{INS-12689; No of Pages 4 Jura fhe NeuologialSdences wx 2013) x net Contents lists avaiable at SiVerse ScienceDirect nt Journal of the Neurological Sciences ELSEVIER four com/locate/in Prevalence of Patient-reported dysphagia in multiple sclerosis patients: An Italian multicenter study (using the DYMUS questionnaire) * Solaro **; C. Rezzani, Erika Trabucco *, M.P. Amato SV, Zipoli,E, Portaccio M. Giannini SF. Patti’, E. D'Amico ¢, MLL. Stromillo™, R. Bergamaschi ” {Pip Merl PA Micon Hosp ASL Geneve ene ay . Frau *. L Lorefice *, S. Bonavita , M. Della Corte ', M.G. Grasso , L, Finamore §, A. Ghezzi", P. Annovazzi ", M. Rottoli ,C. Gasperini’, D. Restivo ", D. Maimone ", P. Rossi 5 1 Ge Ree rerdpartinewn si Scere! Mapa (CRS), tat Neola Nace Mond, Pv, ly {2 GF rari Scone Newrecinz, ety Ser Mapa Utes eta, aly | 2 ene bt Medcna Cink alcolar, Unters oie a "WG ewe, Second Users dol Se & Nap ly * Fonacone Sat cin Roms ay Ger St Scere Mulip AOS. 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Scena Newoingihe cel Compartment Unies tS ay ARTICLE INFO ABSTRACT ‘ae hens Received 29 Aap 2012 Receive in revised frm 9 May 2013, ‘Acct 13 Hay 2012 ‘nae oe ce Obietv:Miiipeslersis(N6) san inflammatory dscase a he central nervous tem (CNS) witha chronic = 0001 Pox 12 a 30001 Reaping Reming Secondary Progreive, Primary Rage, Please cite this article a: Solar ¢, eta, Prevalence of patent-reported (using the DYMUS questionnair),] Neurol Sc (2013), multiple Inp/bxdotorg/10.1016/}jns.2013.05.020 ysphagia in sclerosis patents: An Kallan multicenter studySolr et ou of te Nell Scenes (2012) 2 214 answered yes to 5-10 questions (Group Ml), see Table 2 for positive answer for each item. we compare the 2 groups a significant difference for VAS, EDSS and disease duration but not for gender, age and disease course was observed (see Table 3. ‘The relative weight of item #10 was negligible: among 9.3% who answered yes (175 out of 1875 patients) to question 10, only 42, (2:38) answered no to the other nine questions, we use EDSS score of35 to dichotomize the sample in two groups, DYMUS was positive in 207% patents, onthe hand this means that 1 subjects of 5 with low disability shows swallowing problems, and if We use EDSS of 20 as cut-off value to divde the sample the frequency of patient-reported dysphagia is stil high (15%),We observed nosignif- icant center effect. (ut of 1174 subjects who scored 0 at VAS, 1147 (97.7) where in the patient-reported dysphagia-no group and only 17 subject in the patient-reported dysphagia-no group had a VAS score higher than 1. 4 Discussion In the management of MS patients, patint-reparted dysphagia Fepresents one ofthe current challenges in clinical practice. The correc ‘management ofthis symptom andthe identification of patient-teported. ‘dysphagia at an early stage of MS could alow the prevention of compli- ‘ations such as pneumonia andthe development of intervention tech niques to modify specific aspects of swallowing. ‘Our group had previously validated the ad hoc questionnaire, DYMUS, with a preliminary process analysing the data of 226 patients, ‘When tested ona large dataset of 1724 MS patients, the DYMUS ques- ‘ionnaire confirmed tobe of quick administration and very consistent. ‘aking into account that Cronbach's alpha, the widely used measure of intemal consistency, is considered good for values above 0.70, the value of 0.91 obtained by the DYMUS questionnaire is excellent. Previous studies have usd relatively small samples, have not used ad-hoc questionnaire administered by a direct interview, and have been performed ina single centre, ‘The current study has shown acorelation between patient-reported. ‘dysphagia and EDSS and disease course but not with age, gender and slisease duration. When we looked at the VAS score we observed that about 98% of patients in the patient-eported dysphagia-no group ‘scored 0 or 1 confirming the correlation between this subjective score and the DYMUS questionnaite, (Our findings confirm that swallowing problems are relatively fe- ‘quent, even in MS patients with a rather mild form of the disease. In fact, the questionnaire was abnormal in 31% of the patients in aco hhort characterized by a high percentage of relapsing remitting courses (71%) and alow disability (mean EDS 3.3), inspite ofa rel atively long disease duration (mean 11.4 years). In our opinion, test- ing the presence of patient-reported dysphagia in patents with only mild clinical manifestation is relevant, because the identification of Patient-reported dysphagia for preventive purposes is clearly more 'useful in patients with intial dysfunction than in severely impaired patients, where preventive interventions are often already ongoing. “The DYMUS questionnaire confirmed tobe an easy self-administered, ‘not time consuming (less than 1 minute) and consistent questionaire ‘to detect patent-eported dysphagia and its main characteristic in MS Patients, The questionnaire was arministeed in a classical out-paients sample and inthe future the results have wo be confirmed in more disable patients as well. We propose the DYMUS questionnaire as a practical Sandardized instrument that measure important outcomes forthe pre liminary selection of patients wio shouldbe submited for more specific Instrumental analyses and tobe addressed to programs fr the preven ton of complication, ‘There is definitely a ned fr further study inthis area, However, the dysphagia literature is so scarce that we feel itis necessary to take a Pragmatic approach, beginning with the development of a practical ‘screening tol tobe validated in a large sample of subjects and subse- {quently correlated with clinical and instrumental indices, Moreover in the future the DYMUS questionnaire will need tobe tested versus an in srumental measure in order to evaluate the specificity and sensibility Of the tool and to evaluate if there i a correlation between severity of the swallowing problems at the fibrascopy and the DYMUS score. Inconetusion, this study represents the largest, mul-cente sample ‘of MS patients evaluated for dysphagia utilizing an ad-hoc question nae of patient-reported dysphagia, fundamental to draw a strategy for determining an appropriate collaborative symptomatic therapy in Ms. ‘Author's contributions =Dr. Solara - Study concept and design, study supervision = Dr. Rezzani- Analysis and interpretation Dr. Trabueco - Acquisition of data Dr. Amato ~ Acquisition of data + Dr. Zipoli~ Acquistion of data + Dr. Portacco - Acquisition of data + Dr. Giannini - Acquisition of data Dr. Patti - Critical revision ofthe manuscript for important intel Jectual content| = Dr. DAmico - Acquisition of data Dr, Frau - Acquisition of data Dr, Lorefice - Acquistion of data ~ Dr. Bonavita- Acquisition of data + Dr, Della Core - Acquisition of data Table Compaen teten Group (Oymus sere 1-4) v Croup (Oy se 5-10. cop ee ee TOSS Die ae eee WAS ae Female im ¥ a ‘Grom tt-a) m7 26 zy a 13 1 = @ co ‘hoo 008 sta sian Task eaup (5-10) & us se 35 s 2 uso sor sao eam oan nae se i Relapsing Renting SP Sony Progressive, Pinar ogre. Sgncan diereoce between group (ve rou It malvrte ana (pvaie< 0201), Please cite this ance as: Solar C, etal, Prevalence of patient-eported dysphagia in multiple sclerosis patients: An Italian multicenter study (using the DYMUS questionnair),} Neurol Sci (2013), itp/dxdotorg/ 10.1016 jjn=-2013.050204 Soa et Jura fhe Neola Senrs (203) ne = Dr Grasso - Acquisition of data - Dr. Finamore - Acquistion of data ~ Dr. Ghezz - Acquisition of data ~ Dr. Annovazz - Acquistion of data = Dr. Rotol - Acquistion of data = Dr.Gasperini ~ Acquistion of data Dr. Restivo - Acquistion of data Dr, Maimone - Acquisition of data + Dr. Rossi ~ Acquisition of data + Dr. Stromillo- Acquisition of data + Dr. Bergamaschi - Study concept and design Coniict of interest ‘The authors declare that they have no conflict of interest ‘Appendix A ‘O-items questionnaire for assessment of Dysphagia in Multiple Sclerosis (DYMUS). ‘The questionnaire can be divided into two sub-questionnaires: for the assessment of dysphagia to solid (7 items, in bold), and for the assessment of dysphagia to liquid (3 items, in italic). Instructions for patent: This questionnaire is aimed at evaluating your current ability to perform swallowing activities. Please answer ‘each question indicating yes or na, Each item concerns your present state, exception made forthe last item that refers tothe lat 6 months, 7 Do you have diticlies swallowing soil food (wach as met, bread and the ‘er 2 Doe have difiaitessualoving gi (sch wate, mi andthe te)? 3. Do you hives gobow sensation in our thes dorng swallowing? ‘4 o you have ood ticking in your rat? ‘So you cough or o you haves choking semation fers ingestion? {Doe cough od ou havea can sotto ete ston?” "7. Doypou need to sallow more and more times before completely swallowing sot od? {Do you need oct fod in smal pieces before suaiowing? Do yu ne te mor nd mre sp bre competesaig Lid? 10. Do you have wight lon? References 1H] Thomas, wes Dysphagia non sts in muti ers News Iooszaer-e - a BB Gag? Rupp Gro MG, De Vics Paks oat le sleeis- prevalence sd progiosicaters AaNel Scan 0:10:40 3. 19] DePauw A Osage Ocoghes, Caron H Oyphapa aero Cin New! Reson 20:14 345-81 (4) Poona Derahsace emai M Solemn Minagar A Mags AK. dysphagia ape sceoas Mu Scler 2010 1632 15 Neda YP anrarpaneal rtny mip ces: Dos 6] Taso aerpmasci Busca M,FomarA Cv. stag ‘rtp ers Mun pahogenes lags NewS 2008-2999 00-3" [7] Weiner w wetzel SC Kappos Hoshi MM Wie Rade BW a Swag booms in ulifle sees eoretion between vate an ‘eyo Er al 270-82 ‘ 18) Abram Scheider LC Seth Ca Rocca NC, Newrolagse mpi ‘Qs asin outpatients with male cere oper dphele ap tomutaogy. Nereehab Neu Rep (00710713, 1a] Began Crvel Reza Pa Slr Ros. The DYMUS ‘questionnaire forthe asesmeat of djptapa in mie ees. | Newol S ‘on 15 200800: [no Segaasch K.Rezzani Mingus, Amato ME, at Mars Mc Va ‘ation ofthe DYALS gars forthe acento yopaga a mac Scere Funct New ep 210243) 158-62 {nn Foiman CH, Reingold SC Ean Gl, Hartung HP, Kaos Dagostic ‘ater lp sero: 005 vevons tthe “Mobo ier Neurol 2005:58:00-8 Pease cite this article a: Solar C, etal, Prevalence of atient-reported dysphagia {using the DYMUS questionnaire). J Neurol ci (2013), tp:/dxalotorg/10.1016;}ns2013.05020 in multiple sclerosis patients: An Italian multicenter study