Introduction

Swallowing difficulties (oropharyngeal dysphagia (OD)) are common post-stroke but there is no specific guidance on treatment. We have updated the 2018 Cochrane review of dysphagia interventions to explore whether there is evidence of a significant benefit from OD interventions on swallowing impairment.

Methods

RCT’s of patients with a new onset of OD after stroke published before January 2021 were included. Results were screened and analysed by two independent researchers. Trials were divided to specific intervention types and data was analysed against 8 outcomes, the primary outcome being swallowing impairment (SI).

Results

83 additional trials were analysed producing a review to a total of 129 trials. Three interventions were associated with reductions in outcomes: Acupuncture: SI (SMD −0.94 [95% CI−1.25,−0.63], p < 0.0001); dysphagia (OR 0.41 [95% CI 0.33, 0.49], p < 0.0001); and penetration aspiration scale score (PAS) (MD −0.68 [95% CI −1.17, −0.19], p = 0.006). Behavioural therapy: SI (SMD −0.88 95% CI −1.28, −0.48], p < 0.0001); dysphagia (OR 0.41 [95% CI 0.29, 0.59], p < 0.0001); PAS (MD −0.77 [95% CI −1.11, −0.42], p < 0.0001); and chest infection/pneumonia (OR 0.43 [0.25, 0.74], p = 0.002). Neuromuscular electrical stimulation (NMES): SI (SMD −0.96 95% CI −1.38, −0.54], p < 0.0001) and dysphagia (OR 0.39 [95% CI 0.27, 0.56], p < 0.0001). The limited number of trials precluded comment on other interventions included within the review. Heterogeneity of trials ranged from mild-significant.

Conclusions

Low-to-moderate quality evidence from small-moderate sized trials suggest that Acupuncture, Behavioural and NMES interventions reduce swallowing impairment after stroke. Large, high-quality trials are needed to test whether specific interventions are effective.