Pekacka-Egli Anna Maria, Kazmierski Radoslaw, Lutz Dietmar, Pekacka-Falkowska Katarzyna, Maszczyk Adam, Windisch Wolfram, Spielmanns Marc
Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland.
Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland.
J Clin Med. 2021 Apr 15;10(8):1714. doi: 10.3390/jcm10081714.
Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings.
This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018-2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES.
19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences ( < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients ( < 0.001).
Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.
对急性卒中后患者进行吞咽困难评估可降低营养不良、脱水和吸入性肺炎等并发症的发生率。这也有助于避免不必要的饮食限制。本研究的目的是验证对吞咽困难进行定期重新评估是否会改变康复环境中急性卒中后患者的饮食管理。
这项单中心回顾性研究纳入了2018年至2019年间转诊至住院神经康复中心的63例患者。进行了标准化的临床吞咽评估和吞咽功能纤维内镜评估（FEES）。根据功能性经口进食量表（FOIS）评估饮食水平。作为主要终点，在出院时、康复入院时以及FEES检查后，根据诊断程序评估FOIS值。
共纳入19名女性（30%）和44名男性（70%），平均年龄75岁（标准差±10.08）。组间方差分析显示，急性护理环境中的饮食处方与康复中心临床和内镜重新评估后的饮食处方之间存在显著差异（<0.001）。63名登记患者中有41名（65%）的饮食建议发生了变化（<0.001）。
在卒中患者的早期恢复期通过FEES进行器械诊断可导致饮食限制方面具有临床意义的改变，并降低肺炎发生率。我们的研究结果强调了对参与神经康复的卒中患者进行定期和高质量吞咽困难诊断的必要性。
