Swallowing Status Comparison between Primary Dysphagia and Post-stroke Dysphagia in Inpatient Rehabilitation Facilities.

Abstract

Objectives: To examine the improvement of discharge swallowing status between patients with a primary dysphagia diagnosis and those with Post-stroke dysphagia discharged from inpatient rehabilitation facilities (IRFs).

Methods: A retrospective cohort design used data from the United States Uniform Data System for Medical Rehabilitation (UDS_MR) during 2016 and 2017. Ordinal logistic regression model compared the swallowing status at discharge between the two comparison groups, accounting for baseline patient and clinical characteristics. Multiple imputations with the fully conditional specification method was used to deal with the missing observations for the discharge swallowing status variable.

Results: The mean age of the sample was 71.4 years (SD = 12.8). A total of 992 patients were retrieved from the study data, including 64 patients with a primary dysphagia diagnosis and 928 patients with Post-stroke dysphagia. Adjusted ordinal logistic regression model revealed that patients with primary dysphagia had lower odds of improving their swallowing status (odds ratio [OR] 0.300: 95% Confidence Interval [CI] 0.142, 0.636) than those with Post-stroke dysphagia at discharge from IRFs. Similarly, the multiple imputations method revealed that patients with primary dysphagia had lower odds of swallowing status improvement at discharge from IRFs (OR 0.563: 95% CI 0.342, 0.925).

Discussion: Patients with a primary dysphagia diagnosis receiving rehabilitation services in IRFs demonstrated substantially worse swallowing status compared to those with Post-stroke dysphagia in a large national sample. This finding suggests that healthcare providers should be aware of the differences occurring in swallowing improvement across dysphagia diagnosis groups.