Screening dysphagia risk in 534 older patients undergoing rehabilitation after total joint replacement: a cross-sectional study

BACKGROUND: Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this postacute phase, they might suffer from other symptoms, including dysphagia, defined as a dysfunction of the digestive system, characterized by an objective difficulty or a sensation of difficulty in swallowing. It is considered as a very challenging problem in older people and early detection is fundamental for a prompt and effective management. However, up to date, there is a lack of data on dysphagia risk screening in orthopedic rehabilitation inpatients. AIM: The aim of this study was to evaluate dysphagia risk through Eating Assessment Tool (EAT-10) in older people undergoing rehabilitation after total hip or knee arthroplasty. DESIGN: Cross-sectional study. SETTING: Rehabilitation Unit. POPULATION: All consecutive patients undergone total hip or knee arthroplasty, aged >= 65 years, referring to Orthopedics Rehabilitation Unit Mons. Luigi Novarese Hospital, Moncrivello, Italy, for a 24-month period (from 1st January 2018 to 31st December 2019). We excluded patients with: 1) diagnosis of neurological diseases; 2) pharyngeal or esophageal cancer; 3) maxillofacial cancer; 4) tracheotomy. METHODS: Dysphagia risk was assessed through EAT -10. The cohort was divided into two groups, according to water swallowing test (WST), in order to evaluate differences in terms of different EAT-10 scores. Furthermore, based on pathological WST, we have stratified study participants by the American Speech-Language-Hearing Association (ASHA)'s National Outcomes Measurement System (NOMS) swallowing scale in order to evaluate differences in terms of the different EAT -10 scores. RESULTS: We included 534 participants (180 men, 357 women), mean aged 74.8 +/- 5.6 years. Thirty-one patients (5.8%) had pathological WST and 34 (6.4%) reported EAT-10 >= 3. There were significant differences (P<0.001) between groups (pathological WST vs. normal WST) in terms of all EAT-10 total scores. EAT-10 reported a high specificity (96.8% if >= 3 and 98.4% if >= 4), but a low sensitivity (58.1% if >= 3 and 54.8% if >= 4). CONCLUSIONS: EAT-10 might be considered as useful screening tools for dysphagia in older people, considering the high specificity of EAT10 >= 4. CLINICAL REHABILITATION IMPACT : Screening dysphagia risk should be recommended also in patients undergoing rehabilitation in order to set up an early diagnosis and management.

Automated summary

The study aimed to evaluate the risk of dysphagia in older patients undergoing rehabilitation after total hip or knee arthroplasty using the Eating Assessment Tool (EAT-10). The results showed significant differences in EAT-10 scores between patients with pathological water swallowing tests and those with normal tests, indicating the usefulness of EAT-10 as a screening tool for dysphagia in older individuals.