The Effectiveness of Chin-Down Manoeuvre in Patients With Dysphagia: A Systematic Review and Meta-Analysis

Journal of Oral Rehabilitation

Li, M., Huang, S., et al. (2024).

Journal of Oral Rehabilitation, 51(4), 762-774.

This systematic review and meta-analysis investigates the impact of the compensatory chin-tuck maneuver on various swallowing-related outcomes (e.g., aspiration, upper esophageal sphincter opening, pharyngeal residue) in adults with dysphagia.

National Natural Science Foundation of China; Technology Development Fund of Nanjing Medical University (China); Connotation Construction Project of Nanjing Medical University for Priority Academic of Nursing Science (China)

From database inception to December 30, 2022

Randomized controlled trials and quasi-experimental studies

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The following findings were reported regarding the use chin-tuck in adult patients with dysphagia:<br /> <ul> <li>Across five studies, the use of a chin-tuck posture was associated with reduced risk of aspirating thin and/or thickened liquids (MD=-1.35, 95% CI=-2.25 to -0.44), Z=2.92, p&lt; 0.01).</li> <li>Across two studies, the chin-tuck maneuver was associated with reduced oral transit time (MD=-0.81, 95% CI= -1.20 to -0.43, Z=4.17, p&lt;0.001).</li> <li>Across three studies, a significant increase in maximum swallowing pressure at the level of the upper esophageal sphincter was reported (MD=-82.07, 95% CI= -112.77 to -51.37, Z=5.24, p&lt; 0.001).</li> <li>At least one measure of pharyngeal residue was significantly improved in five of five studies. However, due to insufficient data and heterogeneity regarding outcome measures, no meta-analysis could be performed.&nbsp;</li> <li>Across two studies, a significant reduction in maximum swallowing pressure at the velopharynx was reported.</li> <li>Due to mixed findings across a limited number of studies, no overarching statement could be made about the impact of the chin-tuck maneuver on duration of laryngeal closure, duration of upper esophageal sphincter relaxation and opening, timing of swallow trigger, and maximum swallowing pressure at the meso-hypopharynx.</li> </ul> These findings should be interpreted with caution due to the reduced methodological rigor of included studies, small sample sizes and overall paucity of evidence across comparisons, lack of long-term follow-up, heterogeneity between studies, and an overall lack of investigation of the impact of specific diagnoses or swallowing impairments on outcomes. Additional high quality research is indicated.