2025 Volume 29 Issue 2 Pages 51-60
Introduction: It is known that a high percentage of patients in the acute phase of stroke present with feeding and swallowing dysfunction. It is important to predict feeding and swallowing function at discharge from an early stage, and to consider targeted rehabilitation and alternative nutrition. However, there are few evaluation methods that are simple and can be easily implemented by non-professionals. Therefore, we investigated the usefulness of the Assessment of Swallowing Ability for Pneumonia (ASAP), which was developed as a method of feeding and swallowing for pneumonia in the elderly and can be easily and quantitatively assessed by any healthcare professional, as an assessment of feeding and swallowing ability for acute stroke patients.
Materials and Methods: The subjects were 211 patients (median: 75 years old, male/female: 130/81) who were admitted to Nagoya Ekisaikai Hospital for stroke between January and December 2023, and who could be adequately evaluated by a speech-language pathologist. The items included general patient information, stroke-related information, nutritional assessment, feeding and swallowing assessment, cognitive function tests, ADL assessment, and anthropometric assessment. Statistical analysis was performed using ordinal logistic regression analysis with the Functional Oral Intake Scale (FOIS) at discharge as the objective variable and items predicted as confounders in previous studies as explanatory variables. When ASAP was extracted as an independent factor, ROC curves were used to calculate cutoff values, area under the curve, sensitivity, and specificity for predicting oral intake of a dysphagia diet at discharge (FOIS: 4 or higher), and oral intake of a normal diet (FOIS: 6 or higher).
Results: Ordinal logistic regression analysis revealed that age (odds ratio: 0.951, 95% confidence interval: 0.917–0.984, p＝0.005), ASAP (odds ratio: 1.110, 95% confidence interval: 1.080–1.150, p＜0.001) and Barthel Index (odds ratio: 1.010, 95% confidence interval: 1.000–1.030, p＝0.021) were extracted as independent factors. The ROC curves for oral intake of dysphagia and normal diet and ASAP at discharge were cutoff: 63, area under the curve: 0.968, sensitivity: 92%, specificity: 90% and cutoff: 86, area under the curve: 0.948, sensitivity: 91%, specificity: 92%.
Conclusion: ASAP has the potential to provide a simple assessment of feeding and swallowing function in patients with acute stroke.
