Clinical outcomes associated with speech, language and swallowing difficulties post-stroke.
Stephanie A Kaylor, Shajila A Singh
PMID 37916686WHAT IT FOUND
Dysphagia after stroke was linked to greater disability, and swallowing difficulty with aspiration was linked to poorer oral intake in 68 South African adults.
Links with referral timing and aspiration pneumonia risk factors were not clear.
Key findings
01Among the 68 participants, 53 had dysphagia, 50 had aphasia, 50 had dysarthria, and 11 had apraxia of speech; 88% had co-occurring diagnoses.
02Dysphagia was linked to moderate to severe physical disability at admission and discharge, and dysphagia with aspiration pneumonia was linked to severe disability at discharge.
03Dysphagia with aspiration was linked to poorer oral intake, but poor oral hygiene, low consciousness, tube feeding and feeding dependence were not significantly linked to aspiration pneumonia.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study used convenience sampling in five private hospitals in the Cape Metropolitan area, so the participants may not represent stroke patients in other settings. The sample was smaller than the 85 participants required by the power analysis, so several findings had low statistical power. The study was observational, so it cannot show that any treatment or delay caused an outcome. Several associations, including referral time and length of stay, had p values above the p<0.01 threshold. Instrumental swallow assessments were rare, so aspiration may have been missed in some participants. Aspiration pneumonia occurred in only five participants, which makes risk factor comparisons unstable. Oral hygiene was assessed only by visual inspection, not a standardised measure. Weight loss was listed as an outcome, but the supplied text does not report weight loss results.
The easy way to misread this
Do not read the 3-day longer stay after late referral as evidence that late referral caused longer stay. The p value was 0.042, which did not meet the study's p<0.01 threshold, and the cohort was small and observational.