Evaluation of the effectiveness of safe nutrition program applied to acute stroke patients with dysphagia

Introduction: Dysphagia is a common complication in acute stroke patients. Although there are treatment options, healing takes time. Managing this process in the safest way is important for the physical and mental health of the patient. Purpose: This study aimed to evaluate the effectiveness of a safe nutrition program applied to acute stroke patients with dysphagia. Method: A total of 78 patients, 39 in the control group and 39 in the experimental group, participated in this study, which was conducted in a quasi-experimental design with a non-randomized control group. The study was completed in three stages: control, preparation and intervention periods. In the first period, control group patients were included. The information of the patients and caregivers was completed with an information form, and the evaluations were completed with scales (NIHSS, MMSE) and measurements (BMI, BUN/Creatinine). Mini Nutritional Assessment (MNA), modified Rankin Score (mRS), Barthel Index (BI) and Swallowing Anxiety Scale (YKÖ) were administered at discharge. No intervention was applied other than the routine practices of the clinic. Patients were additionally evaluated with the Stroke-Specific Quality of Life Scale (SS-QOL) and Beck Depression Scale (BDI) in the third month. During the preparation period, a training program on dysphagia and safe nutrition was organized for the nurses of the clinic. During the intervention period, patients data were collected using the same methods as the control group. Patients and caregivers were included in a training program accompanied by the guidebook titled 'Stroke and Dysphagia', created by the researchers, and telephone follow-up was carried out for three months after discharge. It was re-evaluated at discharge and in the third month. Results: The average age of all patients participating in the study was 67.6±12.5 years. 66.7 (n=52) of the patients had a stroke for the first time, and 83.3% (n=65) was ischemic stroke. 71.8% (n=56) of the patients had hypertension and 39.7% (n=31) remained in the intensive care ünit (ICU). The total hospital stay of the patients was 11.7±8.9 days, and the average length of stay with NGT was 21.0±28.6 days. The average age of the caregivers was 49.5±13.2 and 73.1% (n=57) were women. When the experimental and control groups were evaluated in terms of sociodemographic and clinical characteristics and the first measurement results (NIHSS, MNA, mRS, BI) were found to be similar (p>0.05). Among the primary outcome measures of the safe nutrition program, aspiration pneumonia, dehydration and malnutrition, only the malnutrition rate decreased significantly in the experimental group compared to the control group (p=0.039). When the two groups were compared in terms of secondary outcome measures, the improvement achieved in the third month compared to discharge, a significant improvement was seen in favor of the experimental group only in the mRS (p=0.006) and BI (p=0.002) parameters. In the third month, the swallowıng anxıety scale score was found to be lower in the experimental group compared to the control group (p=0.002), and the SS-QOL score was found to be higher (p=0.003). Conclusion: The safe nutrition program was found to be effective in preventing malnutrition from dysphagia complications in stroke patients. It was thought that it may also benefit swallowing anxiety and quality of life.