Dysphagia in Adults with Multiple Sclerosis

Abstract

Dysphagia, or swallowing impairment, may affect adults diagnosed with Multiple Sclerosis (MS) but prevalence estimates vary greatly. Unreliable estimates may be contributing to the lack of established protocols for diagnosing and treating dysphagia in MS and, therefore, a heightened risk of adverse outcomes. This thesis addresses these issues in four studies. First, a self-report questionnaire was given to 103 adults with MS in a metropolitan outpatient clinic. Responses revealed that 38% of cases had swallowing problems, with both physical and social consequences. These findings suggest that dysphagia in MS is relatively common and routine screening should be done to establish optimal care. The second study aimed to validate an existing diagnostic tool, the 10-item Dysphagia in Multiple Sclerosis (DYMUS) questionnaire. Analyses revealed that a 5-item DYMUS had high internal consistency, satisfactory reproducibility, and adequate correlation with the commonly used 10-item Eating Assessment Tool (EAT-10). The 5-item DYMUS is a valid tool that is quick to administer and score. Once diagnosed with dysphagia, preventive or compensatory treatment can reduce symptoms of dysphagia, such as weight loss and aspiration pneumonia. A systematic review was conducted to identify the best available treatment options for MS-related dysphagia. Five studies were identified, with two showing positive therapeutic effects but limited internal validity. Therefore, a randomized controlled trial was conducted to compare one of these interventions, neuromuscular electrical stimulation plus exercise (n = 6), to sham stimulation plus exercise (n = 6). Symptoms of dysphagia were significantly more reduced in those receiving the active condition, providing the strongest evidence to date for dysphagia treatment in MS. Finally, findings across the studies are summarised. In addition, evidence-based recommendations for clinical practice, thesis limitations and future directions are discussed.