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Cited by 41Dysphagia Assessment and ManagementAmyotrophic Lateral Sclerosis ResearchVoice and Speech Disorders

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

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Chapin, Jennifer L., Gray, Lauren Tabor, Vasilopoulos, Terrie, Anderson, Amber, DiBiase, Lauren, York, Justine Dallal, Robison, Raele, Wymer, James +1 more·2020·PLOS ONE
DOI 10.1371/journal.pone.0236804PMC PMC7425890
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Abstract

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.

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  • Multiple studies have characterized swallowing impairment in ALS and emphasize the importance of early recognition and multidisciplinary management.

    “Multiple studies have characterized swallowing impairment in ALS and emphasize the importance of early recognition and multidisciplinary management (Chapin et al., 2020; Elbe et al., 2020; Toepfer et al., 1999; Toepfer et al., 1997).”

    From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Chapin et al., 2020

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Cited by

Sorted by citations

Authors
Chapin, J. L., Gray, L. T., Vasilopoulos, T., Anderson, A., DiBiase, L., York, J. D., Robison, R., Wymer, J., & Plowman, E. K.
Affiliations
  • University of Florida (US)
  • Holy Cross Hospital (US)
  • University of Florida Health (US)
Corresponding author
Plowman, Emily K.
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2020-08-13
Volume
15
Issue
8
Pages
e0236804
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0236804
PMC
PMC7425890
OpenAlex
W3049378075
Cited by
41
References
1
Citations by year
2026: 7 · 2025: 7 · 2024: 2 · 2023: 8 · 2022: 10 · 2021: 6 · 2020: 1
FWCI
8.90
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Amyotrophic Lateral Sclerosis Association (17-CM-323)
  • Foundation for the National Institutes of Health (1R01NS100859-01)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
  • Health Sciences › Medicine › Physiology › Voice and Speech Disorders
Keywords
amyotrophic lateral sclerosis, ALSFRS-R, pharyngeal dysphagia, swallowing impairment, bulbar function, penetration-aspiration, videofluoroscopic swallowing study, diagnostic accuracy, dysphagia screening, swallowing safety
MeSH terms
Aged, Amyotrophic Lateral Sclerosis, Deglutition, Deglutition Disorders, Female, Fluoroscopy, Humans, Male, Middle Aged, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Area Under Curve

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