Analysis of Dysphagia Handicap Index in Stroke Patients and Associated Factors

Abstract

There have been many studies on swallowing-related quality of life; however, few studies have looked at a homogenous subject group or the influential factors in detail. Thus, this study aimed to analyze key factors of swallowing-related quality of life in stroke patients. Methods: Forty-five stroke patients answered the Dysphagia Handicap Index (DHI). The relationship between the DHI and demographic information, post-stroke condition, and swallowing-related index was examined. The key factors affecting the DHI were analyzed by stepwise multiple regression analysis. Results: The average DHI of stroke patients was higher than that of normal groups reported by previous studies. In subscale, the functional and physical score were higher than the emotional score. The DHI of stroke patients showed significant correlation with the post-onset time, the Korean Mini Mental State Examination (K-MMSE), the National Institutes of Health Stroke Scale (NIHSS), the Geriatric Depression Scale (GDS), the Penetration Aspiration Scale (PAS), the Functional Dysphagia Scale (FDS), and the American Speech-Language-Hearing Association National Outcomes Measurements System swallowing scale (ASHA NOMS). Among the swallowing-related factors, FDS and PAS were the most influential factors, accounting for 66.3% of the DHI. When dealing with FDS sub-items, ‘pharyngeal transit time’, ‘bolus formation’, ‘coating of pharyngeal wall after swallow’ showed the most influence, accounting for 60.2% of the DHI. Conclusion: The swallowing-related quality of life in stroke patients declined due to dysphagia. Swallowing functions significantly affected stroke patients’ swallowing-related quality of life, and swallowing problems in the pharyngeal phase had more impact than those in the oral phase.