Abstract
Swallowing impairment (dysphagia) post-stroke results in poorer outcomes. Pharyngeal electrical stimulation (PES) is a potential treatment for post-stroke dysphagia. In a post hoc analysis, we investigated PES using videofluoroscopy swallow studies (VFSS) from the STEPS trial incorporating multiple measures of safety (penetration aspiration scale-PAS), speed and duration (timing), and efficiency (clearance), as opposed to the original trial which only measured PAS scores. 81 randomised participants (PES (N = 43) versus sham (N = 38)) were analysed at baseline and 2 weeks. Participants swallowed up to 6 × 5 ml and 1 × 50 ml of thin liquid barium at 40% w/v, images at ≥25 fps. Based on PAS, the 5 ml mode bolus (most frequently occurring PAS from 6 × 5 ml) and the worst 50 ml bolus were chosen for further analysis. Eight timing measures were performed, including stage transition duration (STD) and pharyngeal transit time (PTT). Clearance measures comprised oral and pharyngeal residue and swallows to clear. Comparisons of change of scoring outcomes between PES and sham were done at 2 weeks. Wilcoxon Signed Ranks Test was also used to evaluate longitudinal changes from both groups' combined results at two weeks. Between-group analysis showed no statistically significant differences. Issues with suboptimal image quality and frame rate acquisition affected final numbers. At two weeks, both groups demonstrated a significant improvement in most safety scores (PAS) and STD, possibly due to spontaneous recovery or a combination of spontaneous recovery and swallowing treatment and usual care. A nonsignificant trend for improvement was seen in other timing measures, including PTT. This study, which conducted additional measurements of kinematic and residue analysis on the STEPS data did not detect “missed” improvements in swallowing function that the PAS is not designed to measure. However, more studies with greater numbers are required.
Highlights
Dysphagia is associated with poorer outcomes [1, 2]
126 participants received Pharyngeal electrical stimulation (PES) or sham and had both a videofluoroscopy swallow studies (VFSS) completed at baseline and 2 weeks
Our findings with regards to PA scores agree with the overall conclusion from the original Swallowing Treatment using Electrical Pharyngeal Stimulation Trial (STEPS) study which did not show a significant change between groups for safety
Summary
Dysphagia is associated with poorer outcomes [1, 2]. Despite this, there are few proven treatments for post-stroke (PSD) dysphagia and a pressing need for more high-quality trials in order to assess which specific interventions are effective [3]. Pharyngeal electrical stimulation (PES) is a potential treatment for PSD and has been used in several published studies to date [7, 11,12,13]. The largest of these was the Swallowing Treatment using Electrical Pharyngeal Stimulation Trial (STEPS) [7]. We investigated the effect of PES on multiple measures of both speed and duration (timing) and efficiency (clearance) as well as safety (PAS) by conducting a retrospective analysis on the STEPS data
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