Swallowing therapy for dysphagia in acute and subacute stroke

Abstract

Background Dysphagia (swallowing problems), which is common a er stroke, is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay. Treatments provided to improve dysphagia are aimed at accelerating recovery of swallowing function and reducing these risks. This is an update of the review first published in 1999 and updated in 2012. Objectives To assess the e ects of swallowing therapy on death or dependency among stroke survivors with dysphagia within six months of stroke onset.

Swallowing Disorders in the Older Population

“…Moderate-quality evidence suggested that swallowing interventions reduced hospital length of stay but that these interventions did not reduce case fatality rate or the combined outcome of death or disability. 44 Higher-quality evidence to support the positive impact of rehabilitative interventions for dysphagia in older adults with a variety of etiologies is desperately needed.…”

An Overview of Systematic Reviews and Meta-Analyses on Acupuncture for Post-Acute Stroke Dysphagia

“…Subsequently nine studies were excluded, and the reasons for exclusion were as follows: one SR included observational studies, two articles were conference abstracts, one SR we were unable to get the full text, four studies were not SRs, and one article was a duplicate. Finally, 31 studies were included in our study [8][9][10]. The study flow chart is shown in Figure 1.…”

“…A total of 31 studies were published between 2006 and 2019 [8][9][10], nine SRs [8][9][10][36][37][38][39][40][41] were published in English-language journals, and the remaining 22 were in the Chinese-language. Four of the 31 SRs were Cochrane reviews [8][9][10]41], 21 were journal articles [14][15][16][17][18][19][20][21][22][23][24][25][26][27]29,30,[36][37][38][39][40], one was a conference paper [28] and five were theses (three Masters and two PhDs degrees) [31][32][33][34][35]. The first authors of 29 SRs [8, were from China, including one [39] from Hong Kong, and the first author of the other two SRs were from UK [10] and Sri Lanka [9] but with the same corresponding author from UK.…”

“…Four of the 31 SRs were Cochrane reviews [8][9][10]41], 21 were journal articles [14][15][16][17][18][19][20][21][22][23][24][25][26][27]29,30,[36][37][38][39][40], one was a conference paper [28] and five were theses (three Masters and two PhDs degrees) [31][32][33][34][35]. The first authors of 29 SRs [8, were from China, including one [39] from Hong Kong, and the first author of the other two SRs were from UK [10] and Sri Lanka [9] but with the same corresponding author from UK. Only four [8][9][10]41] SRs published on Cochrane listed the evidence-based medicine background of co-authors, the remaining 27 were unclear, and the number of co-authors ranged from one to nine, we were unable to get this information from the five [31][32][33][34][35] theses.…”

“…Another Cochrane review in 2012 [9] reported that acupuncture can reduce the prevalence of dysphagia, alleviate clinical symptoms such as difficulty swallowing and meanwhile improve the life quality of the patients. However, the latest updated Cochrane review on swallowing therapy, which included an analysis of acupuncture failed to show the improvement of swallowing ability, although heterogeneity was high [10]. Overviews of SRs and meta analyses can be performed to synthesize these studies to determine whether acupuncture is an effective treatment, thus it is necessary to conduct an overview focusing on the SRs and meta analyses of acupuncture for dysphagia after stroke.…”