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- 검색키워드
- 저자 : Kimberly P. Hreha (검색결과 3 건)
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Kimberly P. Hreha,Sarah Sheridan,Ickpyo Hong,Grace J. Kim 대한작업치료학회 2022 대한작업치료학회지 Vol.30 No.2
This prospective, observational study of acute stroke survivors was completed to report our clinical application ofthe Penetration-Aspiration Scale (PAS), an 8-point multidimensional assessment, used in conjunction with theVideo Fluoroscopic Swallow Study (VFSS). In addition, we were interested in determining the association of PASscores at admission, demographics and clinical characteristics with functional recovery (measured by theFunctional Independence Measure [FIM]) at discharge from an inpatient rehabilitation hospital. There werethirty-five patients that met inclusion and consented. Out of the 35, 34 (97%) were successfully assessed withthe PAS with VFSS. Multivariate regression model revealed that the PAS scores, sex, length of stay, andadmission FIM scores were significantly associated with functional recovery at hospital discharge (all p values <.05). We conclude that the PAS was feasible to administer with VFSS and implement in our inpatient setting. ThePAS provided information about the depth of the airway invasion, material remaining after the swallow, and theresponse to aspiration, which were not reported in a standardized way prior to this study. The associationbetween the PAS and functional recovery at discharge suggests that stroke survivors with swallowing impairmenthave less functional improvement noted at discharge than those with better swallowing scores. Therefore, peoplewith dysphagia may need additional services and care. Future research should determine if using the PAS canimprove clinical practice and ensure consistency across care transitions (expansion), as those with dysphagiamay need additional services and care.
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Ickpyo Hong,Kimberly P. Hreha 대한연하재활학회 2020 Swallowing Rehabilitation Vol.3 No.1
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 (UDSMR) 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.
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Kevin T. Pritchard,Kimberly P. Hreha,Ickpyo Hong 대한연하재활학회 2020 Swallowing Rehabilitation Vol.3 No.1
Objectives: To examine the association of stroke-induced dysphagia during an inpatient rehabilitation facility (IRF) stay and depressive symptoms at a 3-month follow-up. Methods: A retrospective cross-sectional design using the Stroke Recovery in Underserved Populations 2005-2006 study database. Hierarchical logistic regression models were utilized to examine if stroke-induced dysphagia is a significant predictor for depressive symptoms at 3-month follow-up across the stepwise introduction of the demographics and clinical characteristics at the IRF discharge and 3-month follow-up. Multiple imputations with Markov-chain Monte Carlo method was used to address the covariates with missing observations. Results: In a total of 1,045 stroke survivors, 335 (32.1%) stroke survivors had dysphagia and 710 (67.9%) stroke survivors did not have dysphagia during the IRF stay. The adjusted logistic regression model and multiple imputation method revealed that stroke survivors with dysphagia are more likely to have depressive symptoms at 3-month follow-up (Odds ratio [OR] 3.169, 95% confidence interval [CI] 1.379-7.283; OR 1.746, 95% CI 1.153-2.642, respectively). A high level of functional and cognitive status, functional support, and community participation at the 3-month follow-up was inversely associated with depressive symptoms (OR 0.973, 95% CI 0.951- 0.995; OR 0.884, 95% CI 0.829-0.942; OR 0.793, 95% CI 0.714-0.882). Discussion: Stroke survivors experiencing dysphagia during the IRF stay had a higher risk of developing depressive symptoms compared to those without dysphagia at 3-month follow-up. Healthcare providers should pay attention to dysphagia care in IRFs which might prevent the development of depressive symptoms when the stroke survivors are discharged and back in their communities.
eArticle
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