Does the Multidimensional Burden of Post-Stroke Dysphagia Differ Between the Acute and Subacute Phases? A Cross-Sectional, ICF-Based Comparison of 187 Adults

Abstract Background. Clinicians often assume that swallowing is most impaired in the first days after stroke and eases in the subacute phase. That view rests largely on intake-based or screening measures. We asked whether the broader, multidimensional burden of post-stroke dysphagia differs between phases when assessed with an International Classification of Functioning, Disability and Health (ICF) instrument. Method. In a secondary cross-sectional analysis of the ICF-based Dysphagia Assessment Tool (ICF-DAT) validation cohort, 187 consecutive adults with first-ever stroke were each assessed once on the 57-code ICF-DAT (0–4 qualifier scale). Seventy-four were acute (≤7 days post-stroke) and 113 subacute (days 8–30). Five core qualifiers (ingestion b510, muscle tone b735, speaking d330, eating d550, drinking d560) were compared by one-way analysis of variance (ANOVA) with partial eta-squared as effect size; articulation (b320) was not recorded in the source dataset and was excluded. Results. Acute means were slightly higher (more impaired) on four of five qualifiers; ingestion differed negligibly in the opposite direction. No comparison was significant (all p > 0.05; partial η² ≤ 0.015). Severity was Mild 0.5%, Moderate 72.7%, Severe 26.7% overall; severe dysphagia occurred in 25.7% of acute and 27.4% of subacute patients. Environmental factors were barriers for every patient in both phases. Conclusions. At group level, multidimensional post-stroke dysphagia burden did not differ significantly between phases. This cross-sectional comparison describes group similarity, not within-patient recovery, and non-significance is not proof of equivalence. Calendar phase alone should not triage assessment intensity; thorough, context-focused assessment remains warranted across both phases.