To compare swallowing outcomes and discharge destinations in acute stroke tube-feeding-dependent dysphagia patients treated during inpatient rehabilitation (IR) with neuromuscular-electrical-stimulation (NMES) in addition to traditional dysphagia therapy (TDT) versus TDT alone.

Acute-stroke tube-feeding-dependent dysphagia increases risk for medical complications and need for institutional care.

IR retrospective case-control study involving 359 patients with acute-stroke having initial Functional-Oral-Intake-Scale (FOIS) scores of 3 or lower (profound to severe tube-feeding-dependent dysphagia). One-hundred-ninety received NMES with TDT, and 169 case-controls, received only TDT. Treatment occurred in hourly sessions 5-days/week. There were no significant differences between groups for stroke type, (χ2=4.7;p=.19). Groups differed by age (t=3.48;p=.001) with NMES group having average 66.8 years compared to 71.9 years for case-controls. NMES length-of-stay in IR averaged 4 days longer, 22.9 days versus 18.9 days for case-controls (t=3.35;p=.001). Both groups were admitted to IR at approximately 20 days post-stroke (t=.06;p=.95). Initial FOIS scores showed NMES group more impaired compared to case-controls for swallowing ability (t=2.01;p=.045). Main outcome measure was comparison of FOIS scores after treatment (N=359, data 2005-2017), and comparison of discharge destinations (N=267, data 2012-2017).

NMES post-treatment mean FOIS score was 4.21+/-2.1 versus 2.94+/-1.96 for case-controls (t=5.85, p<.001). NMES group post-treatment mean FOIS gain was 3.24+/-2.26 points versus 1.87+/-2.01 for case-controls (t=6.05;p<.001). Post-treatment, 51.6% (98 of 190) NMES patients had minimal or no swallowing restrictions (FOIS scores 5-7), whereas 26.6% (45 of 169) case-controls improved to FOIS scores of 5-7, (χ2 =23.3;p<.0001).Groups differed by discharge destinations: NMES having more discharges to community than case-controls, 60% versus 44% (χ2=9.16;p=.003), and NMES having fewer acute-care transfers compared to controls, 8% versus 25%, (χ2=32.7;p<.0001).

NMES with TDT was significantly more effective than TDT alone during IR in treating acute-stroke feeding-tube-dependent dysphagia; and was associated with significantly more discharges to community and less transfers back to acute-care.