Physical Activity Clinical Trial
Official title:
Dysphagia in Elderly Medical Patients: Occupational Therapy Evaluation and Prevalence
Dysphagia in hospitalized elders is associated with less positive outcomes in
rehabilitation, increased likelihood of readmission, increased comorbidity and mortality,
and increased length of hospital stay. In light of an increase in the elderly population in
Denmark, the consequences of dysphagia, and the importance of minimizing the risk of
disability and frailty, it is vital to emphasize safe participation of the elderly dysphagic
patient in eating, drinking and swallowing. Danish occupational therapists have an important
role in the dysphagia management, but no Danish evidence-based occupational therapy
assessments for dysphagia of elderly medical patients exist. In order to oblige this lack,
the objective of the study is to provide an assessment tool with operational definitions of
dysphagia which includes the complexity of performance in eating, drinking and swallowing,
is evidence-based, and guides occupational therapists in the treatment planning in a
client-centred and purposeful manner.
The study involves a quantitative approach, and is initiated by a translation and cultural
adaptation of the Canadian "The McGill Ingestive Skills Assessment" (MISA). Hereafter, the
psychometric qualities are tested. On basis of the data collected for the psychometrics, the
prevalence and characteristics of dysphagia in the study population are investigated.
Provided that the psychometric testing of the MISA reveals satisfactory levels, the effect
of using the MISA in the treatment planning is investigated.
It is hypothesized that:
The Danish translation of the MISA will demonstrates satisfactory content validity,
reliabilities, convergent validity, known-groups validity, predictive validity, criterion
validity, high levels of sensitivity/specificity and are responsive to change.
Dysphagia is prevalent in elderly medical patients at the time of admission to acute medical
care and there can be found a correlation between dysphagia severity and the presence of
comorbidity, disability, frailty, the length of hospital stay, the place of discharge and
the number of readmissions for elderly medical patients.
The study is divided into four study parts.
Study I aims to translate and cultural adapt the MISA into Danish occupational therapy
terminology, to secure equivalency between the original and the translated version, and to
test its interrater- and intrarater reliability as well as internal consistency.
Study II aims to investigate the convergent validity, known-groups validity, predictive
validity and the responsiveness of the MISA.
Study III aims to test the criterion-related validity and the diagnostic accuracy of the
MISA using the Flexible Endoscopic Evaluation of Swallowing (FEES) and the Assessment of
Motor and Process Skills (AMPS) as gold standards; and to compare the diagnostic accuracy
for aspiration of the MISA compared to the Water Swallow Test, when using the FEES as the
gold standard.
Study IV aims to investigate the prevalence and characteristics of dysphagia in elderly
medical patients, and to identify its potential associations between comorbidity,
disability, frailty, length of hospital stay, place of discharge and number of readmissions.
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