Association Between the Intensity and Frequency of Swallowing Rehabilitation and Oral Intake at Discharge in Older Patients with Acute Post-stroke Dysphagia

This retrospective cohort study aimed to clarify the concurrent effects of intensity and frequency of early swallowing rehabilitation for post-stroke dysphagia. Using data from acute-care hospitals included in the Japanese Diagnosis Procedure Combination database between April 2020 and March 2021, we identified patients aged >= 65 years with dysphagia after acute stroke on admission who received swallowing rehabilitation within three days of hospitalization. Swallowing rehabilitation within seven days of hospitalization, starting from admission, was categorized into four types according to intensity (long/short per day) and frequency (high/low proportion of days performed). The primary outcomes were presence of dysphagia and recovery of total oral intake at discharge. Generalized estimating equations were used to assess the effects of rehabilitation intensity and frequency, adjusting for patient and hospital characteristics. Of the 4,669 patients with post-stroke dysphagia, 913 underwent swallowing rehabilitation within three days of hospitalization. The proportions of patients with dysphagia and total oral intake at discharge were 80% and 47%, respectively. The intensity and frequency of swallowing rehabilitation were not associated with dysphagia at discharge. Higher intensity or higher frequency was associated with total oral intake at discharge (odds ratio [95% confidence interval]:1.62 [0.93-2.81], 2.00 [1.11-3.60], and 2.75 [1.59-4.76] for low-intensity and high-frequency, high-intensity and low-frequency, and high-intensity and high-frequency groups, respectively). This nationwide study showed that the intensity and frequency of acute-phase swallowing rehabilitation were not associated with recovery from dysphagia after a stroke. However, they were associated with an improved oral intake at discharge.