Gaps in Guidelines on Long-Term Management Strategies for Post-Stroke Dysphagia
European Journal of Neurology
Karisik, A., Labeit, B., et al. (2025).
European Journal of Neurology, 32(8), e70307.
<div>This systematic review of guidelines provides recommendations for the management of post-stroke dysphagia.</div>
No funding received
From January 2014 to January 2025
<div>Guidelines</div>
10
<div>Recommendations regarding screening for post-stroke dysphagia were as follows:</div>
<div>
<ul>
<li>A standardized screening should be conducted within 24 hours or as soon as possible (10/10 guidelines).</li>
<li>Patients should be screened before oral intake (9/10 guidelines).</li>
<li>Water-swallow tests or mixed-consistency tests should be used for initial screening (4/10 guidelines).</li>
<li>Screening should be administered by trained nurses, SLPs, or physicians (9/10 guidelines).</li>
</ul>
</div>
<div>Recommendations for assessment of post-stroke dysphagia included:</div>
<div>
<ul>
<li>For patients with failed initial screening or risk factors (i.e., severe facial palsy, aphasia, or dysarthria; moderate to severe stroke; coughing, choking, wet voice, or food-residuals in the mouth; cognitive impairment; pneumonia; or suspected aspiration), diagnostic assessment should be conducted as early as possible (8/10 guidelines).</li>
<li>Further assessment should include clinical and/or instrumental swallowing examination (8/10 guidelines).</li>
<li>Instrumental examination should include FEES or VFSS (5/10 guidelines).</li>
</ul>
</div>
<div>Recommendations regarding treatment of post-stroke dysphagia were as follows:</div>
<div>
<ul>
<li>Compensatory behavioral maneuvers and therapeutic swallowing exercises should be applied (8/10 guidelines).</li>
<li>Diet modifications are advised based on assessments (5/10 guidelines).</li>
<li>Oral health care interventions are advised (5/10 guidelines).</li>
<li>Patients and care partners should be instructed regarding dysphagia management strategies (2/10 guidelines).</li>
</ul>
</div>
<div>The following were recommendations regarding follow-up for post-stroke dysphagia:</div>
<div>
<ul>
<li>Diet modifications and swallowing function should be evaluated regularly (3/10 guidelines).</li>
<li>Dysphagia should be reassessed prior to discharge or transfer to rehabilitation (1/10 guidelines).</li>
<li>Swallowing function should be reassessed daily in the acute setting, weekly until stable, monthly between 3-6 months post-discharge, and every 2 months during the chronic stage from 6-12 months post-discharge (1/10 guidelines).</li>
</ul>
</div>
