Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Dietetics and Nutrition Services Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2022 Oct 21;101(42):e31137. doi: 10.1097/MD.0000000000031137.
In dysphagia, food or water cannot be delivered safely through the oral cavity to the stomach; both are treated using texture-modified food and thickened fluid. Before, each country had its own diet modifications and texture measurement standards. In 2012, the International Dysphagia Diet Standardisation Initiative (IDDSI) was developed by several countries. Owing to cultural differences, it was necessary to determine whether the IDDSI could well be applied to clinicians and patients without difficulties in East Asia countries. To evaluate the IDDSI scale to find out the difficulties applying this scale in East Asia countries to educate the clinicians and patients. In May 2021, we enrolled physicians, nurses, nutritionists, and swallowing therapists involved in dysphagia treatment at a single center in Seoul. To evaluate the degree of understanding and difficulties of adapting IDDSI to clinicians in East Asia countries, we used the 17-item questionnaire with IDDSI sample foods and foods in Asian countries. In first 7 items, we compared IDDSI with the previously used scale based on the National Dysphagia Diet (NDD). In the next 10 questions, only the IDDSI levels were answered, and the absolute values of the answer-response differences were calculated. The IDDSI showed a significantly high intraclass correlation with the previously used NDD-based scale; the coefficient was higher for the nutritionists (0.988) and swallowing therapists (0.991). When evaluating whether the IDDSI could applied well in East Asia countries, the absolute values of the answer-response differences were lower than 0.5 in majority of levels, except for Level 4. Because the IDDSI framework might successfully be applied universally regardless of food culture, a worldwide standard for food rheology in dysphagia treatment might be possible.
在吞咽困难中，食物或水无法安全地通过口腔输送到胃中；两者都采用质地改良的食物和增稠的液体进行治疗。以前，每个国家都有自己的饮食调整和质地测量标准。2012 年，由多个国家制定了国际吞咽障碍饮食标准化倡议（IDDSI）。由于文化差异，有必要确定 IDDSI 是否可以在东亚国家的临床医生和患者中毫不费力地应用。评估 IDDSI 量表，以找出在东亚国家应用该量表的困难，从而对临床医生和患者进行教育。2021 年 5 月，我们在首尔的一家单一中心招募了参与吞咽困难治疗的医生、护士、营养师和吞咽治疗师。为了评估 IDDSI 对东亚国家临床医生的理解程度和适应困难程度，我们使用了包含 IDDSI 样本食物和亚洲国家食物的 17 项问卷。在前 7 个项目中，我们将 IDDSI 与之前基于国家吞咽障碍饮食（NDD）的量表进行了比较。在接下来的 10 个问题中，仅回答了 IDDSI 级别，并且计算了答案反应差异的绝对值。IDDSI 与之前使用的基于 NDD 的量表具有显著高的组内相关系数；营养师（0.988）和吞咽治疗师（0.991）的系数更高。在评估 IDDSI 是否可以在东亚国家很好地应用时，大多数级别下的答案反应差异的绝对值低于 0.5，除了第 4 级。由于 IDDSI 框架可能无论食物文化如何都能成功地普遍应用，因此在吞咽困难治疗中，食物流变学可能会有一个全球标准。
