Força muscular respiratória e sua relação com o risco de disfagia em idosos pós-acidente vascular cerebral: estudo transversal

Abstract

Introduction: Stroke is one of the leading causes of disability and mortality in the world. Its functional consequences are heterogeneous and go beyond disability/disadvantage to perform instrumental activities of daily living. In the acute phase, muscle weakness, including respiratory muscle weakness, and dysphagia contribute to the incidence of pulmonary infection and morbidity and mortality. However, although some studies on respiratory muscle strength (RMS), an important marker of ventilatory capacity and predictor of overall performance, especially in individuals with neurological dysfunctions, have been conducted in individuals after acute phase stroke, little is known about this variable, in the chronic phase and, much less, its association with the risk of dysphagia, the major cause of disability and death in the elderly after stroke. Objective: To investigate respiratory muscle strength and risk of dysphagia in chronic fase post-stroke. The primary outcomes of interest were maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The secondary outcome was the risk of dysphagia and its association with RMS. Method: Cross-sectional study approved by scientific research ethics committee (83573318.2.0000.5020 and number 2.520.8810). RMS was measured by manovacuometry and the risk of dysphagia by Eating Assessment Toll (EAT-10). The functional independence measure (FIM) was used to measure the degree of disability. Data were presented using tables with simple and relative absolute frequencies for categorical data. In the analysis of quantitative data, when the hypothesis of normality was rejected by the Shapiro-Wilk test, the median and quartiles (Qi) were calculated. In the analysis of categorized data, the chi-square test or Fisher's exact test was applied. In the comparison of the medians, the Mann-Whitney or Kruskal-Wallis test was calculated. To analyze the correlation between the RMS and the risk of dysphagia, the Pearson test was used. The Epi Info version 7.2 program for Windows was used, with a significance level of 5%. Results: There was a reduction in the RMS of the elderly after chronic stroke in relation to their controls matched by sex, age and body mass index (MIP p=0,002 e MEP p<0,001). RMS was negatively correlated with the risk of dysphagia (MIP r = -0,629; MEP r = -0,399). Conclusion: Even in the chronic phase after stroke, the elderly have respiratory muscle weakness and this increases the probability of dysphagia.