The Effect of Compliance on Clinical Outcomes for Patients with Dysphagia on Videofluoroscopy

Abstract

This study investigates clinical outcomes and the degree of compliance in patients who received advice on dysphagia management and the effect of the level of compliance on the incidence of chest infections and aspiration pneumonia, cause of death, and hospital readmission. We performed a retrospective cohort study of 140 patients who had videofluoroscopic studies at Princess Margaret Hospital, Christchurch, New Zealand, from 1 January 1996 to 30 June 1997. The degree to which recommendations on dysphagia management were followed was correlated with the incidence of chest infections, aspiration pneumonia, and readmissions to the hospital. Cause of death, including the contribution of aspiration pneumonia, was assessed by review of medical records and death certificates. Information was available for 89% of the cohort. Twenty-one percent of the survivors never complied with the advice given. Noncompliant subjects were younger (p < 0.05) and more likely to be living at home rather than receiving institutional care (p = 0.05). Noncompliers had more hospital admissions because of chest infections or aspiration pneumonia (22% vs. 1.5%; p < 0.001). Home-dwelling noncompliant subjects received more courses of antibiotics (p < 0.02), but there was no difference in the number of chest infections. Fifty-four people died during the study period. Aspiration pneumonia was recorded as a definite or probable cause of death in 26 (52%) of the 50 subjects for whom reliable information was available and in 6 of 7 subjects who made a deliberate and documented decision not to comply. We conclude that noncompliance with recommendations about dysphagia management is associated with adverse outcomes. There was a high mortality rate and aspiration pneumonia was a common cause of death.

Maximising health literacy and client recall of clinical information: An exploratory study of clients and speech-language pathologists

“…Clients with voice disorders (including laryngectomies), dysphagia or cleft lip and/or palate were the focus of the study. This is because clients' understanding and recall of information relating to these disorders is most critical to compliance with treatment (Fagan, Lentin, Oyarzabal, Isaacs & Sellars, 2002;Low, Wyles, Wilkinson & Sainsbury, 2001;Sataloff, 2006). Selection criteria for SLPs were that they had to be practising currently in the greater Cape Town area, and had to have at least 1 year's post-qualification experience in managing at least one of the disorders that formed the focus of the study.…”

Promoting Shared Decision-Making in Rehabilitation: Development of a Framework for Situations When Patients with Dysphagia Refuse Diet Modification Recommended by the Treating Team

“…However, the results of one study [4] suggest that as many as 40% do not. Low et al [5] note that there is a correlation between the level of compliance and the type of advice given. In their study, patients were more likely to adhere to recommendations regarding modification of solids than with recommendations of liquid modification.…”

“…Noncompliance with recommendations about dysphagia management is associated with adverse outcomes [5]. Numerous studies have examined reasons for noncompliance; however, most of these studies, conducted in acute care and nursing home settings, considered that the sources of noncompliance with the diet modifications prescribed for hospitalized patients were hospital staff [7][8][9].…”

Recent developments in diagnosis and intervention for aspiration and dysphagia in stroke and other neuromuscular disorders

“…Further indirect evidence for the benefit of dysphagia diagnosis and treatment comes from a New Zealand study [13] in which dysphagic patients who were diagnosed by VFSS, but who failed to comply with therapy and recommendations, had an 86% mortality rate (mostly within 1 year) compared with 40% of patients who complied. Pneumonia was the main cause of death.…”