Compliance With Swallowing Instruction and Quality of Life in Patients With Parkinson's Disease: A Retrospective Assessment of Instructional Methods to Maintain and Improve Quality of Life.

Objectives: To investigate the effects of swallowing instructional methods and content on instructional compliance among patients with Parkinson's disease (PD). Methods: Overall, 59 of the 317 patients with PD who underwent a videofluoroscopic examination of swallowing (VF) and completed the Japanese version of the Dysphagia Handicap Index (DHI-J) within 45 days before and after VF were analyzed. Based on records of compliance with alternative strategies from the time of instruction to 6 months, patients were classified into the compliance (CP) and noncompliance (NCP) groups. Results: The NCP and CP groups included 31 (52.5%) and 28 (47.5%) patients, respectively. No significant differences in self-reported severity or DHI score were identified, and quality of life (QOL) and awareness did not influence compliance. The CP group had more patients who received instruction using swallowing charts or handouts than the NCP group. More patients lived with family members. The NCP group had significantly higher DHI-Physical (P) and DHI-Total scores and lower QOL post-instruction reassessment (Post) than pre-instruction reassessment (Pre). Conversely, the CP group had significantly lower DHI-P, DHI-Emotional, and DHI-Total scores and higher QOL in Post than in Pre. Conclusions: When teaching swallowing with alternative strategies for dysphagia, using visual elements rather than verbal instructional elements alone is beneficial for improving compliance with instructional content. Compliance with swallowing instructions can maintain and improve QOL after the intervention. Patients living with family members demonstrated better compliance, likely due to meals provided by family members, along with advice and cooperation influencing compliance with the guidelines.