Association Between Active Gait Training for Severely Disabled Patients with Nasogastric Tube Feeding or Gastrostoma and Recovery of Oral Feeding: A Retrospective Cohort Study

Abstract

Hideki Arai,1,2 Jiro Takeuchi,2 Masafumi Nozoe,3 Tatsuyuki Fukuoka,4 Satoru Matsumoto,1 Takeshi Morimoto2 1Department of Rehabilitation, Toyonaka Heisei Hospital, Toyonaka, Osaka, Japan; 2Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; 3Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women’s University, Kobe, Hyogo, Japan; 4Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Higashihiroshima, Hiroshima, JapanCorrespondence: Takeshi MorimotoDepartment of Clinical Epidemiology, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya-City, Hyogo 663-8501, JapanTel [phone]Fax [phone]Email [email protected]: This study evaluates the effect of introducing active gait training (AGT) to patients who are severely disabled with nasogastric tube feeding or gastrostoma on the recovery of oral feeding.Patients and Methods: We conducted a historical cohort study at a single rehabilitation center in Japan between January 2013 and December 2019. In this study, 154 severely disabled patients with nasogastric tube feeding or gastrostoma due to neurological diseases or disuse syndrome admitted in a rehabilitation ward were included, and their median age was 84 years. AGT was systematically implemented in August 2016, which consisted of using orthosis or assistance from physical therapists. We compared the recovery of oral feeding between periods before (Pre-AGT) and after (Post-AGT) the introduction of AGT.Results: Among the 154 severely disabled patients included, 59 (38%) were admitted in the Post-AGT period. Twenty-eight (30%) and 54 patients (92%) started gait training in the Pre-AGT and Post-AGT periods, respectively (p < 0.001). Significantly more patients recovered oral feeding in the Post-AGT than in the Pre-AGT periods (49% vs 19%, respectively; p < 0.001). After the introduction of AGT, the adjusted hazard ratio for the recovery of oral feeding was 4.0 (95% confidence interval, 1.9– 8.3; p < 0.001).Conclusion: After the introduction of AGT to patients, increased recovery of oral feeding was observed in this retrospective evaluation. AGT should be considered for patients with tube feeding to help them recover oral feeding even if patients were severely disabled and required full assistance during gait training.Keywords: active gait training, dysphagia, lateral hypothalamus, oral feeding, orexin, tube feeding

Keywords

• active gait training
• dysphagia
• lateral hypothalamus
• oral feeding
• orexin
• tube feeding