Exercise-based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post-stroke: A double-blind placebo-controlled trial.

Abstract

Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post-stroke dysphagia; but application data remain conflicted. This study investigated effectiveness and safety of an exercise-based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke. Stroke patients (n=53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub-acute rehabilitation hospital were randomised to MDTP+NMES [NMES], MDTP+sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1hour per day for 3weeks and monitored to 3months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia-related complications. Post-treatment dysphagia severity and treatment response were significantly different between groups (P≤.0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ2 =5, P≤.022) and improved functional outcome by 3months post-stroke (RR=1.72, 1.04-2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to "return to pre-stroke diet" of 4.317 [95% CI: 1.08- 17.2, P< .03]. Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre-stroke diet) resulted from a programme of MDTP alone vs NMES or UC.