Comprehensive Tool to Assess Oral Feeding Support for Functional Recovery in Post-acute Rehabilitation

Waza, Masahiro; Maeda, Keisuke; Katsuragawa, Chihiro; Sugita, Atsuko; Tanaka, R.; Ohtsuka, Asako; Matsui, Tomo; Kitagawa, Keiko; Kishimoto, Taiki; Fukui, Hitoshi; Kawai, Kensuke; Yamamoto, Masahiko; Isono, Michio

doi:10.1016/j.jamda.2018.10.022

Cited by 12 publications

(12 citation statements)

References 29 publications

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“…In that study, all 13 items were demonstrated to be necessary and sufficient for component assessment, and the total KT index score was shown to correlate significantly with the result of other relevant evaluation measures, such as the FOIS, Barthel Index, Mini Nutritional Assessment-Short Form, and Cognitive Performance Scale. A historical control study conducted in a rehabilitation hospital showed that the KT index improved nutrition-related factors, such as BW and oral intake (kcal), along with ADL (FIM) and discharge rate ( Waza et al, 2019 ). A similar outcome was seen in the present case: the patient experienced improved BW, oral intake (kcal), and ADL, which enabled her to return home.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Oral Intake Evaluation Tool (the Kuchi-kara Taberu Index) Facilitated Functional Eating Rehabilitation: A Case Report in a Frail Older Patient with Malnutrition and Suspected Iatrogenic Sarcopenia

Hidaka

Watanabe²,

Nishikawa³

et al. 2022

Gerontology and Geriatric Medicine

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Frail older hospital patients are susceptible to malnutrition and iatrogenic sarcopenia. This can be linked to the decreased appetite and oral intake that can arise in largely bed-bound patients who do not get up even for rehabilitation and meals. The KT index was devised as an easy-to-use evaluation tool to address oral intake issues, and it has potential utility for expediting a multidisciplinary comprehensive rehabilitation program. To our knowledge, no reports have described real-world evidence on multidisciplinary team interventions with this tool. Herein, we report the case of a frail older patient whose oral intake improved following a KT Index-based intervention.

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Section: Discussionmentioning

confidence: 99%

A Comprehensive Oral Intake Evaluation Tool (the Kuchi-kara Taberu Index) Facilitated Functional Eating Rehabilitation: A Case Report in a Frail Older Patient with Malnutrition and Suspected Iatrogenic Sarcopenia

Hidaka

Watanabe²,

Nishikawa³

et al. 2022

Gerontology and Geriatric Medicine

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“…The previous studies have shown that using the KT index can assess patients from a comprehensive perspective and increase their subsequent care and treatment effectiveness in various settings such as the acute phase, convalescent phase, and nursing home [13][14][15]. On the contrary, if intensive treatment for severe pneumonia, severe complications of pneumonia, or severely impaired consciousness is prioritized, the KT index may not be applicable.…”

Section: Discussionmentioning

confidence: 99%

“…The KT index comprised 13 items as follows: willingness to eat, overall condition, respiratory condition, oral condition, cognitive function while eating, oral preparatory and propulsive phases, severity of pharyngeal dysphagia, position and endurance while eating, eating behavior, daily living activities, food intake level, food modification, and nutrition. Each item was rated from 1 (worst) to 5 (best) points and recorded in a radar chart, which visualized the weak items and the effects of intervention through the time-series charts [11,12,14,15]. The intervention group provided an outline of multidisciplinary opinions and intervention plans according to the results of the KT index at every conference.…”

Section: Interventionsmentioning

confidence: 99%

“…Although a previous case report and case control study demonstrated the usefulness of the KT index for older patients with dysphagia [14,15], interventional studies investigating the effectiveness of the KT index in older patients with pneumonia have not been conducted yet. Thus, the current intervention study aimed to verify whether the MDCC program using the KT index promotes oral intake in older patients with pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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The effects of promoting oral intake using the Kuchi-kara Taberu index, a comprehensive feeding assistant tool, in older pneumonia patients: a cluster randomized controlled trial

Shamoto

Koyama²,

Momosaki

et al. 2020

BMC Geriatr

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Background The multidisciplinary comprehensive care (MDCC) program promotes the improvement of oral intake for older patients. The Kuchi-kara Taberu (ingesting orally in Japanese, KT) index was developed to objectively assess patient conditions in the MDCC program. This trial examined the effects of the index in promoting oral intake in older patients with pneumonia. Methods A cluster randomized controlled trial was conducted in 10 local hospitals targeting older patients with pneumonia (≥65 years). Ten hospitals were allocated randomly to either the intervention or the control group. Both groups (each with five hospitals) received the MDCC program for oral feeding, which consisted of professional assessment, care, and treatment. The KT index was used by the intervention group, focusing on improving low score items. The primary outcome was determined using the Functional Oral Intake Scale (FOIS) at discharge or 1 month after admission. Results One hundred and twelve patients (46 women and 66 men) who participated from 10 hospitals, with a median age of 88 years (interquartile range [IQR], 80–91), were examined. The median FOIS level and the number of patients with oral intake (FOIS ≥ level 4) at discharge were 4 (IQR, 4–6) and 89 (79.5%), respectively. The duration of nil per os was 2 (IQR, 1–5) days. Clusters were not matched in the presence of Kuchi-kara Taberu Shiawase-wo Mamoru-kai-certified medical staff promoting oral intake in patients with dysphagia in each hospital. The median FOIS levels of 53 patients in the intervention group and 59 patients in the control group were 5 (IQR, 4–6) and 4 (IQR, 4–5), respectively, showing no statistically significant difference (P = 0.76). According to a multivariate analysis, the KT index had no positive effect on FOIS levels. Conclusions This trial was not able to demonstrate the usefulness of the KT index due to random assignment failure. However, both the intervention and control groups showed a high prevalence of oral intake (FOIS ≥ level 4) at discharge. Trial registration UMIN-Clinical Trial Registry, UMIN000025172, December 17, 2016.

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“…This study revealed that maintaining optimal BMI is an advantage for survival, however our participants without enteral nutrition showed a -0.48% (-1.44-0%) decrease in BMI during the observation period. Although we excluded patients on enteral nutrition from the analysis, they tended to have a lower rate of BMI decrease despite the lower KTBC total score [BMI decrease, -0.09% (-0.79-0.41%); KTBC total score, 27 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) points]. This means that enteral nutrition is an alternative method that can supply adequate energy and protein for patients at risk of dysphagia.…”

Section: Plos Onementioning

confidence: 99%

Importance of feeding status evaluation in older patients undergoing hemodialysis

et al. 2023

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Older hospitalized patients undergoing hemodialysis are increasingly experiencing malnutrition caused by dysphagia. However, only a few studies have focused on this problem. We used the Kuchikara Taberu Balance Chart (KTBC) to evaluate the patients’ feeding status and examined its association with their nutritional status and prognosis. This study included elderly patients undergoing hemodialysis who were hospitalized at Nagasaki Renal Center for > 3 days between June 2021 and February 2022. In total, 82 inpatients were included [mean age, 73.4 ± 10.0 years; men, 57.3%; median dialysis vintage, 79.0 months (interquartile range, 37.3–164.8)]. We classified patients with lower than the median KTBC score (57 points) as being at risk for dysphagia; 37 patients (45.1%) were at risk for dysphagia. Spearman’s rank correlation coefficient (ρ) elucidated that the KTBC total score was significantly associated with each nutritional indicator [serum albumin level (ρ = 0.505, p < 0.001); geriatric nutritional risk index (ρ = 0.600, p < 0.001); and nutritional risk index (ρ = -0.566, p < 0.001)]. The KTBC score was also closely associated with the body mass index (ρ = 0.228, p = 0.04). Patients with a lower KTBC score showed poor prognosis (log-rank test: p = 0.001), and age- and sex-adjusted Cox proportional analysis showed that the KTBC score was associated with life prognosis (hazard ratio, 0.90; 95% confidential interval, 0.86–0.94; p < 0.001). Therefore, we concluded that the patients at risk of dysphagia, identified using the KTBC score, were malnourished and had a poor prognosis. Hence, the evaluation of dysphagia using the KTBC is encouraged to prevent malnutrition in vulnerable older patients undergoing hemodialysis.

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Comprehensive Tool to Assess Oral Feeding Support for Functional Recovery in Post-acute Rehabilitation

Cited by 12 publications

References 29 publications

A Comprehensive Oral Intake Evaluation Tool (the Kuchi-kara Taberu Index) Facilitated Functional Eating Rehabilitation: A Case Report in a Frail Older Patient with Malnutrition and Suspected Iatrogenic Sarcopenia

A Comprehensive Oral Intake Evaluation Tool (the Kuchi-kara Taberu Index) Facilitated Functional Eating Rehabilitation: A Case Report in a Frail Older Patient with Malnutrition and Suspected Iatrogenic Sarcopenia

The effects of promoting oral intake using the Kuchi-kara Taberu index, a comprehensive feeding assistant tool, in older pneumonia patients: a cluster randomized controlled trial

Importance of feeding status evaluation in older patients undergoing hemodialysis

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