes the results difficult to generalise.
Overall, even though the severity of dysphagia may have been a confounding factor, the impact of bolus modification on health-related quality of life in patients with oropharyngeal dysphagia appears to be negative, with increased modification of food and fluids often correlating to a decreased quality of life. Further, associated disease factors, such as decreased life expectancy, may also have affected health-related quality of life. More research is needed.
吞咽困难，即口咽性吞咽困难，在许多患者群体（如中风和癌症患者群体）以及社区老年居民中普遍存在。通常采用食团调整的方法进行处理：改变食物（通常是切碎、捣碎或制成泥状）或液体（通常是增稠），使其更易于或更安全地吞咽。尽管这种治疗方法很普遍，但 anecdotal evidence 表明患者不喜欢这种处理方式，这可能会影响依从性和幸福感。本综述旨在研究食团调整对健康相关生活质量的影响。
由在口咽性吞咽困难方面有经验的言语病理学家对文献进行系统综述。通过电子数据库 PubMed 和 Embase 完成文献检索，并使用了截至2012年9月的所有可用排除日期。检索仅限于英文全文出版物且发表在同行评审期刊上。
八项研究符合纳入标准。一般来说，食团调整通常与较差的生活质量相关。对食物的调整似乎比对液体的调整更有害，但这可能是由于对食物进行重大改变所暗示的功能障碍严重程度增加所致。检索到的研究数量相当少。研究中发现的方法、术语和评估程序的多样性使得结果难以推广。
总体而言，尽管吞咽困难的严重程度可能是一个混杂因素，但食团调整对口咽性吞咽困难患者健康相关生活质量的影响似乎是负面的，食物和液体调整的增加往往与生活质量下降相关。此外，相关疾病因素，如预期寿命缩短，也可能影响健康相关生活质量。需要更多的研究。
