Objective: Objective: To demonstrate the value of using the DHI in movement disorders clinics.

Background: Background: Dysphagia has a negative effect on work, leisure, and social situations.  While instrumental evaluations provide valuable information on the anatomy and physiology of swallowing skills, understanding clinical outcomes that matter most to patients is fundamental to delivering high-quality care.  Patient reported outcomes measures (PROMS) consist of validated and reliable questionnaires that quantify health from the patient’s perspective and provide important information regarding efficacy of treatment on the patient’s quality of life. The Dysphagia Handicap Index has been cited as the most suitable dysphagia outcomes tool for clinical practice.

This poster will outline three examples using the DHI in clinical research to support dysphagia PROMS in patient care. 1) Use of the DHI before and after botulinum toxin injection (BoNT) in cervical dystonia (CD); 2) Use of the DHI and Voice Handicap Index (VHI) in PD over disease duration; 3) Use of the DHI before and after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson disease.

Method: Methods: Study #1) 18 individuals with CD completed the DHI and a videofluorgraphic swallowing study (VFSS) before BoNT injection and two weeks following BoNT injection; #2) 277 subjects with PD of various stages of disease progression completed the DHI and VHI; #3) 14 subjects with PD completed the DHI and a VFSS before DBS and 3 months and 12 months post DBS of the STN on/off medication and on/off DBS stimulation.

Results: Results: Study #1) Subjects perceived worsening physical handicapping effects of dysphagia and worse self-perceived severity of dysphagia with higher BoNT dose; #2) voice and swallowing changes in PD occur in a linear fashion throughout the course of the disease; #3) subjects with PD perceive improved emotional, functional and overall handicapping effects of dysphagia after DBS of the STN even without improved instrumental VFSS results.

Conclusion: Conclusions: The use of PROMS in clinical practice provides health care providers with important information regarding the effect of dysphagia quality of life in individuals with PD and CD and may assist in determining risk/benefit status for invasive medical procedures such as DBS and BoNT injections. Further studies are warranted with larger sample sizes.

References: 1. Silbergleit A, Schultz L, Jacobson B, Beardsley T, Johnson A. The Dysphagia Handicap Index: Development and Validation. Dysphagia. 2012;27:46-52. https://doi.org/10.1007/s00455-011-9336-2
2. Timmerman AA, Speyer R, Heijnen BJ, Klijn-Zwijnenberg IR. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia. Dysphagia. 2014;29:183-198. https://doi.org/10.1007/s00455-013-9511-8
3. Silbergleit AK, Schultz L, Hamilton K., LeWitt PA, Sidiropoulos C. Self-perception of voice and swallowing handicap in Parkinson disease. J Parkinsons Dis 2021. Doi:10.3233/JPD-212621.
4. Silbergleit AK, LeWitt P, Junn F, Schultz LR, Collins D, Beardsley T, Hubert M, Trosch R, Schwalb JM. Comparison of dysphagia before and after deep brain stimulation in Parkinson’s disease. Mov Disord. 2012;27(14):1763-1768.
5. Sallum RAA, Duarte AF, Cecconello I. Analytic review of dysphagia scales. Arq Bras Cir Dig. 2012;24(4):279-282.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/use-of-the-dysphagia-handicap-index-dhi-patient-reported-outcomes-measure-in-parkinson-disease-and-cervical-dystonia/