Implementation of a standardized out-of-hospital management method for Parkinson dysphagia

Abstract

Objective: Our objective is to explore the effectiveness and feasibility of establishing a swallowing management clinic to implement out-of-hospital management for Parkinson disease (PD) patients with dysphagia. Method: Two-hundred seventeen (217) voluntary PD patients with dysphagia in a PD outpatient clinic were divided into a control group with 100 people, and an experimental group with 117 people. The control group was given dysphagia rehabilitation guidance. The experimental group was presented with the standardized out-of-hospital management method as overall management and information and education materials. Rehabilitation efficiency and incidence rate of dysphagia, as well as relevant complications of both groups were compared after a 6-month intervention.Results: Rehabilitation efficiency and the incidence rate of dysphagia including relevant complications of patients treated with the standardized out-of-hospital management were compared with those seen in the control group. The differences have distinct statistics meaning (p<0.01). Conclusion: Establishing a swallowing management protocol for outpatient setting can effectively help the recovery of the function of swallowing, reduce the incidence rate of dysphagia complications and improve the quality of life in patients with PD.

Interventions to promote oral nutritional behaviours in people living with neurodegenerative disorders of the motor system: A systematic review

“…After removal of duplicates, a total of 4326 records were screened, of which 150 full-text articles were considered potentially eligible for inclusion. Following detailed screening 14 articles [18][19][20][21][22][23][24][25][26][27][28][29][30][31] were included in the systematic review. The majority of the excluded articles did not relate to oral nutrition or the study design did not include a control group.…”

“…The characteristics of the 14 included studies are reported in Tables 2 and 3 as well as Supplementary Table 1. [18][19][20][21][22][23][24][25][26][27][28][29][30][31] All included studies were intervention studies with a control group reporting on interventions used to promote oral nutritional behaviours in participants with NDMS. Eight studies reported on interventions used to assist with swallowing difficulties 19 20 22 23 25 26 29 30 and six studies 18 21 24 27 28 31 reported on interventions targeting dietary content.…”

“…Of the 14 included studies, two studies 20 31 were reported as a conference meeting abstract with limited reporting details whilst the remaining studies were available as journal articles. The studies were published between 2008 22 and 2017 19 31 and were conducted in the USA (n = 4), 22 26 29 31 Australia (n = 2), 25 27 Brazil (n = 3), 18 19 28 China (n = 1), 30 Germany (n = 1), 21 Israel (n = 1), 23 Italy (n = 1) 24 and Canada (n = 1). 20 Care settings comprised of clinics/units in eight studies 18 19 21 23 24 28-30 and acute-care hospitals and subacute residential facilities in four studies.…”

“…All ratings were either for low or unclear risk of bias, with the exception of three high risk ratings for the selection bias domains for the non-randomised studies in Ayres et al 19 and Wei et al 30 and two high risk ratings for performance bias in Wills et al 31 and Sheard et al 27 due to the open labelled nature of the studies in which participants were not blinded (Supplementary Table 2). The studies receiving the greatest number of low risk of bias ratings (n = 5 for each) were Robbins et al 26 and Troche et al 29 The study by Cleary et al 20 was a conference meeting abstract with limited reporting and so no further details were available to allow the critical appraisal of the methods of this study.…”

“…The effectiveness of a swallowing management clinic with outpatient support was assessed in one study in PD (n=217). 30 The intervention was a standardised out-of-hospital management intervention including long-term attention and overall management (establishment of a swallowing management clinic, swallowing archives, periodic re-examination with individualised intervention strategies), multi-media training combined with feedback to raise awareness and education, out-of-hospital rehabilitation training (swallowing skill training, oral muscle exercises, mis-inhalation protection, pronunciation, effective cough, pharynx cold stimulation and empty swallowing training), eating prescription (guidance on appropriate posture, amount per morsel, food property selection', compensatory strategies), and a web chat platform to monitor, prompt and educate patients and for patients to ask questions. The control group received face and tongue training and eating considerations but did not receive the out-of-hospital management intervention.…”