The Influence of Hemoglobin and Swallowing Ability on Daily Living Activities After Hospital Discharge in Taiwanese Stroke Patients: A Longitudinal Study

Objective: This study aimed to examine the mediating effect of swallowing ability on hemoglobin levels and activities of daily living (ADL).Design: Prospective longitudinal study.Setting: Two rehabilitation wards in a national referral center for Northern Taiwan, followed by discharge.Participants: 101 participants were admitted for first or recurrent infarction or hemorrhagic stroke and transferred to the rehabilitation ward of a medical center (N=101).Interventions: Not applicable.Main Outcome Measures: Hemoglobin data were collected from medical records. Swallowing ability and ADL were measured using the Functional Oral Intake Scale and Barthel Index, respectively, with higher scores indicating better functioning.Results: Mediation analysis performed using path analysis illustrated that hemoglobin at the time of transfer to the rehabilitation ward had a direct and positive effect on swallowing ability at 1-3 days before discharge (path coefficient=0.21, 95% confidence interval [CI]: 0.04-0.35, P=.018), and swallowing ability at 1-3 days before discharge had a direct and positive effect on ADL at 1 month after discharge (path coefficient=0.36, 95% CI: 0.13-0.57, P=.002). Hemoglobin level at the time of transfer to the rehabilitation ward did not directly influence ADL 1 month after discharge (path coefficient=0.12, 95% CI:-0.05-0.28, P=.166). These results indicate that swallowing ability substantially mediates the relation between previous hemoglobin levels and subsequent ADL. Conclusion: Low hemoglobin levels and poor swallowing ability should be concurrently addressed to improve ADL performance. Archives of Physical Medicine and Rehabilitation 2023;104:1638-45 (c) 2023 by the American Congress of Rehabilitation Medicine.

Automated summary

This study examines the mediating effect of swallowing ability on hemoglobin levels and activities of daily living (ADL). The results show that hemoglobin levels at the time of transfer to the rehabilitation ward directly affect swallowing ability before discharge, and swallowing ability before discharge directly affects ADL one month after discharge. Therefore, improving hemoglobin levels and swallowing ability can simultaneously enhance ADL performance.