, Volume 34, Issue 6, pp 896–903 | Cite as

The Modified Barium Swallow Impairment Profile as a Predictor of Clinical Outcomes of Admission for Pneumonia or Choking in Dysphagic Patients with Parkinson’s Disease

  • Amanda Hui-Juan KooiEmail author
  • Jasmine Pei-Ling Boo
  • Samuel Yong-Ern Ng
  • Sanchalika Acharyya
  • Kwang-Hwee Goh
  • Kay-Yaw Tay
  • Wing-Lok Au
  • Louis Chew-Seng Tan
Original Article


Dysphagia increases risk of pneumonia in patients with Parkinson’s disease (PD). However, no studies have investigated the association between objective measures of swallowing dysfunction and clinical outcomes. Therefore, we aimed to study the link between scores obtained on the modified barium swallow impairment scale profile (MBSImP) and hospital admissions for pneumonia and choking, in groups of patients with PD on different feeding modes. 157 patients who completed MBS studies were divided into three groups based on their feeding modes (oral, enteral, and rejected enteral feeding with oral feeding at own risk). Videos were analysed using the MBSImP. We evaluated the association of the oral, pharyngeal, and combined scores, with risk of admission for pneumonia and choking. Kaplan–Meier plots and log-rank tests were used to compare survival distributions among feeding groups. Cox regression models were generated to estimate hazard ratios (HRs) and 95% confidence intervals. Patients in the group that rejected enteral feeding scored the highest on the MBSImP, followed by enteral then oral feeding. Within the group that rejected enteral feeding, higher pharyngeal (HR = 3.73, p = 0.036) and combined scores (HR = 1.63, p = 0.034) significantly increased the risk of pneumonia and choking. In the enteral feeding group, higher oral subscores (HR = 2.16, p = 0.011) increased risk for the event, while higher pharyngeal (HR = 0.40, p = 0.004) subscores reduced risk for pneumonia and choking. This is the first study to analyse the association of MBSImP scores with clinical outcomes in PD patients. Patients who rejected enteral feeding had the highest risk for pneumonia and choking that could be predicted by their MBSImP scores. In the enteral feeding group, this risk was partially reversed. Compliance with feeding modes reduces the risk of pneumonia and choking.


Parkinson’s disease Deglutition Deglutition disorders Modified barium swallow Modified barium swallow impairment profile Pneumonia Clinical outcomes 



This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme (TCR12dec010) and administered by the Singapore Ministry of Health’s National Medical Research Council.

Compliance with Ethical Standards

Ethical approval

The study was approved by the Centralized Institutional Review Board of the Singapore Health Service.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Speech Therapy DepartmentTan Tock Seng HospitalSingaporeSingapore
  2. 2.Department of NeurologyNational Neuroscience InstituteSingaporeSingapore
  3. 3.Duke-NUS Medical SchoolSingaporeSingapore

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