Lee Byung Joo, Eo Hyoshin, Park Donghwi
Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu 41133, Korea.
Department of Physical Medicine and Rehabilitation, College of Medicine, Ulsan University Hospital, University of Ulsan, Ulsan 44033, Korea.
J Clin Med. 2021 Sep 22;10(19):4300. doi: 10.3390/jcm10194300.
The videofluoroscopic dysphagia scale (VDS) is used to predict the long-term prognosis of dysphagia among patients with the condition. Previously, a modified version of the VDS (mVDS) was established to overcome the relatively low inter-rater reliability of VDS, and was verified in patients with dysphagia, such as stroke patients. However, the validity of mVDS in patients with amyotrophic lateral sclerosis (ALS) has never been proved. Therefore, in this study, we attempted to seek the validity of the mVDS score in patients with ALS suffering from dysphagia.
Data from the videofluoroscopic swallowing study (VFSS) of 34 patients with ALS and dysphagia were retrospectively collected. We investigated the presence of aspiration pneumonia and the selected feeding method based on the VFSS. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were performed during the data analysis.
In patients with ALS and dysphagia, the mVDS scores were statistically correlated with the selected feeding method ( < 0.05) and the presence of aspiration pneumonia ( < 0.05). In the ROC curve analysis, the area under the ROC curve values for the selected feeding method and the presence of aspiration pneumonia were 0.886 (95% confidence interval (CI), 0.730-0.969; < 0.0001) and 0.886 (95% CI, 0.730-0.969; < 0.0001), respectively.
The mVDS can be a useful tool for quantifying the severity of dysphagia and interpreting the VFSS findings in patients with ALS and dysphagia. However, further studies involving a more general population of patients with ALS are needed to elucidate a more accurate cut-off value for the allowance of oral feeding and the presence of aspiration pneumonia.
视频荧光吞咽量表（VDS）用于预测吞咽困难患者吞咽功能的长期预后。此前，为克服VDS评分者间信度相对较低的问题，建立了改良版VDS（mVDS），并在吞咽困难患者（如中风患者）中得到验证。然而，mVDS在肌萎缩侧索硬化症（ALS）患者中的有效性尚未得到证实。因此，在本研究中，我们试图探寻mVDS评分在ALS吞咽困难患者中的有效性。
回顾性收集34例ALS吞咽困难患者的视频荧光吞咽造影检查（VFSS）数据。我们根据VFSS调查了吸入性肺炎的发生情况和所选的喂养方式。我们还评估了mVDS与所选喂养方式之间以及mVDS与吸入性肺炎发生情况之间的相关性。数据分析过程中进行了多因素逻辑回归和受试者工作特征（ROC）分析。
在ALS吞咽困难患者中，mVDS评分与所选喂养方式（<0.05）和吸入性肺炎的发生情况（<0.05）存在统计学相关性。在ROC曲线分析中，所选喂养方式和吸入性肺炎发生情况的ROC曲线下面积值分别为0.886（95%置信区间（CI），0.730 - 0.969；<0.0001）和0.886（95%CI，0.730 - 0.969；<0.0001）。
mVDS可作为量化ALS吞咽困难患者吞咽功能障碍严重程度和解读VFSS结果的有用工具。然而，需要进一步纳入更广泛的ALS患者群体进行研究，以阐明允许经口进食和存在吸入性肺炎更准确的临界值。
