A Systematic Review of Randomized Controlled Trials in the Field of Dysphagia Rehabilitation

Carnaby, Giselle; Madhavan, Aarthi

doi:10.1007/s40141-013-0030-1

Cited by 22 publications

(31 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is however acknowledged that for this type of intervention, it is usually impossible to blind the therapist and subject to the intervention. Attrition is a common feature for studies that involve a complex intervention within a multifaceted cancer care pathway, and randomised studies within this field are only beginning to emerge [16, 25]. Excluding studies that did not meet quality criteria may therefore have disadvantaged our ability to address our primary aims in this exercise.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

et al. 2017

View full text Add to dashboard Cite

BackgroundDysphagia is a significant side-effect following treatment for head and neck cancers, yet poor adherence to swallowing exercises is frequently reported in intervention studies. Behaviour change techniques (BCTs) can be used to improve adherence, but no review to date has described the techniques or indicated which may be more associated with improved swallowing outcomes.MethodsA systematic review was conducted to identify behavioural strategies in swallowing interventions, and to explore any relationships between these strategies and intervention effects. Randomised and quasi-randomised studies of head and neck cancer patients were included. Behavioural interventions to improve swallowing were eligible provided a valid measure of swallowing function was reported. A validated and comprehensive list of 93 discrete BCTs was used to code interventions. Analysis was conducted via a structured synthesis approach.ResultsFifteen studies (8 randomised) were included, and 20 different BCTs were each identified in at least one intervention. The BCTs identified in almost all interventions were: instruction on how to perform the behavior, setting behavioural goals and action planning. The BCTs that occurred more frequently in effective interventions, were: practical social support, behavioural practice, self-monitoring of behaviour and credible source for example a skilled clinician delivering the intervention. The presence of identical BCTs in comparator groups may diminish effects.ConclusionsSwallowing interventions feature multiple components that may potentially impact outcomes. This review maps the behavioural components of reported interventions and provides a method to consistently describe these components going forward. Future work may seek to test the most effective BCTs, to inform optimisation of swallowing interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2990-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

“…For consistency with other reviews, data was extracted on study quality using an 11-item checklist [24] used previously to assess the quality of dysphagia clinical trials [25]. Each of the 11 items (Table 2) is given a score of 1 if the criterion is met, yielding a summary score of 0 (lowest) to 11 (highest quality).…”

Section: Introductionmentioning

confidence: 99%

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Dysphagia following stroke is prevalent and associated with increased morbidities and poorer outcome . The effectiveness of common dysphagia treatments remains uncertain as treatment studies have often been plagued by variable methodology and results …”

Section: Introductionmentioning

confidence: 99%

“…4 The effectiveness of common dysphagia treatments remains uncertain as treatment studies have often been plagued by variable methodology and results. 5 Neuromuscular electrical stimulation (NMES) is a popular modality for dysphagia treatment, with many speech pathologists choosing this treatment type as the primary form of intervention. 6 NMES is a form of electrotherapy used to strengthen muscular contractions during swallowing.…”

Section: Introductionmentioning

confidence: 99%

Exercise‐based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post‐stroke: A double‐blind placebo‐controlled trial

Carnaby

Lagorio

Silliman

et al. 2020

J of Oral Rehabilitation

View full text Add to dashboard Cite

Background Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post‐stroke dysphagia; but application data remain conflicted. Objective This study investigated effectiveness and safety of an exercise‐based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke. Methods Stroke patients (n = 53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub‐acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia‐related complications. Results Post‐treatment dysphagia severity and treatment response were significantly different between groups (P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake (χ2 = 5, P ≤ .022) and improved functional outcome by 3 months post‐stroke (RR = 1.72, 1.04‐2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to “return to pre‐stroke diet” of 4.317 [95% CI: 1.08‐ 17.2, P< .03]. Conclusion Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre‐stroke diet) resulted from a programme of MDTP alone vs NMES or UC.

show abstract

“…Recent systematic reviews have been primarily concerned with identifying the type of intervention and its impact on swallowing outcomes [ 11 ], or establishing the methodological quality of previous trials [ 15 ]. A review by Cousins et al [ 11 ] found some evidence in support of interventions targeting swallowing and jaw mobility after head and neck cancer, but heterogeneity in outcomes and interventions meant that meta-analysis was not possible.…”

Section: Introductionmentioning

confidence: 99%

Identification of behaviour change components in swallowing interventions for head and neck cancer patients: protocol for a systematic review

et al. 2015

View full text Add to dashboard Cite

BackgroundDysphagia (difficulty in swallowing) is a predictable consequence of head and neck cancer and its treatment. Loss of the ability to eat and drink normally has a devastating impact on quality of life for survivors of this type of cancer. Most rehabilitation programmes involve behavioural interventions that include swallowing exercises to help improve swallowing function. Such interventions are complex; consisting of multiple components that may influence outcomes. These interventions usually require patient adherence to recommended behaviour change advice. To date, reviews of this literature have explored whether variation in effectiveness can be attributed to the type of swallowing exercise, the use of devices to facilitate use of swallowing muscles, and the timing (before, during or after cancer treatment). This systematic review will use a behavioural science lens to examine the content of previous interventions in this field. It aims to identify (a) which behaviour change components are present, and (b) the frequency with which they occur in interventions deemed to be effective and non-effective.Methods/designClinical trials of behavioural interventions to improve swallowing outcomes in patients with head and neck cancers will be identified via a systematic and comprehensive search of relevant electronic health databases, trial registers, systematic review databases and Web of Science. To ascertain behaviour change intervention components, we will code the content for its theory basis, intervention functions and specific behaviour change techniques, using validated tools: the Theory Coding Scheme, Behaviour Change Wheel and Behaviour Change Technique Taxonomy v1. Study quality will be assessed for descriptive purposes only. Given the specialisation and focus of this review, a small yield of studies with heterogeneous outcome measures is anticipated. Therefore, narrative synthesis is considered more appropriate than meta-analysis. We will also compare the frequency of behavioural components in effective versus non-effective interventions, where effectiveness is indicated by statistically significant changes in swallowing outcomes.DiscussionThis review will provide a synthesis of the behaviour change components in studies that currently represent best evidence for behavioural swallowing interventions for head and neck cancer patients. Results will provide some guidance on the choice of optimal behavioural strategies for the development of future interventions.Systematic review registrationPROSPERO CRD42015017048Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0077-4) contains supplementary material, which is available to authorized users.

show abstract

A Systematic Review of Randomized Controlled Trials in the Field of Dysphagia Rehabilitation

Cited by 22 publications

References 26 publications

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

Swallowing interventions for the treatment of dysphagia after head and neck cancer: a systematic review of behavioural strategies used to promote patient adherence to swallowing exercises

Exercise‐based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post‐stroke: A double‐blind placebo‐controlled trial

Identification of behaviour change components in swallowing interventions for head and neck cancer patients: protocol for a systematic review

Contact Info

Product

Resources

About