The effectiveness of tongue strengthening exercise in increasing tongue strength among older people with dysphagia: A systematic review

Abstract

• Regular training or retraining is recommended after the TSE intervention during the training period to increase or maintain the exercise effect in the long term. • Exercise must pay attention to the implementation frequency and duration and must be carried out continuously and a follow-up or supervision process. • Nurses can collaborate with other healthcare professionals to intervene but still pay attention to the clinical outcomes of the older people. This systematic review aimed to systematically identify the tongue strengthening exercise (TSE) effectiveness in increasing tongue strength in older people with dysphagia. This study was a systematic review following the PRISMA checklist guidelines and using inclusion and exclusion criteria. Article searching was conducted in Scopus, PubMed, ProQuest, EBSCO, Cochrane, Taylor and Francis, Clinical Key Nursing, and secondary searches. Article quality assessment was performed using the critical appraisal skills program (CASP) tool and the Joanna Briggs Institute (JBI) critical appraisal checklist for quasi-experimental studies. The risk of bias assessment was performed using the Cochrane risk of bias assessment tool. This systematic review protocol was registered from PROSPERO with registration number CRD42020219382. We found 151 patients in five studies that were included for analysis. The results showed that TSE increases tongue strength in older people with dysphagia. The intervention duration was 8 weeks, with a frequency of three times a week of exercise. The most widely used instrument for measuring tongue strength is the Iowa oral performance instrument (IOPI). This review showed that TSE is an intervention that can be given to older people that can be applied in nursing practice both in the community and clinical settings. The treatment is easy to perform, low-cost, and significantly effective in increasing tongue strength.