使用综合进食辅助工具口部 Kuchi-kara 进食指数促进老年肺炎患者经口进食的效果：一项群组随机对照试验。
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.
机构信息
Department of Geriatric Internal Medicine, Takano Hospital, 214 Higashi-machi, shimokitaba, Hirono-machi, Futaba-County, Fukushima, 960-0402, Japan.
Department of Disaster and Comprehensive Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
出版信息
BMC Geriatr. 2020 Jan 31;20(1):36. doi: 10.1186/s12877-020-1447-x.
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.
背景
多学科综合护理（MDCC）方案可促进老年患者改善经口进食。为了客观评估 MDCC 方案中患者的状况，开发了 Kuchi-kara Taberu（日语中意为“经口摄入”，简称 KT）指数。本试验旨在研究该指数在促进老年肺炎患者经口进食方面的效果。
方法
本研究采用整群随机对照试验，纳入了 10 家当地医院的老年肺炎（≥65 岁）患者。10 家医院被随机分配至干预组或对照组。两组（各有 5 家医院）均接受 MDCC 方案下的经口喂养护理，包括专业评估、护理和治疗。干预组采用 KT 指数，重点改善低评分项目。主要结局指标为出院或入院后 1 个月时的功能性经口摄食量表（FOIS）评分。
结果
共 10 家医院的 112 名患者（46 名女性，66 名男性）参与了本研究，患者的中位年龄为 88 岁（四分位距 [IQR]，80-91）。出院时 FOIS 评分的中位数和经口进食患者比例（FOIS≥4 分）分别为 4 分（IQR，4-6）和 89 例（79.5%）。患者的经口禁食时间中位数为 2 天（IQR，1-5）。每个医院都有经 Kuchi-kara Taberu Shiawase-wo Mamoru-kai 认证的医护人员促进吞咽障碍患者经口进食，因此两组的聚类在有无这方面医护人员方面并不匹配。干预组和对照组各有 53 名和 59 名患者的 FOIS 评分中位数分别为 5 分（IQR，4-6）和 4 分（IQR，4-5），差异无统计学意义（P=0.76）。多变量分析显示，KT 指数对 FOIS 评分无积极影响。
结论
由于随机分组失败，本试验未能证明 KT 指数的有效性。但是，干预组和对照组的患者出院时经口进食比例（FOIS≥4 分）均较高。
试验注册号
UMIN-Clinical Trial Registry，UMIN000025172，2016 年 12 月 17 日。
Zotero 插件