Poster 14: Individuals With Severely Disordered Level of Consciousness: Factors Associated With Returning to Oral Feeding During Inpatient Rehabilitation

Abstract

Objective: To identify factors associated with return to oral feeding in unconscious patients undergoing inpatient rehabilitation. Design: Retrospective, case-controlled study. Setting: 2 freestanding rehabilitation hospitals. Participants: 73 subjects admitted to acute inpatient rehabilitation at cognitive levels ranging from a Rancho Los Amigo Level I-III. Interventions: Not applicable. Main Outcome Measure: Return to some type of oral feeding during inpatient rehabilitation. Results: Group 1 (n=36) subjects remaining NPO during inpatient rehabilitation was 61% men, mean age ± SD of 41.86±18.11. Admission to inpatient rehabilitation on average 66.59±76.46 days after injury with 38.69 days average rehabilitation length of stay (LOS). Group 2 (n=37), subjects returning to some type of oral feeding during inpatient rehabilitation was primarily men (73%), mean age ± SD of 36.62±16.93. Admission to inpatient rehabilitation 63.32±71.9 days after injury with an average rehabilitation LOS of 49.81±20.224 days. Differences between age, duration of injury, and sex distribution were nonsignificant. Group 1 mean discharge cognitive FIM score was equal to 6.06 and motor FIM score was equal to 16.17. Group 2 mean discharge cognitive FIM score was equal to 9.22 and motor FIM score was equal to 25.89. Differences observed between the 2 groups were significant (cognitive FIM, t=−2.848, P=0.006; motor FIM, t=−2.965, P=0.004). Overall 12 (16.4%) of the 73 patients in the study sample developed pneumonia during inpatient rehabilitation with 8 (66.6%) of the 12 being in the NPO group and 4 (33.3%) of the 12 being in the oral feeding group (χ2=1.758, P=0.185). Group 2 discharge diet levels were: 18 (48.6%) of 37 therapeutic feedings with speech only, 9 (24.3%) of 37 dysphagia diet, 13 (35.1%) of 37 regular diet. Conclusions: Participants who were able to return to oral feedings during inpatient rehabilitation had longer rehabilitation LOS, higher discharge cognitive and motor FIM scores, and no increase in pneumonia rates as compared with subjects who were unable to return to oral feedings. The majority of patients who returned to oral feedings were able to advance to 3 meals daily.