Therapeutic Effect and Optimal Electrode Placement of Transcutaneous Neuromuscular Electrical Stimulation in Patients With Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Life

Doan, T. N., Ho, W. C., et al. (2022).

Life, 12(6), 875.

This systematic review and meta-analysis evaluate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on swallow function in patients with post-stroke dysphagia, including investigating the optimal electrode placement.

China Medical University Hospital (Taiwan); Asia University Hospital (Taiwan)

From database inception to January 2022

Randomized controlled trials

24, with 20 included in meta-analysis

Results demonstrated a large, positive effect for NMES in combination with conventional swallowing therapies (CSTs) compared to CSTs alone for individuals with post-stroke dysphagia (SMD = 0.91, 95% CI: 0.68 to 1.14). Large and medium significant effects were also noted in favor of NMES plus CST compared to CST alone when electrode placement was individualized based on dysphagia evaluation results (SMD = 1.65, 95% CI: 0.38 to 2.91), when electrodes were horizontally placed above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16), when electrodes were horizontally placed above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14) and improved self-reported quality of life (SMD = 0.6, 95% CI: 0.26 to 0.94). For the purpose of this review, CSTs were broadly defined as swallowing treatments using compensatory strategies, texture-modified diet, postural adjustment, or swallow maneuvers. Administration of NMES alone in comparison to CSTs alone resulted in nonsignificant improvement in swallow function in 2 of 3 reported studies. <br /><br />Moderate heterogeneity between studies, small sample sizes, lack of differentiation in CSTs provided, and small number of studies included in subgroup analyses were notable limitations to this study. Further research is indicated to determine the true efficacy of NMES in isolation or in combination with CSTs for individuals with stroke-induced dysphagia.