Effects of Chin Tuck Against Resistance Exercise on Post-Stroke Dysphagia Rehabilitation: A Systematic Review and Meta-Analysis

Frontiers in Neurology

Liu, J., Wang, Q., et al. (2022).

Frontiers in Neurology, 13, 1109140.

This systematic review and meta-analysis examines the effect of chin-tuck against resistance (CTAR) exercises compared to no exercises or Shaker exercise interventions on swallowing safety and oral intake ability in adults with post-stroke dysphagia.

National Social Science Fund of China

From database inception to February 2022

Randomized controlled trials (RCTs) and quasi-RCTs

9 studies included in the systematic review. 8 studies included in the meta-analysis.

Chin tuck against resistance (CTAR) exercise demonstrated statistically significant improvements in swallow safety compared to no exercises (MD=&minus;1.43; 95% CI=&minus;1.81 to &minus;1.06; <em>P</em>&lt;0.00001) and to the Shaker exercise (MD=&minus;0.49; 95% CI=&minus;0.83 to &minus;0.16; <em>P</em>=0.004) as measured by penetration-aspiration scale scores. Oral intake ability as measured by the Functional Oral Intake Scale (FOIS) or Fujishima Ichiro food intake level scale found a greater intervention-induced effect in the CTAR group compared with the no exercise group (SMD=&minus;1.82; 95% CI=&minus;3.28 to &minus;0.35;&nbsp;<em>P</em>=0.01); however, no significant difference in FOIS scores was found between CTAR and Shaker exercise groups. Compared to no exercise interventions, CTAR showed statistically significant improvement in psychological condition, significantly better oral cavity and laryngeal elevation/epiglottic closure, decreased residue in the valleculae and pyriform sinuses scores, and higher rates of nasogastric tube removal. Compared with the Shaker exercise group, one study found that the CTAR group reported significantly lower drop-out rates, more positive feedback regarding motivation, interest, and enjoyment, and lower physical fatigue. "The findings of this study suggest that CTAR exercise is an effective therapeutic method for post-stroke dysphagia rehabilitation and is superior to Shaker exercise in improving swallowing safety with positive effect to patients&rsquo; psychological condition" (p. 10).