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.
Fibreoptic Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopic Swallow Studies (VFSS) are instrumental assessments of dysphagia which provide videos of the internal structures of swallowing. They are commonly regarded as 'gold-standard' assessments; however, there is no consensus regarding a gold-standard measure to analyse the video recordings that they produce. Measures require sound psychometric properties to be suitable for clinical or research purposes. To date, no review of psychometric properties of FEES and VFSS measures has been undertaken or formally reported. This review assessed the quality of the psychometric properties of visuoperceptual measures of FEES and VFSS. Electronic databases were searched for studies reporting on psychometric qualities of visuoperceptual measures which are used to analyse recordings from FEES and VFSS. All dates until February 2017 were included. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to evaluate the methodical quality of studies. The measures' overall quality was then assessed by combining COSMIN ratings with quality criteria. Forty-five studies, reporting on 39 measures, met the inclusion criteria for this review. Data about the measures' psychometric properties were very limited. Twenty-one measures had information available about reliability only, while 18 had information on up to five of the possible nine psychometric properties categorised within the COSMIN framework. The majority of the FEES and VFSS measures' psychometric properties were rated as 'indeterminate' overall, due to the small number of studies, issues with design, statistical analyses, and reporting practices of extant studies. There is insufficient evidence to recommend any individual measure included in this review as valid and reliable to interpret VFSS and FEES recordings. Further research, which utilises robust methodological design and reporting, is needed to examine the psychometric properties of measures for FEES and VFSS.
The negative impact of increased bolus modification on health-related quality of life (HRQoL) in persons with oropharyngeal dysphagia (OD) has been described in previous literature; however, findings may have been influenced by the severity of OD and underlying etiology. The current systematic review therefore aims to investigate the relationships between HRQoL and OD and to report on changes in HRQoL and OD following intervention. This review was conducted in accordance with the PRISMA statement. A systematic search of the literature was performed using PubMed and Embase. All available English publications up to February 2016 that reported on OD and HRQoL were included. Articles that studied OD arising from esophageal dysfunction or included less than 15 participants with OD, were excluded. Thirty-five studies met the inclusion criteria. Inverse bidirectional relationships were found between decreased HRQoL and increased OD severity. Following intervention, changes were evident through improved HRQoL with decreased OD severity. The findings of this paper highlight the importance of targeting HRQoL in patients with OD. However, because of the heterogeneity in methodology, terminology, and assessment procedures used in the retrieved articles, the generalization of study results is limited. More research investigating the relationships between HRQoL and OD is needed. Future studies should implement study designs that lead to stronger levels of evidence, quantify the severity of OD and underlying diseases, use validated measures and less ambiguous terminology.
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