The Journal of the Convergence on Culture Technology (문화기술의 융합)

The International Promotion Agency of Culture Technology (국제문화기술진흥원)
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Prevalence and associated factors of dysphagia in patients hospitalized with acute stroke

급성 뇌졸중 입원 환자의 연하장애 유병률과 관련요인

  • 장희경 (경상대학교 간호대학) ;
  • 윤숙경 (경상대학교병원 간호부) ;
  • 길초롱 (경상대학교 건강과학연구원)
  • Received : 2019.01.31
  • Accepted : 2019.02.11
  • Published : 2019.02.28
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Abstract

The aims of this study were to evaluate the prevalence of dysphagia in patients hospitalized with acute stroke and to identify factors associated with dysphagia. The study was conducted in a tertiary hospital and a total of 131 patients hospitalized with acute stroke (aged 34-92 years old, 58.0% male) were enrolled. The prevalence of dysphagia was 24.4% out of 131 participants and risk factors associated with dysphagia were age, neurological severity, oral health status, and dependence in activity of daily living of participants. Considering the long-term rehabilitation trajectory, it is necessary to apply the early screening and preventive nursing intervention for dysphagia during acute stage of stroke patient.

본 연구는 급성 뇌졸중 입원 환자의 연하장애 유병률과 그 관련요인을 탐색하기 위한 서술적 조사연구로, 일상급종합병원에 급성 뇌졸중으로 진단받은 입원 환자 131명(연령 범위 34-92세, 58.0% 남성)을 대상으로 수행되었다. 본 연구의 결과 급성 뇌졸중 입원 환자의 유병률은 24.4%였으며, 대상자의 나이, 뇌졸중 중증도, 구강상태, 일상활동 의존도가 연하장애에 영향을 미치는 것으로 나타났다. 이러한 결과를 기반으로 뇌졸중 발병 직후부터 연하장애 조기 발견을 위한 적극적인 간호사정과 예방적 중재 프로그램 개발과 적용이 필요하다.

Keywords

표 5. 급성 뇌졸중 환자의 흡인 위험도 영향요인 Table 5. Multiple logistic regression to explain the dysphagia in stroke patients (N=131)

GJMGCK_2019_v5n1_417_t0005.png 이미지

표 1. 대상자의 인구사회학적 및 건강관련 특성 Table 1. General and Health-related Characteristics of the Participants (N=131)

GJMGCK_2019_v5n1_417_t0006.png 이미지

표 2. 연하장애 유무에 따른 대상자 특성의 차이 Table 2. Socio-demographic and health-related characteristics of the participants (N=131)

GJMGCK_2019_v5n1_417_t0007.png 이미지

표 3. 흡인위험과 뇌졸중 중증도에 따른 연하장애 유병률 Table 3. Prevalence of dysphagia according to risk of aspiration and Stroke severity (N=131)

GJMGCK_2019_v5n1_417_t0008.png 이미지

표 4. 측정변수들 간의 상관관계 Table 4. Correlation among variables (N=131)

GJMGCK_2019_v5n1_417_t0009.png 이미지

References

  1. Korean Stroke Society, "Stroke 2nd ed.", Seoul, PanMun Education, 2015.
  2. Statistics Korea, "Annual report on the causes of death statistics", 2017. http://kosis.kr/publication/publicationWord.do
  3. S. Kumar, M.H. Selim, L.R. Caplan, "Medical complications after stroke", The Lancet Neurology, Vol. 9, No. 1, pp. 105-118, 2010. https://doi.org/10.1016/S1474-4422(09)70266-2
  4. W.K. Kim, "Dietary modification in dysphagia", Journal of the Korean Dysphagia Society, Vol. 1, No. 1, pp. 47-49, 2011. https://doi.org/10.3938/jkps.59.47
  5. S.K. Daniels, L.A. Ballo, M.C. Mahoney, A.L Foundas, "Clinical predictors of dysphagia and aspiration risk: Outcome measures in acute stroke patients", Archives of Physical Medicine and Rehabilitation, Vol. 81, No. 8, pp. 1030-1033, 2000. https://doi.org/10.1053/apmr.2000.6301
  6. M.E. Groher, M.A. Crary, "Dysphagia: Clinical management in adults and children", Elsevier Health Sciences, 2015.
  7. M. McFarlane, A. Miles, P. Atwal, P. Parmar, "Interdisciplinary management of dysphagia following stroke", British Journal of Neuroscience Nursing, Vol. 10, No. 1, pp. 13-20, 2014. https://doi.org/10.12968/bjnn.2014.10.1.13
  8. M. Arnold, K. Liesirova, A. Broeg-Morvay, J. Meisterernst, M. Schlager, M.L. Mono, H. Sarikaya, "Dysphagia in acute stroke: Incidence, burden and impact on clinical outcome", PLoS One, Vol. 11, No. 2, e0148424, 2016. https://doi.org/10.1371/journal.pone.0148424
  9. K.H. Choi, "Epidemiology of dysphagia", Journal of the Korean Dysphagia Society, Vol. 1, No. 1, pp. 1-8, 2011.
  10. N. Roy, J. Stemple, R.M. Merrill, L. Thomas, "Dysphagia in the elderly: Preliminary evidence of prevalence, risk factors, and socioemotional effects", Annals of Otology, Rhinology & Laryngology, Vol. 116, No. 11, pp. 858-865, 2007. https://doi.org/10.1177/000348940711601112
  11. S.Y. Kim, "The impact of SWAL-QOL on overall quality of life in normal elderly people: Focusing on Jeonbuk province", The Journal of the Korea Contents Association, Vol. 14, No. 6, pp. 288-297, 2014. https://doi.org/10.5392/JKCA.2014.14.06.288
  12. L. Rofes, V. Arreola, J. Almirall, M. Cabre, L. Campins, P. Carcia-Peris, "Diagnosis and management of oropharyngeal dysphagia and its nutritional and respiratory complications in the elderly", Gastroenterology Research & Practice, Vol. 2011, pp. 1-13, 2011. http://dx.doi.org/10.1155/2011/818979
  13. K.W. Lee, S.J. Choi, S.B. Kim, J.H. Lee, S.J. Lee, "A survey of caregivers' knowledge about caring for stroke patients", Annals of Rehabilitation Medicine, Vol. 39, No. 5, pp. 800-815, 2015. https://doi.org/10.5535/arm.2015.39.5.800
  14. G. Maiuri, A. Corsonello, F. Monteleone, A. Nicoletti, F. Fedele, G. Marrazzo, B. Mazzei, "Overlooked dysphagia: A life-threatening condition", Aging Clinical and Experimental Research, Vol. 30, No. 2, pp. 217-219, 2018. https://doi.org/10.1007/s40520-017-0769-9
  15. J.A. Logemann, "Swallowing disorders", Best Practice & Research Clinical Gastroenterology, Vol. 21, No. 4, pp. 563-573, 2007. https://doi.org/10.1016/j.bpg.2007.03.006
  16. M. Trapl, P. Enderle, M. Nowotny, Y. Teuschl, K. Matz, A. Dachenhausen, M. Brainin, "Dysphagia bedside screening for acute-stroke patients: The Gugging Swallowing Screen", Stroke, Vol. 38, No. 11, pp. 2948-2952, 2007. https://doi.org/10.1161/STROKEAHA.107.483933
  17. W.W. Song, S.H. Yi, E.J. Kim, H.N. Kim, J.J. Park, K.I. Choi, B.J. Ryu, "Validation of Gugging Swallowing Screen for patients with stroke based on videofluoroscopic swallowing study", Journal of the Korean Academy of Rehabilitation Medicine, Vol. 33, No. 6, pp. 704-710, 2009.
  18. S.R. Jung, S. Ryu, B.J. Oh, W. Kim, K.S. Lim, "Initial prognosis predictors of functional recovery in acute ischemic stroke", Journal of the Korean Society of Emergency Medicine, Vol. 17, No. 5, pp. 438-446, 2006.
  19. D.H. Kim, M.H. Oh, H.A. Jung, J.J. Kim, "The relationships among ADL, self-esteem, and motivation for rehabilitation of stroke patients", The Journal of Korean Society of Occupational Therapy, Vol. 21, No. 4, pp. 59-70, 2013. https://doi.org/10.14519/jksot.2013.21.4.06
  20. K.B. Slot, E. Berge, P. Dorman, S. Lewis, M. Dennis, P. Sandercock, "Impact of functional status at six months on long term survival in patients with ischaemic stroke: Prospective cohort studies", The bmj, Vol. 336, No. 7640, pp. 376-379, 2008. https://doi.org/10.1136/bmj.39456.688333.BE
  21. R.N. Ratnaike, "Practical guide to geriatric medicine", McGraw-Hill Professional Publishing, 2002.
  22. S. Watanabe, K. Shimozato, H. Oh-Shige, M. Umemura, S. Fujiwara, Y. Abe, I. Oh-Iwa, "Examination of factors associated with aspiration pneumonia following stroke", Oral Science International, Vol. 11, No. 1, pp. 15-21, 2014. https://doi.org/10.1016/S1348-8643(13)00009-8
  23. S.K. Yun, H.M. Kim, E.J. Mo, M.Y. Kim, M.J Kim, C.R. Gil, H.K. Chang, "Validation of the Korean version of the standardized swallowing assessment and the National Institute of Health Stroke Scale among acute stroke patients", International Journal of Advanced Culture Technology, Vol. 6, No. 4, pp. 124-130, 2018. https://doi.org/10.17703//IJACT2018.6.4.124
  24. M.S. Kim, Y.H. Park, "The risk of dysphagia and dysphagia-specific quality of life among community dwelling older adults in senior center", Korean Journal of Adult Nursing, Vol. 26, No. 4, pp. 393-402, 2014. http://dx.doi.org/10.7475/kjan.2014.26.4.393
  25. C.Y. Kim, Y.M. Lee, E.H. Ha, "Development and evaluation of a dysphagia assessment tool and an intervention program for the elderly in the long-term care facilities", Journal of the Korea Academia-Industrial Cooperation Society, Vol. 13, No. 2, pp. 685-693, 2012. http://dx.doi.org/10.5762/KAIS.2012.13.2.685
  26. J.Y. Ha, S.M. Lee, "Effects of swallowing rehabilitation program among elderly in geriatric hospitals", Journal of Korean Public Health Nursing, Vol. 28, No. 3, pp. 650-618, 2014. http://dx.doi.org/10.5932/JKPHN.2014.28.3.605
  27. F. Faul, E. Erdfelder, A. Buchner, A.G. Lang, "Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses", Behavior Research Methods, Vol. 41, No. 4, pp. 1149-1160, 2009. https://doi.org/10.3758/BRM.41.4.1149
  28. A. Leibovitz, B. Sela, J. Zlotnik, Y. Baumohel, R. Segal, "Plasma levels of amino acids in elderly long term care residents with oropharyngeal dysphagia: Comparison of hand-oral with tube-enteral-fed patients", Amino Acids, Vol. 29, No. 3, pp. 263-266, 2005. https://doi.org/10.1007/s00726-005-0217-6
  29. N.H. Kim, Y. S. Kwon, M. Kim, K.H. Lee, H.W. Kwak, "A study on the nutritional status, symptoms, and information needs in stroke patients with dysphagia", Journal of Korean Biological Nursing Science, Vol. 13, No. 1, pp. 72-80, 2011.
  30. M.S. Oh, K.H. Yu, J.H. Lee, S. Jung, I.S. Ko, J.H. Shin, "Validity and reliability of a Korean version of the national institutes of health stroke scale", Journal of Clinical Neurology, Vol. 8, No. 3, pp. 177-183, 2012. https://doi.org/10.3988/jcn.2012.8.3.177
  31. J. Eilers, A.M. Berger, M.C. Peterson, "Development, testing, and application of the oral assessment guide", Oncology Nursing Forum, Vol. 15, No. 3, pp. 325-330, 1988.
  32. J. Rankin, "Cerebral vascular accidents in patients over the age of 60: III. Diagnosis and treatment", Scottish Medical Journal, Vol. 2, No. 6, pp. 255-268, 1957. https://doi.org/10.1177/003693305700200604
  33. J.C. Van Swieten, P.J. Koudstaal, M.C. Visser, H.J.A. Schouten, J. van Gijn, "Interobserver agreement for the assessment of handicap in stroke patients", Stroke, Vol. 19, No. 5, pp. 604-607, 1988. https://doi.org/10.1161/01.STR.19.5.604
  34. E.J. Kim, W.T. Kim, M.H. Young, Y.A. Yang, "The clinico-statistical study of dysphagia caused by geriatiric disease", Korea Aging Friendly Industry Association, Vol. 2, No. 1, pp. 61-69, 2010.
  35. J.K. Lee, "Epidemiology, natural recovery, long-term outcome of post stroke dysphagia", Journal of the Korean Dysphagia Society, Vol. 4, No. 1, pp. 1-5, 2014. https://doi.org/10.34160/jkds.2014.4.1.001
  36. J. Kim, B.M. Oh, G.J. Lee, S.A. Lee, S.W. Chun, T.R. Han, "Clinical factors associated with severity of post-stroke dysphagia", Brain & Neurorehabilitation, Vol. 4, No. 2, pp. 116-120, 2011. https://doi.org/10.12786/bn.2011.4.2.116
  37. S.J. Kim, "Music therapy protocol development to enhance swallowing training for stoke patients with dysphagia", Journal of Music Therapy, Vol. 47, pp. 102-119, 2010. https://doi.org/10.1093/jmt/47.2.102
  38. Y.J. Lee, "Factors affecting functional recovery in patients with acute ischemic stroke", Unpublished Master's Thesis. Korea University, Seoul, Korea, 2017.
  39. H.J. Song, "Factors related to the functional state of acute stroke patients at discharge", Unpublished Master's Thesis. Yonsei University, Seoul, Korea, 2018.
  40. S.B. Seo, J.S. Lee, M.J. Koo, "A study on the hospital reservation system and appointment system using smartphone", The Journal of the Convergence on Culture Technology, Vol. 3, No. 1, pp. 29-33, 2017. http://dx.doi.org/10.7236/JCCT.2017.3.1.29
  41. J. Moon, Y. Won, "Effects of orofacial exercises training program using smart phone on swallowing function and tongue strength in acute stroke patients with dysphagia", Journal of the Korea Institute of Electronic Communication Sciences, Vol. 11, No. 10, pp. 995-1002, 2016. https://doi.org/10.13067/JKIECS.2016.11.10.995
  42. R. Shaker, J.E. Geenen, "Management of dysphagia in stroke patients", Gastroenterology & Hepatology, Vol. 7, No. 5, pp. 308-332, 2011.
  43. H.J. Song, J.H. Park, J.Y. Dong, K.S. Lee, "Multi-dimensional factors related to the functional state of acute ischemic stroke patients - for patients visiting a hospital in Gangwon-do", The Korean Journal of Health Service Management, Vol. 12, No. 2, pp. 125-134, 2018. https://doi.org/10.12811/kshsm.2018.12.2.125
  44. S. Awano, T. Ansai, Y. Takata, I. Soh, S. Akifusa, T. Hamasaki, T. Takehara, "Oral health and mortality risk from pneumonia in the elderly", Journal of Dental Research, Vol. 87, No. 4, pp. 334-339, 2008. https://doi.org/10.1177/154405910808700418
  45. M.C. Brady, D.L. Furlanetto, R.V. Hunter, "Improving oral hygiene in patients after stroke", Stroke, Vol. 38, pp. 1115-1116, 2007. https://doi.org/10.1161/01.STR.0000258295.00571.55
  46. E.K. Kim, M.S. Kim, H.K. Lee, "A study on the oral health and oral health related quality of life of stroke patients in a rehabilitation ward: A pilot study", Journal of Dental Hygiene Science, Vol. 16, No. 2, pp. 127-133, 2016. http://dx.doi.org/10.17135/jdhs.2016.16.2.127
  47. J.H. Beom, "Cost-effectiveness and utility analysis of stroke unit compared with general ward in acute stroke care", Unpublished Master's Thesis. Seoul National University, Seoul, Korea, 2012.
  48. S.S Choi, "Impact of hospital admission times on acute ischemic stroke patients protector stroke-related knowledge scores", Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology, Vol. 6, No. 9, pp. 495-504, 2016. http://dx.doi.org/10.14257/AJMAHS.2016.09.05
  49. S.C. Park, S.M. Cho, D.G. Kim, C.Y. Lim, J.W. Lee, J.W. Hong, J.N. Kwon, "Short-term prognosis according to time of treatment of patients with acute cerebral infarction: Measurement by NIHSS", Journal of Physiology & Pathology in Korean Medicine, Vol. 26, 2012.