LONG-TERM FUNCTIONAL OUTCOME IN PATIENTS WITH NEUROGENIC DYSPHAGIA

Objective: The purpose of this prospective cohort study was: (1) to do cument and investigate long-term post-treatment outcome focusing on sw allowing disability; and (2) to reveal variables predicting successful functional follow-up results in 63 patients with neurogenic dysphagia . All patients were admitted to an inpatient neurologic rehabilitation unit, Main outcome measurements: Information was gathered through cha rt review and questionnaires. Functional outcome was categorized accor ding to the degree of feeding status: (1) total tube feeding; (2) oral and tube feeding combined; (3) oral feeding with compensation; and (4 ) total oral feeding. 'Improvement' was determined as a positive shift in the type of feeding, 'deterioration' as a negative shift and 'no c hange' was defined as remaining at the same nutritional level. The saf ety of feeding was assessed by tracking the occurrence of pneumonia. R esults: Seventy percent of the patients achieved an improved immediate outcome after therapy. During long-term follow-up examinations, 43% o f all patients showed further improvement, 57% did not show any change in their feeding ability and no deterioration was reported for any pa tient, Comparisons of the relative frequencies of the feeding modaliti es before and after therapy revealed a significant reduction in tube f eeders and a significant increase in oral feeders with compensation du ring inpatient-treatment. The outpatient-interval showed a significant shift in total oral feeders without compensations but no significant improvement within the tube feeders and within the partial oral feeder s. The improvement in nutritional status was not associated with an in creased risk of pneumonia, Additional comparisons of the relative freq uencies of the compensatory strategies indicated a significant reducti on in all treatment techniques at final follow-up. Using logistic regr ession, predictors of successful post-discharge outcome involved a dec reasing pre-treatment interval and unexpectedly low Barthel-ADL mobili ty scores. Conclusions: As a result we advocate regular follow-up cont rols using videofluoroscopic and/or videoendoscopic examination. This facilitates comparisons of swallowing efficiency with and without comp ensation in order to reduce compensatory strategies as early as possib le. The analysis of predictive variables suggests early use of therapy to enhance the chances of successful long-term outcome. (C) 1997 Else vier Science Ireland Ltd.