Outcome of Rehabilitation and Swallowing Therapy after Percutaneous Endoscopic Gastrostomy in Dysphagia Patients

Abstract

The objective of this study was to investigate the outcomes of rehabilitation (with swallowing therapy) after percutaneous endoscopic gastrostomy (PEG) in patients with neurogenic dysphagia. Forty-seven patients (29 males and 18 females) who were transferred to the rehabilitation ward of our hospital after receiving PEG tube placements during a 5-year period were enrolled in this study. Patients' demographic data, comorbidities, nutritional statuses, and laboratory biomarkers before the PEG procedure were collected. Rehabilitation (with swallowing therapy) outcomes such as changes in Functional Independence Measure (FIM) and dysphagia grade (using Fujishima's classification) were evaluated. Significant improvements in FIM scores and dysphagia grades after rehabilitation therapy were observed. Twenty-seven patients (57.4 %) were discharged with some oral intake and 10 patients (21.3%) were discharged PEG-free (defined as the PEG tube not being used or removed). Factors associated with being discharged with some oral intake were increase in FIM score (adjusted OR 1.10, 95 % CI 1.02-1.19) and higher baseline dysphagia grade (adjusted OR 1.88, 95 % CI 1.04-3.39). Factors associated with being discharged PEG-free were longer rehabilitation period (OR 1.03, 95 % CI 1.01-1.04), absence of respiratory disorders (OR 0.12, 95 % CI 0.03-0.35), and increase in FIM score (OR 1.17, 95 % CI 1.08-1.28). Changes in dysphagia grade were significantly correlated with changes in FIM score (r = 0.46, p< 0.0001), indicating that improvement of FIM scores through general rehabilitation therapy may play an important role in the treatment of dysphagia.

Effect of dysphagia rehabilitation in patients receiving enteral nutrition at home nursing care: A retrospective cohort study

“…Dam et al 30 and Toh et al 31 reported that activities of daily living have a major effect on dysphagia rehabilitation treatment in patients with neurological disorders who have received a gastrostomy. In this study, we also found that maintaining the ability to walk was a condition for resuming oral intake.…”

Deprescribing psychotropic medications is associated with improvements in activities of daily living in post‐stroke patients

“…Adjustment factors included baseline values (at admission), age, sex (male), length of hospital stay, rehabilitation therapy (units/day), CCI, FIM‐total, FILS scores, and energy intake. Because swallowing function 41 and nutritional status 42 have been reported to affect outcomes, these variables were added to the analysis. In addition, multiple linear regression analysis was used to determine which psychotropic medication reductions were independently associated with the primary outcome and FIM movement at discharge.…”

Structural cause of dysphagia detected during videofluoroscopic swallow study

“…), but due to his poor general status, curative surgery was deemed not suitable and he was transferred to palliative care. Although PEG followed by swallowing therapy can be effective in some patients with dysphagia , the underlying cause for each patient needs individual assessment and management . A multidisciplinary approach may be useful to rule out structural causes, and noninvasive interventions, such as in this case, may prevent the deterioration of general status if performed earlier.…”