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Involvement of swallowing therapy is associated with improved long-term survival in patients with post-stroke dysphagia.

Abstract：

BACKGROUND:The effects of swallowing therapy (ST) on long-term clinical outcomes in patients with post-stroke dysphagia (PSD) remain unclear. AIM:This study explores the effect of ST, initiated within 6 months of the stroke onset, on long-term pneumonia-free and overall survival rates in PSD patients. DESIGN:Retrospective cohort study. SETTING:Longitudinal Health Insurance Database. POPULATION:The study included 2994 eligible PSD patients between 2005 and 2013. METHODS:Among the scrutinized PSD patients, ST was initiated during the nasogastric intubation (NGI) period and was implemented by physician discretion. Therefore, subjects who underwent ST were classified into the ST-intervention (STI) group and those without ST were classified into the non-ST (NST) group. Propensity score matching (PSM) was used to match age, sex, pneumonia events during the NGI period, the Charlson comorbidity index, and the National Institutes of Health Stroke Scale between the two groups. We started to follow all selected PSD patients 6 months after the onset of stroke for four years. Multivariable adjusted Cox regression and Kaplan-Meier estimations were conducted to assess the effects of ST and the ST duration on pneumonia-free and overall survival. RESULTS:Overall, 1497 PSD patients aged approximately 68 years in each group were selected in this study. The pneumonia-free survival rate in STI subjects was 57.4% and was significantly greater (P=0.003) than that (54.2%) in NST subjects during the follow-up (F/U). A significantly improved (P<0.0001) overall survival rate was observed in STI subjects (75.0%) compared to NST subjects (63.7%) during the F/U. In STI subjects, ST duration ≥ 1 month was significantly (P=0.009) associated with reduced pneumonia incidence compared to those with ST duration<1 month. CONCLUSIONS:Participation of ST within 6 months of the stroke onset is associated with decreased pneumonia incidence and improved long-term survival in selected PSD patients. In the selected STI subjects, longer ST duration may be valuable in pneumonia prevention. CLINICAL REHABILITATION IMPACT:This study reveals that ST initiated within 6 months of the stroke onset may be associated with improved long-term survival in selected PSD patients.

journal_name

Eur J Phys Rehabil Med

journal_title

European journal of physical and rehabilitation medicine

authors

Lo YK,Fu TC,Chen CP,Yuan SS,Hsu CC

doi

10.23736/S1973-9087.19.05893-3

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

728-734

issue

eissn

1973-9087

issn

1973-9095

pii

S1973-9087.19.05893-3

journal_volume

pub_type

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Involvement of swallowing therapy is associated with improved long-term survival in patients with post-stroke dysphagia.