The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL)

Ayres, Annelise; Jotz, Geraldo Pereira; Rieder, Carlos Roberto de Mello; Schuh, Artur Francisco Schumacher; Olchik, Maira Rozenfeld

doi:10.1055/s-0036-1582450

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International Archives of Otorhinolaryngology

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Original Research • Int. Arch. Otorhinolaryngol. 20 (03) • Jul-Sep 2016 • https://doi.org/10.1055/s-0036-1582450 copy

The Impact of Dysphagia Therapy on Quality of Life in Patients with Parkinson's Disease as Measured by the Swallowing Quality of Life Questionnaire (SWALQOL)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Dysphagia is a common symptom in Parkinson's disease (PD) and it has been associated with poor quality of life (QoL), anxiety, depression.

Objective

The aim of this study was to evaluate the quality of life in individuals with PD before and after SLP therapy.

Methods

The program consisted of four individual therapy sessions. Each session comprised guidelines regarding food and postural maneuvers (chin down). The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was applied before and after therapy.

Results

The sample comprised of 10 individuals (8men), with amean (SD) age of 62.2 (11.3) years, mean educational attainment of 7.5 (4.3) years, andmean disease duration of 10.7 (4.7) years. Thirty percent of patients were Hoehn and Yahr (H&Y) stage 2, 50% were H&Y stage 3, and 20% were H&Y stage 4. Mean scores for all SWAL-QOL domains increased after the intervention period, with significant pre- to post-therapy differences in total score (p = 0.033) and domain 4 (symptom frequency) (p = 0.025). There was also a bias significance for domain 5 (food selection) (p = 0.095).

Conclusion

Patients exhibited improvement in swallowing-related quality of life after a SLP therapy program. The earlier in the course of PD, greater the improvement observed after therapy.

Keywords
Parkinson disease; quality of life; deglutition disorders; dysphagia; rehabilitation

Guidelines regarding food
Feeding environment:
- Take your meals in a quiet place.
- Turn off the TV, radio, or any other devices that may distract you while you are eating.
- Focus on eating.
- Do not talk while eating.
- Avoid taking meals when you feel sleepy or very tired.
- Try to take your meals during your “on” time.
Posture while feeding:
- Sit close to the table.
- Remain upright and hold your head up.
- Avoid lying down just after finishing your meal.
- Take small bites of food into your mouth.
- Chew food thoroughly.
- Swallow more than once, until you are sure no food remains in your mouth.
- If you feel there is food “stuck in your throat”, swallow saliva more often.
Meal duration:
- The maximum time for a major meal (breakfast, lunch, and dinner) should be 30 minutes;
- Do not rush through your meal.
Oral hygiene:
- Brush teeth thoroughly after your meals.
- Remember to brush your tongue.
- If you wear dentures, remove them and brush them clean after every meal. Remember to brush your tongue as well.
- Edentulous patients should brush their tongue and clean the rest of the oral cavity with a water-soaked gauze dressing and antiseptic mouthwash.

SWAL-QOL Domain	PRE		POST		p	U^w
SWAL-QOL Domain	Mean	SD	Mean	SD	p	U^w
1. Burden	77.5	±14.44	82.5	±30.73	0.258	−1.131
2. Eating desire	79.15	±19.35	82.49	±24.67	0.527	−0.632
3. Feeding duration	52.5	±39.87	58.75	±36.82	0.833	−0.211
4. Symptom frequency	69.61	±10.82	79.42	±14.97	0.025*	−2.244
5. Food selection	65	±26.87	86.25	±28.53	0.095	−1.667
6. Communication	42.5	±23.71	55	±31.84	0.103	−1.630
7. Fear	66.87	±25.69	76.87	±29.47	0.260	−1.127
8. Mental health	80.5	±22.04	84	±26.64	0.752	−0.315
9. Social Function	71	±28.06	83	±26.58	0.116	−1.572
10. Sleep	31.25	±38.75	46.25	±39.10	0.176	−1.355
11. Fatigue	70.8	±27.28	83.31	±17.58	0.123	−1.544
Total**	64.24	±29.65	74.34	±30.49	0.033*	0.672

SWAL-QOL Domain	Gender^a	H&Y		Age		Education
SWAL-QOL Domain	Gender^a	p	r	p	r	p	r
1. Burden	0.506	0.203	0.469	1.0	0.000	0.772	0.106
2. Eating desire	0.224	0.792	0.103	0.627	−0.176	0.174	0.467
3. Feeding duration	0.895	0.396	−0.323	0.407	−0.295	0.892	−0.050
4. Symptom frequency	0.433	0.646	−0.178	0.365	−0.321	0.464	0.262
5. Food selection	0.694	0.051*	0.665	0.542	0.220	0.331	0.344
6. Communication	0.143	0.807	−0.096	0.892	0.049	0.523	−0.230
7. Fear	0.147	0.560	−0.226	0.134	−0.508	0.086	0.569
8. Mental health	0.589	0.709	0.146	0.519	−0.232	0.089	0.565
9. Social Function	0.893	0.444	0.293	0.379	0.313	0.890	0.050
10. Sleep	0.047*	0.024*	−0.743	0.320	−0.351	0.993	0.003
11. Fatigue	0.147	0.773	0.113	0.324	−0.177	0.358	0.326
Total**	0.554	0.858	−	0.936	−	0.543	−

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[1] Address for correspondence Maira Rozenfeld Olchik, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-002, Brazil (e-mail: mairarozenfeld@hotmail.com).