Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials.

Renée Speyer,Liza Bergström,Lianne Remijn,Timothy Pommée,Anna-Liisa Sutt,Reinie Cordier,Mathieu Balaguer,Bas Joris Heijnen,Michelle McInerney

doi:10.3390/jcm11030685

Abstract

Objective: To determine the effects of behavioural interventions in people with oropharyngeal dysphagia. Methods: Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), after which meta-analyses were performed using a random-effects model. Results: A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training. Conclusions: Behavioural interventions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.

Highlights

Swallowing disorders, or oropharyngeal dysphagia (OD), can be the result of many underlying conditions such as stroke, progressive neurological diseases, and acquired brain injury
During full-text assessment, articles were divided into different types of interventions, as this systematic review reports on behavioural interventions only
When comparing selected interventions based on commonalities across studies against conventional dysphagia treatment (CDT), significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise (CTAR), and expiratory muscle strength training (EMST)

Summary

Introduction

Swallowing disorders, or oropharyngeal dysphagia (OD), can be the result of many underlying conditions such as stroke, progressive neurological diseases, and acquired brain injury. They may be the consequence of treatment side effects; for example, radiation or surgical interventions in patients with head and neck oncological disorders. Depending on underlying disease severity and outcome measures used (e.g., instrumental assessment, screening or patient self-report) [2], prevalence estimates can be as high as 80% in stroke and Parkinson’s disease patients, up to 30% in traumatic brain injury patients, and over 90% in patients with community-acquired pneumonia [3]. OD has a high disease burden and poses a major societal challenge, which is associated with significant psychological and social burden, resulting in reduced quality-of-life for both patients and caregivers [5]

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