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.