Efficacy of Swallowing Rehabilitative Therapies for Adults With Dysphagia: A Network Meta-Analysis of Randomized Controlled Trials
GeroScience
Lee, C. L., Banda, K. J., et al. (2024).
GeroScience, 47, 2047-2065.
<div>This systematic review and network meta-analysis explores the relative effectiveness of swallowing interventions in adults with dysphagia.</div>
None declared
From database inception to September 2024
<div>Randomized controlled trials</div>
25
<div>Traditional dysphagia treatment (TDT) had a very large, positive effect on swallow function in adults with dysphagia (standard mean difference [SMD] = 1.92). The following dysphagia treatments, when combined with TDT, had huge (SMD > 2.0), positive effects on swallow function:</div>
<div>
<ul>
<li><strong>chin tuck against resistance (CTAR): </strong>SMD = 3.44;</li>
<li><strong>expiratory muscle strength training (EMST): </strong>SMD = 2.92;</li>
<li><strong>the Shaker exercise: </strong>SMD = 2.83;</li>
<li><strong>jaw exercises: </strong>SMD = 2.52;</li>
<li><strong>tongue exercises: </strong>SMD = 2.19; and</li>
<li><strong>respiratory muscle training (RMT):</strong> SMD = 2.14.</li>
</ul>
<div>Overall, CTAR combined with TDT demonstrated superior improvements for better swallowing function (netrank = 0.93). Increased frequency and number of treatment sessions was associated with improved swallow function. Session duration had no impact on treatment effectiveness.</div>
<div> </div>
<div>The authors note that a limited maintenance data and a "limited number of studies in the adults with post-extubation dysphagia, oral frailty, and multiple sclerosis could limit the generalizability of the study findings" (p. 2063).</div>
</div>
<p class="MsoNormal">The following dysphagia treatments had large to very large treatment effects regarding the prevention of aspiration:</p>
<ul>
<li class="MsoNormal"><strong>CTAR combined with TDT: </strong>SMD = −1.82;</li>
<li class="MsoNormal"><strong>the Shaker exercise combined with TDT: </strong>SMD = −1.32</li>
<li class="MsoNormal"><strong>EMST alone: </strong>SMD = −1.23; and</li>
<li class="MsoNormal"><strong>EMST combined with TDT: </strong>SMD = −1.10.</li>
</ul>
<p class="MsoNormal">TDT alone and TDT combined with effortful swallowing training, JE, RMT, or TE had no significant effect on aspiration. Overall, combined treatments of TDT and CTAR (net rank = 0.96) and combined treatments of TDT and the Shaker exercise (netrank = 0.76) demonstrated superior improvements for reduced aspiration. Increased frequency was associated with reduced incidence of aspiration for TDT combined with CTAR and EMST alone. Increased number of sessions was associated with reduced incidence of aspiration for TDT combined with CTAR or the Shaker exercise. Session duration had no impact on treatment effectiveness.<br><br>The authors note that a limited maintenance data and a "limited number of studies in the adults with post-extubation dysphagia, oral frailty, and multiple sclerosis could limit the generalizability of the study findings" (p. 2063).</p>
