This meta-analysis aimed to assess the efficacy and safety of the combination of acupuncture with swallowing training for poststroke dysphagia.
Method:
Nine electronic databases (including PubMed and China National Knowledge Infrastructure) were searched from their inception through June 2016. Seventeen studies were included in this meta-analysis. Data on 1479 eligible patients were extracted, and the relative risk (RR) and standard mean difference (SMD) with 95% CI for the effective rate (ER), swallowing function assessment (SFA), individual activity (IA), eg., modified Barthel Index (MBI) and quality of life (QOL) were evaluated.
Results:
The pooled ER (RR 1.26, 95% CI 1.19 to 1.34, P<0.001, 14 studies) and SFA (SMD 1.06, 95% CI 0.79 to 1.32, P<0.001, five studies) suggested that combination therapy yielded a significantly higher ER and improved the SFA scores to a greater degree than swallowing training alone in patients with poststroke dysphagia. The pooled QOL score (SMD 1.06; 95% CI −0.04 to 2.17, P=0.06, two studies) did not differ between groups. The MBI data (SMD 1.47, 95% CI 1.07 to 1.87, P<0.001, one study) showed significant improvement in IA. Some evidence of publication bias was observed for the ER, although the trim-and-fill analysis and fail-safe number indicated no influence of publication bias on its pooled effect size. There was no evidence of publication bias of any other outcome measures.
Conclusion:
This study showed that acupuncture combined with swallowing training may improve the ER, swallowing function and activities of daily life of patients with poststroke dysphagia compared with conventional swallowing training alone.
CastellDODonnerMW. Evaluation of dysphagia: a careful history is crucial. Dysphagia1987; 2: 65–71.
3.
ArnoldMLiesirovaKBroeg-MorvayA, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One2016; 11: e0148424 e0148424.
4.
WiesekeABantzDSiktbergL, et al. Assessment and early diagnosis of dysphagia. Geriatr Nurs2008; 29: 376–383.
5.
ClavéPRofesLCarriónS, et al. Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people. Nestle Nutr Inst Workshop Ser2012; 72: 57–66.
6.
EkbergOHamdySWoisardV, et al. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia2002; 17: 139–146.
7.
EslickGDTalleyNJ. Dysphagia: epidemiology, risk factors and impact on quality of life—a population-based study. Aliment Pharmacol Ther2008; 27: 971–979.
8.
ParkJWKimYOhJC, et al. Effortful swallowing training combined with electrical stimulation in post-stroke dysphagia: a randomized controlled study. Dysphagia2012; 27: 521–527.
9.
HuangKLLiuTYHuangYC, et al. Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy. J Stroke Cerebrovasc Dis2014; 23: 2547–2553.
10.
CaiHMaBGaoX, et al. Tongue acupuncture in treatment of post-stroke dysphagia. Int J Clin Exp Med2015; 8: 14090–14094.
11.
GeeganageCBeavanJEllenderS, et al. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst Rev2012; 10: CD000323.
12.
LongYBWuXPXpW. A meta-analysis of the efficacy of acupuncture in treating dysphagia in patients with a stroke. Acupunct Med2012; 30: 291–297.
13.
WangYShenJWangXM, et al. Scalp acupuncture for acute ischemic stroke: a meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med2012; 2012: 1–9.
14.
WongISYNgKFTsangHWH. Acupuncture for dysphagia following stroke: A systematic review. Eur J Integr Med2012; 4: e141–e150.
15.
XieYWangLHeJ, et al. Acupuncture for dysphagia in acute stroke. Cochrane Database Syst Rev2008: CD006076CD006076.
16.
LiuCHHsiehYTTsengHP, et al. Acupuncture for a first episode of acute ischaemic stroke: an observer-blinded randomised controlled pilot study. Acupunct Med2016; 34: 349–355.
17.
BakhtiyariJSarrafPNakhostin-AnsariN, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iran J Neurol2015; 14: 119–124.
18.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg2010; 8: 336–341.
19.
JulianPHDouglasGAJonathanAS. Assessing risk of bias in included studies. In: JulianPHSallyG, eds. Cochrane Handbook of Systematic Reviews of Interventions Version 5.1.0: The Cochrane Collaboration, 2011.
20.
JonathanJDJulianPHDouglasGA. Analysing data and undertaking meta-analyses. In: JulianPHSallyG, eds. Cochrane Handbook of Systematic Reviews of Interventions Version 5.1.0: The Cochrane Collaboration, 2011.
21.
DerSimonianRLairdN. Meta-analysis in clinical trials. Control Clin Trials1986; 7: 177–188.
22.
EggerMDavey SmithGSchneiderM, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ1997; 315: 629–634.
23.
MaiJLiHFangJ, et al. Estimation of fail-safe number in meta-analysis. J Evi Based Med2006; 6: 297–303.
24.
LuoW-PHuangH-YTanJ-L. Therapeutic effect of acupuncture combined with deglutition training on deglutition disorders complicated by apoplexy. Chin Acupunct Moxibust2004; 24: 528–530.
25.
ZhangW-MZhengPZhangW-Q, et al. Research on standardized treatment of acupuncture associated with rehabilitation training for swallow disturbance after wind-stroke. World J Integrat Trad West Med2007; 2: 659–661.
26.
ZhangJ-HJ-YLZhaoY, et al. Clinical observation of treatment to dysphgia after stroke by tong nao huo luo acupuncture therapy with swallowing training. Liaoning Univ of Trad Chin Med2011; 13: 188–189.
27.
Z-hYJ-fH. Observations on the efficacy of acupuncture plus rehabilitation training in treating post-stroke dysphagia. Shanghai J Acup Moxibu2012; 31: 642–644.
28.
J-bY. Clinical research on dysphagia post-stroke treated with combination of acupuncture and rehabilitation training. J Hebei med Univ2013; 34: 562–564.
29.
YinL-L. Clinical study on acupuncture combined with rehabilitation therapy for 57 cases of swallowing disorders after stroke. J Tradit Chin Med2013; 54: 766–768.
30.
B-DLBaiJGaoW-B, et al. Influence of neck acupuncture combined swallowing training on the pharyngeal phase swallowing disorder after stroke. Chin J Phys Med and Reh2013; 35: 31–32.
31.
ZhangJ-J. Electrical acupuncture combined with swallowing training treatment to 60 cases patients of dysphagia after stroke. Yunnan J Trad Chin Med Mater Med2014; 35: 57–59.
32.
TangJ-QHanT. Curative effect of using acupuncture and rehabilitation training to treat swallowing disorder after cerebral infarction (DFS). J Sichuan Trad Chin Med2014; 32: 146–148.
33.
JiaLLiuDBaiJ, et al. The clinical effect analysis of four-point acupuncture combined rehabilitation training in the treatment of swallowing disorder after stroke. Contemp Med2014; 20: 1–2.
34.
LiuC. Curative effect observation of acupuncture combined with swallowing training in treatment of swallowing disorder after stroke. Med Recapit2014; 20: 2095–2096.
35.
TongSH-bLLiuJ-Q. Clinical observation of acupuncture therapy and swallowing functional rehabilitation for dysphagia after stroke. Acta Chin Med Pharmacol2014; 42: 129–131.
36.
ZhuF-HZ-yWZhengJ-F, et al. Clinical observation of hypoglossal three-point acupuncture combined with swallowing training for wallowing disorders after stroke. Chin J Phys2015; 17: 586–587.
37.
ZhuB-BZhaoC-Y. After swallowing training combined with acupuncture to treat stroke dysphagia randomized controlled study. J Prac Trad Chin Int Med2015; 29: 152–153.
38.
R-tF. Acupuncture combined routine treatment of cerebro-vascular disease and rehabilitation training treatment to 53 cases patients with swallowing disorders after stroke. Trad Chin Med Rea2016; 29: 56–58.
39.
FengSCaoSDuS, et al. [Acuuncture combined with swallowing training for post-stroke dysphagia: a randomized controlled trial]. Zhongguo Zhen Jiu2016; 36: 347–350.
40.
XiaWZhengCZhuS, et al. Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? a randomized controlled trial. Clin Rehabil2016; 30: 237–246.
41.
KubotaTMishimaHHanadaM, et al. Paralytic dysphagia in cerebrovascular disorder: screening tests and their clinical application. Sogo Rehabilitation1982; 10: 271–276.
42.
SachikoOSunQ-L. The assessment and training to feeding and swallowing disorder in patients with stroke. Chin J Rehabil Med1997; 12: 141–142.
43.
ZhuY-L. Neurological Rehabilitation Medicine. 1st ed. Beijing: Military Medical Press, 2001.
44.
EllulJBarerD. On behalf ESDB/COSTAR collaborative dysphagia study inter-observer reliability of a standardized swallowing assessment (SSA). Cerebrovasc Dis1996; 6: 152–158.
45.
O’NeilKHPurdyMFalkJ, et al. The dysphagia outcome and severity scale. Dysphagia1999; 14: 139–145.
46.
FujishimaI. Feeding and swallowing disorder in patients after stroke. 1st ed. Tokyo: Tooth Medical Press, 1999.
47.
McHorneyCABrickerDEKramerAE, et al. The SWAL-QOL outcomes tool for oropharyngeal dysphagia in adults: I. Conceptual foundation and item development. Dysphagia2000; 15: 115–121.
48.
ChenS-LG-xN. Literature research on acu-points selection for acupuncture treatment to neurogenic dysphagia. J Tradit Chin Med2015; 56: 1335–1338.
49.
ShiyangW-LYangX-FCuiJ, et al. Retrospective analysis acu-points selection for acupuncture treatment to dysphagia followed pseudo-bulbar palsy. J Guiyang Coll Trad Chin Med2011; 33: 15–18.
50.
FukudaSKuriyamaNTsuruH, et al. Immediate effects of acupuncture on tongue pressure including swallowing reflex latency in Parkinson’s disease. Acupunct Med2016; 34: 59–61.
