Improving Post-Stroke Dysphagia Outcomes Through a Standardized and Multidisciplinary Protocol: An Exploratory Cohort Study

Abstract

Stroke is a major cause of dysphagia. Few studies to date have reported on standardized multidisciplinary protocolized approaches to the management of post-stroke dysphagia. The aim of this retrospective cohort study was to evaluate the impact of a standardized multidisciplinary protocol on clinical outcomes in patients with post-stroke dysphagia. We performed retrospective chart reviews of patients with post-stroke dysphagia admitted to the neurological ward of Verona University Hospital from 2004 to 2008. Outcomes after usual treatment for dysphagia (T- group) were compared versus outcomes after treatment under a standardized diagnostic and rehabilitative multidisciplinary protocol (T+ group). Outcome measures were death, pneumonia on X-ray, need for respiratory support, and proportion of patients on tube feeding at discharge. Of the 378 patients admitted with stroke, 84 had dysphagia and were enrolled in the study. A significantly lower risk of in-hospital death (odds ratio [OR] 0.20 [0.53-0.78]), pneumonia (OR 0.33 [0.10-1.03]), need for respiratory support (OR 0.48 [0.14-1.66]), and tube feeding at discharge (OR 0.30 [0.09-0.91]) was recorded for the T+ group (N = 39) as compared to the T- group (N = 45). The adjusted OR showed no difference between the two groups for in-hospital death and tube feeding at discharge. Use of a standardized multidisciplinary protocolized approach to the management of post-stroke dysphagia may significantly reduce rates of aspiration pneumonia, in-hospital mortality, and tube feeding in dysphagic stroke survivors. Consistent with the study's exploratory purposes, our findings suggest that the multidisciplinary protocol applied in this study offers an effective model of management of post-stroke dysphagia.

The Efficacy of Prophylactic Antibiotics on Post-Stroke Infections: An Updated Systematic Review and Meta-Analysis

“…For example, dysphagia screening, malnutrition, recumbency and tube feeding were associated with high risks for stroke patients developing pneumonia2627. However, some studies found that a standardized multidisciplinary protocolized feeding tube placement has a beneficial role in preventing aspiration pneumonia in mildly or moderately disabled post-stroke patients2829. Those may indicate that the stroke patient’s clinical conditions have a close link with pneumonia.…”

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

“…But this study was not confined to dysphagic patients only, and a benefit of early detection of dysphagia with standardized screening protocols to prevent pneumonia was especially shown in smaller studies [26, 33]. Another retrospective cohort study ( n = 84) showed that the use of a standardized multidisciplinary approach to the management of post-stroke dysphagia did not only reduce rates of aspiration pneumonia but also reduced in-hospital mortality rates [8]. As a further ray of hope, 2 recent prospective, large, multicenter studies with positive results were published: one found early dysphagia screening to be associated with reduced risk of stroke-related pneumonia and disability [9].…”

Negotiating The Maze: Confronting Dysphagia Together With My Stroke-Afflicted Family Member

“…A multidisciplinary team may consist of neurologists, nurses, rehabilitation physicians, speech therapists, physical therapists, nutritionists, radiologists, and pharmacists (Aoki et al, 2016;Gandolfi et al, 2014). The family caregivers in the present study were unsatisfied with the lack of adequate information regarding dysphagia care, especially from physicians and nurses.…”

“…A multidisciplinary team approach offers an effective model for the management of post-stroke dysphagia (Aoki et al, 2016;Gandolfi et al, 2014). A multidisciplinary team may consist of neurologists, nurses, rehabilitation physicians, speech therapists, physical therapists, nutritionists, radiologists, and pharmacists (Aoki et al, 2016;Gandolfi et al, 2014).…”