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.