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.