ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2019 December;55(6):728-34

DOI: 10.23736/S1973-9087.19.05893-3

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

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

Yu-Kuan LO ¹, Tieh-Cheng FU ^{1, 2}, Carl P. CHEN ³, Shin-Sheng YUAN ⁴, Chih-Chin HSU ^{1, 2, 5} ✉

¹ Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; ² Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; ³ Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; ⁴ Institute of Statistical Science, Academia Sinica, Taipei, Taiwan; ⁵ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan

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.

KEY WORDS: Stroke; Dysphagia; Rehabilitation; Pneumonia, aspiration; Survival rate