Dosages of swallowing exercises in stroke rehabilitation: a systematic review

Abstract

Purpose To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review. Methods Five electronic databases were searched from inception until February 2022 with reference tracing of included studies. Studies were included, where adults with post-stroke dysphagia received rehabilitative, behavioural swallowing exercises, pre/post outcomes were reported, and intervention dosage was described in detail, including frequency, intensity, time, and type of exercise. Two reviewers independently screened studies and rated quality using ASHA Levels of Evidence tool. Data was tabulated and narratively described. Results 54 studies were included with a total 1501 participants. Studies included 28 randomised controlled trials, 8 non-randomised controlled trials, 12 pre/post studies, 3 retrospective case controls and 3 case studies. Results showed inconsistent reporting of intervention dosage, with intensity the least consistently reported dosage component. While swallowing intervention was most commonly provided five times per week for four weeks, there was a wide breadth of type, frequency, intensity and duration of swallowing exercises reported. Dosage under-reporting and variation was particularly observed in “standard care” co-interventions or control groups. Study strengths included following PRISMA guidelines, providing a comprehensive review of swallowing exercise methodology and dosages, and including non-English studies. The limitation was lack of meta-analysis due to the heterogeneity of included studies. Conclusions Dosages of swallowing exercises are inconsistently reported and vary significantly in post-stroke dysphagia studies. Results indicate the need for consistent and comprehensive dosage reporting in dysphagia studies, and for further research into evidence-based principles to optimise swallowing exercise dosages. Systematic review registration number 131294

Research hotspots and trends in post-stroke dysphagia: a bibliometric analysis

“…Rehabilitation exercise can promote long-term improvement of swallowing function through neuroplasticity. These exercises encompass various categories, including oral exercises, indirect swallowing exercises for reinforcing suprahyoid muscles (e.g., chin tuck against resistance and shaker exercise), as well as direct pharyngeal exercises like the effortful swallow and Mendelsohn maneuver ( Choy et al, 2023a , b ). Besides, neurostimulation techniques including PES, NMES, rTMS, and transcranial direct current stimulation (tDCS) are also exerting significant impacts on the rehabilitation of PSD.…”

Evidence and Recommendations for Acute Stroke Rehabilitation from the Japan Stroke Society: Abridged Secondary Publication of the Japanese-language Version

“…An abundance of multicenter studies and meta-analyses have investigated the usefulness of bedside screening for dysphagia. 62 , 65 , 66 , 70 , 71 , 72 , 74 , 75 , 86 , 88 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ) The results of other studies in Japan have also indicated the usefulness of bedside screening for dysphagia, although they were single-center studies. 63 , 69 , 78 , 79 , 80 , 101 , 102 , 103 ) Many studies have found that dysphagia screening after admission is useful for predicting the medium-term and long-term risks of pneumonia and death, and that it may reduce the risk for them.…”

“… 125 ) A recent systematic review of a broad range of studies covering the period from the acute phase to the chronic phase drew no conclusions, given that varied evaluation criteria were used. 95 )…”

“…125) A recent systematic review of a broad range of studies covering the period from the acute phase to the chronic phase drew no conclusions, given that varied evaluation criteria were used. 95) The results of a questionnaire survey of primary stroke centers in Japan showed that SLHTs were involved in swallowing training at 95% of the facilities and ward nurses at 35% of facilities. 44) Although the types of training were unclear, it is surmised that the swallowing training performed by ward nurses was mainly oral stimulation therapy and exercise therapy.…”

Enhancing Spiritual Well-Being, Physical Activity, and Happiness in Hospitalized Older Adult Patients with Swallowing Difficulties: A Comparative Study of Thickeners and Swallowing Exercises

“…Swallowing exercises play a crucial role in enhancing the safety and effectiveness of the swallowing process by facilitating the passage of food through the oral-pharyngeal region [ 5 ]. These exercises encompass various techniques, including chin tuck, oral and facial muscle exercises, effortful swallowing, tongue-holding maneuvers, and supine head-raising [ 6 , 7 , 8 ]. Extensive research suggests that implementing swallowing exercises in patients with dysphagia can lead to increased calorie intake, reduced weight loss, and improved survival rate [ 9 , 10 ].…”