Do stroke clinical practice guideline recommendations for the intervention of thickened liquids for aspiration support evidence based decision making? A systematic review and narrative synthesis

McCurtin, Arlene; Boland, Pauline; Kavanagh, Maeve; Lisiecka, Dominika; Roche, Caoimhe; Galvin, Rose

doi:10.1111/jep.13372

Cited by 17 publications

(20 citation statements)

References 63 publications

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“…Evidence shows that specific instrumental assessments, such as FEES performed at the bedside 322 can reduce pneumonia rates and increase functional outcomes. 109,131,135,323…”

Section: Discussionmentioning

confidence: 99%

European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

Dziewas

Michou

Trapl-Grundschober

et al. 2021

European Stroke Journal

132

119

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Post-stroke dysphagia (PSD) is present in more than 50 % of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and decrease risk of early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioral swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomised trials are needed to improve the quality of evidence for the treatment of PSD.

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“…Evidence shows that specific instrumental assessments, such as FEES performed at the bedside 322 can reduce pneumonia rates and increase functional outcomes. 109,131,135,323…”

Section: Discussionmentioning

confidence: 99%

European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

Dziewas

Michou

Trapl-Grundschober

et al. 2021

European Stroke Journal

132

119

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“…The modification of food consistencies and thickening of liquids is probably the compensatory strategy mostly used in patients with dysphagia; however, the recommendation for its use is much more based on a consensus of good practice than on evidence from research [91][92][93][94]. Evidence on the safety and effectiveness of using strategies to increase the viscosity of liquids is scarce and, in the case of changes in food consistencies and use of mixed consistencies, it is residual [93].…”

Section: Summary Of Evidencementioning

confidence: 99%

Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel

Oliveira

Couto

Santos

et al. 2021

Port J Public Health

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Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.

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“…Clinical practice guidelines ideally are systematically developed statements that assist clinicians to provide appropriate evidence-based care. A systematic review, published in 2020, evaluated the evidence base of recommendations for the intervention of thickened fluids for patients with dysphagia after a stroke [ 31 ]. The included clinical practice guidelines were published between 2010 and 2018, and included guidelines from European, Australasian, African and North American countries.…”

Section: Guidelinesmentioning

confidence: 99%

Treatment burden associated with the intake of thickened fluids

Steele

Ennis

Dobler

2021

Breathe

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The implementation of thickened fluids in patients with dysphagia is widely considered an effective strategy for safe and physiologically improved swallow. However, there is limited evidence to suggest that this intervention reduces the risk of dysphagia-related complications including aspiration pneumonia. In addition, there is growing evidence that this approach is associated with adverse clinical effects including dehydration, malnutrition and reduced health-related quality of life. This review summarises the rationale for thickened fluids, the evidence base (or lack thereof) underpinning their use, and current guideline recommendations.Educational aimsTo review the evidence base for thickened fluids in the management of dysphagia.To examine the evidence that thickened fluids reduce aspiration pneumonia.To provide an overview of the advantages and disadvantages of thickened fluids in the management of dysphagia.

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Do stroke clinical practice guideline recommendations for the intervention of thickened liquids for aspiration support evidence based decision making? A systematic review and narrative synthesis

Cited by 17 publications

References 63 publications

European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel

Treatment burden associated with the intake of thickened fluids

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