Diagnostic utility of the amyotrophic lateral sclerosis Functional Rating Scale-Revised to detect pharyngeal dysphagia in individuals with amyotrophic lateral sclerosis.

Autor: Chapin JL; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America., Gray LT; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America.; Department of Neurology, Phil Smith Neuroscience Institute, Holy Cross Hospital, Fort Lauderdale, FL, United States of America., Vasilopoulos T; Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, United States of America., Anderson A; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America.; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America., DiBiase L; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America.; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America., York JD; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America.; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America., Robison R; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America.; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America., Wymer J; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America., Plowman EK; Aerodigestive Research Core, University of Florida, Gainesville, FL, United States of America.; Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States of America.; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, United States of America.; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Aug 13; Vol. 15 (8), pp. e0236804. Date of Electronic Publication: 2020 Aug 13 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0236804
Abstrakt: Objective: The ALS Functional Rating Scale-Revised (ALSFRS-R) is the most commonly utilized instrument to index bulbar function in both clinical and research settings. We therefore aimed to evaluate the diagnostic utility of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed impairments in swallowing safety (penetration or aspiration) and global pharyngeal swallowing function in individuals with ALS.
Methods: Two-hundred and one individuals with ALS completed the ALSFRS-R and the gold standard videofluoroscopic swallowing exam (VFSE). Validated outcomes including the Penetration-Aspiration Scale (PAS) and Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) were assessed in duplicate by independent and blinded raters. Receiver operator characteristic curve analyses were performed to assess accuracy of the ALSFRS-R bulbar subscale and swallowing item to detect radiographically confirmed unsafe swallowing (PAS > 3) and global pharyngeal dysphagia (DIGEST >1).
Results: Although below acceptable screening tool criterion, a score of ≤ 3 on the ALSFRS-R swallowing item optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 64%, AUC: 0.68) and penetration/aspiration (sensitivity: 79%, specificity: 60%, AUC: 0.72). Depending on score selection, sensitivity and specificity of the ALSFRS-R bulbar subscale ranged between 34-94%. A score of < 9 optimized classification accuracy to detect global pharyngeal dysphagia (sensitivity: 68%, specificity: 68%, AUC: 0.76) and unsafe swallowing (sensitivity:78%, specificity:62%, AUC: 0.73).
Conclusions: The ALSFRS-R bulbar subscale or swallowing item did not demonstrate adequate diagnostic accuracy to detect radiographically confirmed swallowing impairment. These results suggest the need for alternate screens for dysphagia in ALS.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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