Abstract

Purpose Expiratory muscle strength training (EMST) is increasingly utilized in dysphagia rehabilitation; however, little is known about the effects of this approach on swallowing function or physiology. We conducted a systematic review to appraise and synthesize evidence regarding the effects of EMST on videofluoroscopic measures of swallowing in individuals with medical diagnoses, in which dysphagia is a concern. Method A literature search was conducted according to Cochrane guidelines. Of 292 nonduplicate articles, 11 were judged to be relevant for review. These underwent detailed review for study quality, risk of bias evaluation, and synthesis of swallowing outcomes. Results The selected articles described EMST in a variety of patient populations using either the EMST150 or the Phillips Threshold positive expiratory pressure device. The typical protocol involved five sets of five breaths through the device (25 breaths/day), 5 days per week for 4 weeks. Exercise loads were set between 50% and 75% depending on the population, and treatment was typically supervised by a clinician weekly. The Penetration-Aspiration Scale was the most commonly reported videofluoroscopic outcome measure. Conclusions differed as to whether or not swallowing improved following a course of EMST. Differences in videofluoroscopy protocols, methods of summarizing participant performance, and statistical approaches across studies meant that meta-analysis of swallowing outcomes could not be completed. Conclusion This review failed to find clear evidence regarding the effects of EMST on videofluoroscopic measures of swallowing. Heterogeneity in the etiologies and baseline severity of dysphagia across studies and in the methods used to measure swallowing outcomes was a particular barrier to data synthesis.

Highlights

  • Expiratory muscle strength training (EMST) is increasingly utilized in dysphagia rehabilitation; little is known about the effects of this approach on swallowing function or physiology

  • The only studies using devices other than the EMST150 pressure threshold trainer were the two by Plowman et al (2019, 2016), in which a Phillips Threshold positive expiratory pressure trainer was used by patients with amyotrophic lateral sclerosis (ALS) who were unable to achieve the minimum expiratory pressures required to overcome the pressure threshold of the EMST150 valve at its lowest setting

  • We were unable to identify clear evidence regarding the effect of EMST on swallowing function, as measured by videofluoroscopy

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Summary

Introduction

Expiratory muscle strength training (EMST) is increasingly utilized in dysphagia rehabilitation; little is known about the effects of this approach on swallowing function or physiology. We conducted a systematic review to appraise and synthesize evidence regarding the effects of EMST on videofluoroscopic measures of swallowing in individuals with medical diagnoses, in which dysphagia is a concern. Of 292 nonduplicate articles, 11 were judged to be relevant for review These underwent detailed review for study quality, risk of bias evaluation, and synthesis of swallowing outcomes. Conclusion: This review failed to find clear evidence regarding the effects of EMST on videofluoroscopic measures of swallowing. Expiratory muscle strength training (EMST) is an intervention applied in patient populations with respiratory impairments with the goal of increasing the force generation capacity of the expiratory muscles and improving pulmonary function (Sapienza, 2008; Sapienza et al, 2011).

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