Association between Swallowing Disorders and Independence during Mealtime in Neurological Diseases: A Cross-sectional Study

Introduction Mealtimes are important for patient's autonomy and independence. They are linked to values and are a source of normality and fulfilment. Independence during mealtimes means eating and drinking safely and independently. However, the presence of oropharyngeal dysphagia (OD) can compromise independence, particularly among patients with neurological conditions. Objective The present cross-sectional study aims to investigate the association between functional independence during meal and multidimensional assessment of neurological subjects with OD. Methods Subjects with OD (DOSS score <6) and diagnosis of multiple sclerosis, Parkinson's disease, or stroke were recruited. Demographic and clinical data were collected. The swallowing assessment included the Penetration Aspiration Scale (PAS) and the Dysphagia Outcome and Severity Scales (DOSS) during an instrumented assessment, self-reported questionnaire (Eating Assessment Tool-10-EAT-10), Body Mass Index, a meal observation scored with the Mealtime Assessment Scale (MAS) and cognitive assessment using the Mini-Mental State Examination. The level of independence was assessed using the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA NOMS) Swallowing Scale. Univariate and multivariate logistic models were used to analyze data. Results Fifty-eight subjects were recruited (18 MS, 20 PD and 20 stroke), among whom 41 (70%) were defined as dependent during mealtime. In the multivariate analysis, EAT-10 score (odds ratio [OR] [95%CI] 1/4 3.25 [1.64-11.08]), diseases duration (OR [ 95%CI] = 0.87 [0.74-0.97]) and MAS safety (OR [ 95%CI] =1.26 [1.06-1.65]) were significantly associated with independence during mealtime. Conclusion Subject's performance during meal, self-reported questionnaire, and diseases duration are independently associated with independence. The present study broadens the focus on dysphagia, underling the importance of identifying all variables able to increase subjects' independence and autonomy at mealtime.