Association between clinical evaluation and self perception of deglutition with motor disability scale in patients with multiple sclerosis

Piloti, Dandara Tailuma Weiler; Ruiz, Vânia Carolina Devitte; Ribeiro, Marlise de Castro; Almeida, Sheila Tamanini de

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Original Article • CoDAS 34 (2) • 2022 • https://doi.org/10.1590/2317-1782/20212021026 copy

Association between clinical evaluation and self perception of deglutition with motor disability scale in patients with multiple sclerosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To investigate the association between the clinical evaluation and self-perception of deglutition with the motor disability scale in patients with Multiple Sclerosis.

Methods

It is a cross-sectional, prospective study that was conducted with individuals with Multiple Sclerosis treated by the Neuroimmunology outpatient clinic of a hospital in southern Brazil. We reviewed the electronic medical records of patients to extract the score from the last Expanded Disability Status Scale. After the analysis of the inclusion criteria, and in clinical consultation, two protocols were applied: one of self-perception for the risk of dysphagia, through the Brazilian equivalence instrument of the Eating Assessment Tool; and the clinical evaluation of swallowing, with food, through the scale Gugging Swallowing Screen. The data were analyzed through tables, descriptive statistics and the tests: Fisher's Exact Association Test and Chi-square Test to assess the association between the results of the applied scales. We considered a maximum significance level of 5% (p <0.05).

Results

It was possible to observe that there was a significant association between the scores of the Gugging Swallowing Screen scales with the Expanded Disability Status Scale of the patients. In addition, there was also a relation between the results of both protocols with the Expanded Disability Status Scale.

Conclusion

The patients with Multiple Sclerosis in this study presented oropharyngeal dysphagia, what was confirmed by the association between the clinical evaluation of swallowing and the results of the instrument of self-perception of swallowing and the motor disability scale.

Keywords
Multiple Sclerosis; Deglutition Disorders; Deglutition; Disability Evaluation; Adult

Variable	Category	Nº of cases	%
Age	Up to 20	1	2.1
	21 - 40	21	43.8
	41 - 60	25	52.1
	Over 60	1	2.1
Gender	Female	34	70.8
	Male	14	29.2
Treatment	First Line Medicine	26	54.2
Treatment	Second Line Medicine	22	45.8
GUSS Result	Normal Swallowing	18	37.5
GUSS Result	Mild Dysphagia with Risk of Aspiration	29	60.4
	Moderate Dysphagia with Risk of Aspiration	1	2.1
EAT 10	Up to 3	27	56.3
	Over 3	21	43.8
EDSS	0 - 4	27	56.3
	Over 4	21	43.8
Type of MS	Relapsing-Remitting	37	77.1
	Primarily progressive	10	20.8
	Secondarily progressive	1	2.1
Time of diagnosis	0 - 5 years	20	41.7
Time of diagnosis	6 - 10 years	16	33.3
	11 - 15 years	5	10.4
	Over 15 years	7	14.6

Variable	Category	EDSS				p
		0 - 4		Over 4
		n	%	n	%
Treatament¹ 1 Chi-square test;	First line medicine	19	70.4	7	33.3	0.019^a a Significant p≤0,05;
	Second line medicine	8	29.6	14	66.7
Time of diagnosis² 2 Fisher's exact test	0 - 5 years	13	48.1	7	33.3	0.000^b b Significant p≤0,01;
	6 - 10 years	9	33.3	7	33.3
	11 - 15 years	-	-	5	23.8
	Over 15 years	5	18.5	2	9.5
Type of MS²	Relapsing-remitting	26	96.3	11	52.4	0.051^c c Non-significant;
	Primarily progressive	1	3.7	9	42.9
	Secondarily progressive	-	-	1	4.8
EAT 10¹	Up to 3	19	70.4	8	38.1	0.040^a
	Over 3	8	29.6	13	61.9
GUSS Result¹	Normal Swallowing	14	51.9	4	19.0	0.034^a
	Mild Dysphagia with Risk of Aspiration	13	48.1	16	76.2
	Moderate Dysphagia with Risk of Aspiration	-	-	1	4.8

Variable	Category	GUSS Resuly						p
		Normal Swallowing		Mild Dysphagia with Risk of Aspiration		Moderate Dysphagia with Risk of Aspiration
		n	%	n	%	n	%
Treatament¹	First line medicine	17	94.4	8	27.6	1	100.0	0.000^a a Significant p≤0,01;
	Second line medicine	1	5.6	21	72.4	-	-
Type of MS¹	Relapsing-remitting	16	88.9	21	72.4	-	-	0.185^b b Non-significant;
	Primarily progressive	2	11.1	7	24.1	1	100.0
	Secondarily progressive	-	-	1	3.4	-	-
Time of diagnosis¹ 1 Fisher's exact test	0 - 5 years	9	50.0	10	34.5	1	100.0	0.807^b
	6 - 10 years	5	27.8	11	37.9	-	-
	11 - 15 years	1	5.6	4	13.8	-	-
	Over 15 years	3	16.7	4	13.8	-	-
EAT 10¹	Up to 3	15	83.3	11	37.9	1	100.0	0.003^a
	Over 3	3	16.7	18	62.1	-	-

Variable	Category	EAT 10				p
		Up to 3		Over 3
		n	%	n	%
Treatament¹ 1 Chi-square test;	First line medicine	20	74.1	6	28.6	0.003^b b Significant p≤0,01;
	Second line medicine	7	25.9	15	71.4
Type of MS² 2 Fisher's exact test	Relapsing-remitting	24	88.9	13	61.9	0.048^a a Significant p≤0,05;
	Primarily progressive	3	11.1	7	33.3
	Secondarily progressive	-	-	1	4.8
Time of diagnosis	0 - 5 years	10	37.0	10	47.6	0.361^c c Non-significant;
	6 - 10 years	9	33.3	7	33.3
	11 - 15 years	2	7.4	3	14.3
	Over 15 years	6	22.2	1	4.8

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[1] Conflict of interests: nothing to declare.