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

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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.

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Abbreviations

T+:

“Treated” group

T−:

“non-treated” group

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Acknowledgments

We would like to thank all those who cooperated to the implementation of the clinical protocol for post-stroke dysphagia in our hospital.

Conflict of interest

None.

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Authors and Affiliations

  1. Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), Department of Neurological and Movement Sciences, University of Verona, Verona, Italy

    Marialuisa Gandolfi, Nicola Smania, Teresa Squaquara & Paola Zuccher

  2. U.S.O. Neurological Rehabilitation, AOUI Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy

    Marialuisa Gandolfi, Nicola Smania & Paola Zuccher

  3. USO Research Support and Biostatistics, AOUI Verona, Verona, Italy

    Giulia Bisoffi

  4. Section of Clinical Neurology, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy

    Sara Mazzucco

Authors
  1. Marialuisa Gandolfi
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  2. Nicola Smania
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  3. Giulia Bisoffi
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  4. Teresa Squaquara
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  5. Paola Zuccher
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  6. Sara Mazzucco
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Corresponding author

Correspondence to Nicola Smania.

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Gandolfi, M., Smania, N., Bisoffi, G. et al. Improving Post-Stroke Dysphagia Outcomes Through a Standardized and Multidisciplinary Protocol: An Exploratory Cohort Study. Dysphagia 29, 704–712 (2014). https://doi.org/10.1007/s00455-014-9565-2

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  • DOI: https://doi.org/10.1007/s00455-014-9565-2

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