Date Presented 04/22/21
This study was a retrospective cohort design that used data from the U.S. Uniform Data System for Medical Rehabilitation. We examined the improvement of swallowing status between patients with primary dysphagia diagnosis and those with poststroke dysphagia upon discharge from inpatient rehabilitation facilities. A main finding includes that patients with a primary dysphagia diagnosis demonstrated substantially worse swallowing status compared to those with poststroke dysphagia.
Primary Author and Speaker: Kimberly Hreha
Additional Authors and Speakers: Bailee Cloutier, Zana A. McNeil, Erin Pyles, and Breanna Trueblood
Contributing Authors: Sharon Cosper
PURPOSE: To examine the improvement of swallowing status between patients with primary dysphagia diagnosis and those with post-stroke dysphagia at discharge from inpatient rehabilitation facilities (IRFs).
DESIGN: A retrospective cohort study.
METHODS: We used data from the United States Uniform Data System for Medical Rehabilitation (UDSMR) during 2016 and 2017. Ordinal logistic regression model compared swallowing status at discharge between the two comparison groups by accounting for baseline patient and clinical characteristics. Multiple imputation with the fully conditional specification method was used to deal with the missing observations for the discharge swallowing status variable.
RESULTS: The mean age of the sample was 71.4 years (SD = 12.8). A total of 992 patients were retrieved from the study data, including .64 patients with a primary dysphagia diagnosis and 928 patients with post-stroke dysphagia. Adjusted ordinal logistic regression model revealed that patients with primary dysphagia had lower odds of improving swallowing status (odds ratio [OR] 0.300; 95% Confidence Interval [CI] 0.142, 0.636) than those with post-stroke dysphagia at discharge from IRFs. Similarly, the multiple imputation method revealed that patients with primary dysphagia had lower odds of swallowing status improvement at discharge from IRFs (OR 0.563; 95% CI 0.342, 0.925).
CONCLUSION: In a large national sample, patients with primary dysphagia diagnosis receiving rehabilitation services in IRFs demonstrated substantially worse swallowing status compared to those with post-stroke dysphagia. This finding suggests that healthcare providers, especially occupational therapists should be aware of the differences occurring in swallowing improvement across dysphagia diagnosis groups. This is important because then therapists can plan and tailor patients' swallowing recovery.
References
Mann, G., Hankey, G. J., Cameron, D. (2000). Swallowing disorders following acute stroke: Prevalence and diagnostic accuracy. Cerebrovascular Disease,10(5): 380-6.
Takizawa, C., Gemmell, E., Kenworthy, J., Speyer, R. (2016). A systematic review of the prevalence of oropharyngeal dysphagia in stroke, Parkinson's disease, Alzheimer's disease, head injury, and pneumonia. Dysphagia, 31(3): 434-41.
