The characterization of dysphagia in COVID-19 rehabilitation patients: An inpatient rehabilitation cohort study.

Abstract

Severe COVID-19 infection requiring hospitalization is associated with oropharyngeal dysphagia, yet trajectories in the inpatient rehabilitation facility (IRF) setting remain undercharacterized. To investigate the prevalence, risk factors, recovery likelihood, and evolution of dietary requirements of patients with dysphagia due to severe COVID-19 infection admitted to IRF. Retrospective cohort study. Three free-standing urban IRFs. Two hundred forty eight patients with acute symptomatic COVID-19 admitted to IRF between April 2020 and February 2021. Dysphagia was defined by abnormalities on videofluoroscopic swallow study, Functional Oral Intake Scale, or Mann Assessment of Swallowing Ability. Patients with neurologic disease, nil per os status on IRF admission, or indeterminate dysphagia status were excluded. Multidisciplinary IRF dysphagia treatment, per standard of care. Dysphagia prevalence and resolution, dietary consistencies, and Functional Independence Measure scores. Of the included patients, 46.0% had dysphagia on admission (n = 114), most commonly oropharyngeal (89.7%), followed by oral (8.6%) and pharyngeal (1.7%). Dysphagia resolved during an average 3-week IRF stay in 43.5% of cases. Higher Functional Independence Measure comprehension scores were associated with lower likelihood of dysphagia (p = .002) and higher likelihood of resolution (p = .021). Discharge to home was common in both those with persistent and resolved dysphagia (86.5% vs. 88.6%). Additionally, 92.1% (n = 105) of patients with dysphagia on admission were discharged on a normal or International Dysphagia Diet Standardisation Initiative Level 6/0 diet. In this large study of dysphagia in patients with COVID-19 requiring IRF, a strong, novel association between cognitive function and both dysphagia incidence and recovery was observed in patients without discrete neurologic injury. Although persistent dysphagia was common at discharge, most patients transitioned to a normal or near-normal diet.