Systematic Review |
Dysphagia treatment post stroke: a systematic review of randomised controlled trials
1 Research Associate, Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, Parkwood Hospital, Rm B-3019b, 801 Commissioner's Rd. E. London, ON N6C 5J1, Canada
2 Department of Physical Medicine and Rehabilitation, Parkwood Hospital, 801 Commissioner's Rd. E. London, ON N6C 5J1, Canada
3 Graduate Department of Speech-Language Pathology, Rehabilitation Sciences Building, Centre for Function and Well Being, Faculty of Medicine, University of Toronto, 500 University Ave, 10th floor, Toronto, ON M5G 1V7, Canada
Address correspondence to: Norine Foley. Tel: 1 (519) 685-4292 ext 42738; Fax: (519) 685-4036. Email: norine.foley{at}sjhc.london.on.ca
Background: dysphagia is common following stroke and is associated with the development of pneumonia. Many dysphagia treatment options are available, some still experimental and others already rooted in common practice. Previous reviews of these treatments were limited due to a dearth of available studies. Recently, more trials have been published warranting a re-examination of the evidence.
Objective: a systematic review of all randomised controlled trials (RCTs), updating previous work and evaluating a broader range of therapeutic interventions intended for use in adults recovering from stroke and dysphagia.
Methods: using multiple databases, we identified RCTs published between the years 1966 and August 2007 examining the efficacy of dysphagia therapies following stroke. Across studies, results of similar treatments and outcomes were compared and evaluated.
Results: fifteen articles were retrieved assessing a broad range of treatments that included texture-modified diets, general dysphagia therapy programmes, non-oral (enteral) feeding, medications, and physical and olfactory stimulation. Across the studies there was heterogeneity of the treatments evaluated and the outcomes assessed that precluded the use of pooled analyses. Descriptively these findings present emerging evidence that nasogastric tube feeding is not associated with a higher risk of death compared to percutaneous feeding tubes; and general dysphagia therapy programmes are associated with a reduced risk of pneumonia in the acute stage of stroke.
Conclusions: dysphagia is known to be a common and potentially serious complication of stroke. Despite the recent newly published RCTs, few utilise the same treatment and outcomes thereby limiting the evidence to support the medical effectiveness of common dysphagia treatments used for patients recovering from stroke.
Keywords: literature review, deglutition disorders, treatment, outcome, cerebrovasular disorders, elderly
Received 1 October 2007; accepted in revised form 26 February 2008.