Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward

Ikenaga, Yasunori; Nakayama, Sayaka; Taniguchi, Hiroki; Ohori, Isao; Komatsu, Naoya; Nishimura, Hitoshi; Katsuki, Yasuo

doi:10.1016/j.jstrokecerebrovasdis.2016.12.005

Cited by 33 publications

(49 citation statements)

References 48 publications

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“…Here, we placed importance on quality of life after the start of ANH, and thus we chose oral intake recovery and discharge to home as the secondary outcomes. Previous studies showed that age and BMI were predictive factors of oral intake recovery in stroke patients with tube-feeding [42,43]. In this study, age and BMI were similar between groups, and there were no significant differences in oral intake recovery between groups.…”

Section: Discussionsupporting

confidence: 58%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Masaki

Kimura

2019

Preprint

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21Background 22 The long-term outcomes of artificial nutrition and hydration (ANH) in the elderly with 23 dysphagia remain uncertain. Enteral nutrition via percutaneous endoscopic gastrostomy 24 (PEG) and total parenteral nutrition (TPN) are major methods of ANH. Although both 25 can be a life-prolonging treatments, Japan has recently come to view PEG as 26 representative of unnecessary life-prolonging treatment. Consequently, TPN is often 27 chosen for ANH instead. This study aimed to compare the long-term outcomes between 28 PEG and TPN in the elderly. 29 Methods 30This single-center retrospective cohort study identified 253 elderly patients with 31 dysphagia who received enteral nutrition via PEG (n=180) or TPN (n=73) between 32 January 2014 and January 2017. The primary outcome was survival time. Secondary 33 outcomes were oral intake recovery, discharge to home, and the incidence of severe 34 pneumonia and sepsis. We performed one-to-one propensity score matching using a 0.05 35 caliper. The Kaplan-Meier method, log-rank test, and Cox proportional hazards model 36 were used to analyze the survival time between groups. 37 Results 38Older patients with lower nutritional states, and severe dementia were more likely to 39 receive TPN. Propensity score matching created 55 pairs. Survival time was significantly 40 longer in the PEG group (median, 317 vs 195 days; P=0.017). The hazard ratio for PEG 41 relative to TPN was 0.60 (95% confidence interval: 0.39-0.92; P=0.019). There were no 42 significant differences between the groups in oral intake recovery and discharge to home. 43The incidence of severe pneumonia was significantly higher in the PEG group (50.9% vs 44 25.5%, P=0.010), whereas sepsis was significantly higher in the TPN group (10.9% vs 45 30.9%, P=0.018). 46 Conclusions 47PEG was associated with a significantly longer survival time, a higher incidence of 48 severe pneumonia, and a lower incidence of sepsis compared with TPN. These results can 49 be used in the decision-making process before initiating ANH. 50 51 4 56 developed as an enteral feeding technique for pediatric patients with dysphagia [1,2]. 57Compared to feeding via a nasogastric tube, enteral feeding via PEG can relieve 58 laryngopharyngeal discomfort and prevent intervention failure; therefore, its use has 59 become widespread for long-term enteral feeding in multiple patient groups including 60 pediatric and geriatric populations [3]. However, studies have reported worse outcomes 61 following PEG feeding in patients with dementia [4,5]; therefore, the use of PEG in 62 elderly populations is controversial [6,7]. 63TPN is another common method of nutritional management [8,9]. Similar to tube 64 feeding, TPN is also occasionally used for ANH in elderly patients with dysphagia [10]. 65 Comparing the outcomes of enteral nutrition and parenteral nutrition are major concerns 66 among clinicians. Previous studies have demonstrated conflicting results among patients 67 who received enteral nutrition versus those who received parenteral nutr...

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Section: Discussionsupporting

confidence: 58%

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Masaki

Kimura

2019

Preprint

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“…The study showed non‐inferiority for the severest MMSE group in the frequency of hospital‐associated dysphagia, and MMSE was not an independent factor for the development of hospital‐associated dysphagia in a multivariable model. These findings differ from a report by Ikenaga et al ., which concluded that dysphagia rehabilitation for stroke‐related dysphagia is influenced by the severity of cognitive impairment . However, it could be considered that the purpose of the intervention was different, with a focus on improving dysphagia and preventing further decline of swallowing ability.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive impairment can negatively impact the effects of dysphagia rehabilitation. The severity of cognitive impairment is associated with aspiration and swallowing reflex evocation, recovery from stroke dysphagia, and nutritional improvement . Therefore, dysphagia rehabilitation in patients with severe cognitive impairment remains a therapeutic challenge for healthcare providers …”

Section: Introductionmentioning

confidence: 99%

Cognitive impairment has no impact on hospital‐associated dysphagia in aspiration pneumonia patients

Maeda

Wakabayashi

Shamoto³

et al. 2017

Geriatrics Gerontology Int

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“…Virtual reality is reasonable to be considered to improve the visual-spatial function (Grade IIa recommendation, Level B evidence).Screening for dysphagiaCommonly used assessments include the Eating Assessment Tool-10 (EAT-10), the Clinical Swallowing Function Assessment Form, the Standardised Swallowing Assessment (SSA) and so on. The inspection methods include repeated saliva swallowing test, Watian drinking water test, dye test and so on [6][7][8][9][10][11]. Patients who had a stroke who could not eat safely and effectively for more than 4 weeks were suggested percutaneous gastrostomy tube insertions (Grade IIa recommendation, Level B evidence).…”

mentioning

confidence: 99%

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of stroke rehabilitation

Zhang

Zhao

Li³

et al. 2020

Stroke Vasc Neurol

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Stroke is the third leading cause of long-term disability. Effective stroke rehabilitation should be provided to patients with a moderate or severe stroke so as to achieve functional recovery. Also, stroke rehabilitation is moving towards more intense therapy models that incorporate technologies such as robotics and computer games. Evidence-based guidelines are useful for promoting the best possible clinical practices. This guideline summarises the modes of stroke rehabilitation in China—three-stage rehabilitation network, rehabilitation of stroke dysfunction, training for activities of daily living, stroke complications and rehabilitation care. The aim of this guideline was to provide a synopsis of best clinical practices in the stroke rehabilitation of adult patients in China.

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Factors Predicting Recovery of Oral Intake in Stroke Survivors with Dysphagia in a Convalescent Rehabilitation Ward

Cited by 33 publications

References 48 publications

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Comparison of long-term outcomes between enteral nutrition via gastrostomy and total parenteral nutrition in the elderly with dysphagia: A propensity-matched cohort study

Cognitive impairment has no impact on hospital‐associated dysphagia in aspiration pneumonia patients

Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of stroke rehabilitation

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