Measuring impairment consequences in adult patients with dysphagia.

摘要

Dysphagia is a common disorder associated with impairment complications and even death. The overall purpose of this thesis was to develop a new tool that measures impairment status at a point in time in individual adult patients with dysphagia. The new tool was to (a) be simple in nature and feasible for use in all clinical settings and with both in and outpatients; (b) have parts for patient self-administration as well as clinician administration; and (c) be adjustable to address specific impairments. Its items were selected to capture the comprehensive meaning of impairment secondary to dysphagia from the perspectives of clinicians, patients and caregivers.; Clinician experts, caregivers and patients agreed on the importance of three impairment complications, namely pulmonary, nutrition and psychology. These consequences were included in the new impairment outcome index for adult patients with dysphagia. However, there were differences in perceptions among the three participant groups. Clinicians and caregivers attributed more relevance to the biomedical consequences of pulmonary and nutrition impairment, but patients prioritized in the reverse order with psychology most important. Patient's perceptions themselves also varied according to their recovery trajectory. The prevailing issue for acute patients was illness anxiety or more specifically the 'fear' of choking to death, while for the chronic patients the focus became depression and embarrassment.; The research next developed a comprehensive item inventory for the new tool. The tool is based on a well-defined conceptual framework specifically targeting the three impairment consequences in individual adult patients with dysphagia, namely pulmonary, nutrition-hydration and psychological impairment. For each impairment the tool addresses current status and risk, thus forming six separate but complementary subscales. Together the six subscales consist of 84 items (20 pulmonary, 18 nutrition-hydration, 46 psychology) that measure current impairment status and 40 items (24 pulmonary, 5 nutrition-hydration, 11 psychology) that measure increased risk for poor impairment. This tool will be important to clinicians because it will be the first to allow them to track impairment complications in their patients and to assess whether their interventions are beneficial in reducing or eliminating these complications.