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BMJ Open Dec 2021Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly... (Review)
Review
INTRODUCTION
Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI.
OBJECTIVE
To systematically map the accessible research literature to answer the research question: DESIGN: Scoping review based on the methodology of Arksey and O'Malley and methodological advancement by Levac DATA SOURCES: MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021.
ELIGIBILITY CRITERIA
All studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included.
DATA EXTRACTION AND SYNTHESIS
Data was extracted by two independent reviewers and studies were categorised based on treatment modality.
RESULTS
A total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into or stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training.
CONCLUSION
This scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.
Topics: Brain Injuries; Deglutition; Deglutition Disorders; Humans; Stroke; Stroke Rehabilitation; Transcranial Direct Current Stimulation
PubMed: 34857571
DOI: 10.1136/bmjopen-2021-053244 -
A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification.The Tohoku Journal of Experimental... Jan 2022Recent advances in dysphagia treatment have given us many methods of stimulating swallowing function, but no attempt has been made to systematically classify them all....
Recent advances in dysphagia treatment have given us many methods of stimulating swallowing function, but no attempt has been made to systematically classify them all. In this review, we provide an exhaustive description of all the techniques and stimulatory substances that stimulate swallowing that have so far been reported in the scientific literature, irrespective of their level of evidence, and we have tried to classify them with the objective of encouraging the future development of research in this direction. The Preferred Reporting Items for Systematic Reviews and Meta-analysis were followed for retrieval of relevant research. A total of 237 records were screened for this literature review. One record was excluded for being published in a language other than English, and 59 articles were excluded for having no original data. Of the 177 records that were assessed for eligibility in this review, 31 were excluded for reasons related to other inclusion and exclusion criteria. Finally, 146 records were classified. We found stimuli related to swallowing published in the literature could be divided into physical and chemical stimuli. Each stimulus had both peripheral and central stimuli when we assessed the main site of action. Physical stimuli included electric, magnetic and thermal stimulations and acupuncture. Chemical stimuli included spices activating transient receptor potential channels, several categories of medications, taste and flavor, and olfactory stimulants. Medications modifying substance P and the dopaminergic system are thought to be peripheral and central stimuli, respectively. This classification may pave the way to discover means to improve swallowing.
Topics: Deglutition; Deglutition Disorders; Humans; Taste
PubMed: 35095028
DOI: 10.1620/tjem.256.1 -
Journal of Clinical and Experimental... 2022Gastrointestinal candidiasis is often neglected and potentially serious infection in cirrhosis patients. Therefore, we evaluated the prevalence, risk factors, and...
BACKGROUND
Gastrointestinal candidiasis is often neglected and potentially serious infection in cirrhosis patients. Therefore, we evaluated the prevalence, risk factors, and outcomes of esophageal candidiasis (EC) in cirrhotics and did a systematic review to summarize EC's available evidence in cirrhosis.
METHODS
Consecutive patients with cirrhosis posted for esophagogastroduodenoscopy (EGD) at a tertiary care institute were screened for EC (cases) between January 2019 and March 2020. EC was diagnosed on EGD findings andor brush cytology. Controls (without EC) were recruited randomly, and EC's risk factors and outcomes were compared between cases and controls.Four electronic databases were searched for studies describing EC in cirrhosis. Prevalence estimates of EC were pooled on random-effects meta-analysis, and heterogeneity was assessed by I. A checklist for prevalence studies was used to evaluate the risk of bias in studies.
RESULTS
EC was diagnosed in 100 of 2762 patients with cirrhosis (3.6%). Patients with EC had a higher model for end-stage liver disease (MELD) (12.4 vs. 11.2; = 0.007), acute-on-chronic liver failure (ACLF) (26% vs. 10%; = 0.003) and concomitant bacterial infections (24% vs. 7%; = 0.001), as compared with controls. A multivariable model, including recent alcohol binge, hepatocellular carcinoma (HCC), upper gastrointestinal (UGI) bleed, ACLF, diabetes, and MELD, predicted EC's development in cirrhosis with excellent discrimination (C-index: 0.918). Six percent of cases developed the invasive disease and worsened with multiorgan failures, and four patients with EC died on follow-up.Of 236 articles identified, EC's pooled prevalence from 8 studies (all with low-risk of bias) was 2.1% (95% CI: 0.8-5.8). Risk factors and outcomes of EC in cirrhosis were not reported in the literature.
CONCLUSIONS
EC is not a rare infection in cirrhosis patients, and it may predispose to invasive candidiasis and untimely deaths. Alcohol binge, HCC, UGI bleed, ACLF, diabetes, and higher MELD are the independent predictors of EC in cirrhosis. At-risk patients with cirrhosis or those with deglutition symptoms should be rapidly screened and treated for EC.
PubMed: 35068792
DOI: 10.1016/j.jceh.2021.03.005 -
Journal of Otolaryngology - Head & Neck... Dec 2021There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and... (Review)
Review
OBJECTIVES
There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and toddlers (OHITs), is underappreciated. As the standard diagnostic tests are either invasive or scarce, valid parent-reported outcome (PRO) questionnaires could play a pivotal role in the understanding and managing SwD in this group. This article reviewed the literature on PRO questionnaires pertaining to SwD in OHITs.
DATA SOURCE
A librarian searched Prospero, Cochrane Library, Embase, Medline, PsycINFO, HaPI, CINAHL, and SCOPUS until February 2021 using the MeSH terms for deglutition and screening methods.
REVIEW METHOD
Questionnaires that examined disease-specific or eating and feeding concerns or difficulties were excluded. Two reviewers independently identified PRO questionnaires for SwD that were used in OHITs and extracted the author names, publication year, questionnaire name, the studied population, and the reported psychometric assessments. A quality assessment was performed based on consensus-based standards for the selection of health measurement instruments (COSMIN) and updated criteria for good measurement properties.
RESULTS
Of the 3488 screened articles, we identified only two questionnaires, the pediatric version of the Eating Assessment Tool (PEDI-EAT-10) and the PRO questionnaire for Swallowing Dysfunction in OHITs. The PEDI-EAT-10 authors assessed the validity and reliability on children with cerebral palsy. However, concerns were identified regarding the developmental process and the internal structure validity. The PRO questionnaire for SwD in OHITs meets criteria but has not yet been validated in the population of interest nor its psychometric properties assessed.
CONCLUSION
Two instruments were identified. The PED-EAT-10 exhibits methodological flaws, while Edmonton PRO questionnaire for SwD in OHITs awaits construct validation and could fill the current knowledge gap.
Topics: Child; Child, Preschool; Deglutition; Humans; Infant; Parents; Psychometrics; Reproducibility of Results; Surveys and Questionnaires
PubMed: 34863293
DOI: 10.1186/s40463-021-00549-3 -
Dysphagia Feb 2023The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value... (Meta-Analysis)
Meta-Analysis Review
The Eating Assessment Tool-10 (EAT-10) is used worldwide to screen people quickly and easily at high risk for swallowing disorders. However, the best EAT-10 cutoff value is still controversial. In this systematic review and meta-analysis, we estimated and compared the diagnostic accuracy of EAT-10 cutoff values of 2 and 3 for screening dysphagia. We searched the PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, WANFANG, and VIP databases from May 2008 to March 2022. The meta-analysis included 7 studies involving 1064 subjects from 7 different countries. Two studies were classified as high quality and five studies as medium quality. With an EAT-10 cutoff value of 2, using flexible endoscopic evaluation of swallowing or video fluoroscopic swallowing study as the gold standard, the pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.89 (95% confidence interval [CI] 0.82-0.93), 0.59 (95% CI 0.39-0.77), 2.17 (95% CI 1.38-3.42), 0.19 (95% CI 0.13-0.29), and 11.49 (95% CI 5.86-22.53), respectively. When a cutoff of 3 was used, these values were 0.85 (95% CI 0.68-0.94), 0.82 (95% CI 0.65-0.92), 4.84 (95% CI 1.72-13.50), 0.18 (95% CI 0.07-0.46), and 26.24 (95% CI 5.06-135.95), respectively. Using EAT-10 cutoff values of 2 and 3, the areas under the curve were 0.873 (95% CI 0.82-0.93) and 0.903 (95% CI 0.88-0.93), respectively, showing good diagnostic performance. EAT-10 can be used as a preliminary screening tool for dysphagia. However, a cutoff of 3 is recommended for EAT-10 due to better diagnostic accuracy.
Topics: Humans; Deglutition Disorders; Deglutition; Fluoroscopy; Odds Ratio; Sensitivity and Specificity
PubMed: 35849209
DOI: 10.1007/s00455-022-10486-6 -
Healthcare (Basel, Switzerland) Dec 2020Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs... (Review)
Review
Texture-modified diets (TMDs) play an important role in ensuring safety for those with dysphagia but come with risks to nutrition and quality of life. The use of TMDs has been addressed with the increasing prevalence of dysphagia in previous decades. However, there is limited literature that investigates the nutrition perspectives of TMD consumers. This review summarises the nutrition outcomes of adults consuming TMDs and thickened fluids (TFs) and identifies the limitations of TMD and TF productions. A systematic database search following PICO criteria was conducted using Cochrane Central (via Ovid), MEDLINE, CINAHL, EMBASE, and Scopus databases. Nutrition intake, meal consumption, adequacy, and meal composition were identified as relevant outcomes. 35 studies were included for analysis. Consumption of TMDs demonstrated a poorer intake compared to regular diets, in particular significant in energy and calcium. Meta-analysis of mean differences showed favourable effects of shaped TMDs on both energy (-273.8 kJ/d; 95%CI: -419.1 to -128.6, = 0.0002) and protein (-12.4 g/d; 95%CI: -17.9 to -6.8, < 0.0001) intake compared to traditional cook-fresh TMDs. Nutrition intake was compromised in TMD consumers. Optimisation of nutrition intake was achievable through enrichment and adjusting meal texture and consistency. However, the heterogeneity of studies and the missing verification of the consistencies lead to difficulty in drawing conclusions regarding particular texture or intervention.
PubMed: 33371326
DOI: 10.3390/healthcare8040579 -
Nutrients Jun 2022The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the... (Review)
Review
The Hydration Status of Adult Patients with Oropharyngeal Dysphagia and the Effect of Thickened Fluid Therapy on Fluid Intake and Hydration: Results of Two Parallel Systematic and Scoping Reviews.
BACKGROUND
The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the hydration status in patients with OD and the effect TF therapy has on it.
METHODS
Two literature reviews following PRISMA methodology (each one including a systematic and a scoping review) were performed: (R1) hydration status in adult patients with OD; (R2) effect of TF therapy on fluid intake and dehydration. Narrative and descriptive methods summarized both reviews. Quality assessment was assessed by Joanna Briggs Institute tools and GRADE.
RESULTS
(R1) Five out of twenty-two studies using analytical parameters or bioimpedance showed poorer hydration status among OD and 19-100% prevalence of dehydration; (R2) two high quality studies (total of 724 participants) showed positive effects of TF on hydration status. Among the articles included, nine out of ten studies that evaluated fluid intake reported a reduced TF intake below basal water requirements.
CONCLUSIONS
Dehydration is a highly prevalent complication in OD. There is scientific evidence on the positive effect of TF therapy on the hydration status of patients with OD. However, strict monitoring of fluid volume intake is essential due to the low consumption of TF in these patients.
Topics: Adult; Deglutition Disorders; Dehydration; Drinking; Fluid Therapy; Humans; Prevalence
PubMed: 35745228
DOI: 10.3390/nu14122497 -
European Archives of... Mar 2023To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review. (Review)
Review
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.
Topics: Adult; Humans; Deglutition Disorders; Deglutition; Stroke Rehabilitation; Retrospective Studies; Stroke
PubMed: 36471047
DOI: 10.1007/s00405-022-07735-7 -
BMJ Open Aug 2020To assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death).
OBJECTIVES
To assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death).
DESIGN
Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.
DATA SOURCES
MEDLINE, Embase and the National Health Service Economic Evaluation Database were searched up to 31 December 2019.
PARTICIPANTS
Patients with poststroke.
PRIMARY OUTCOME MEASURES
The costs associated to poststroke OD and its complications.
DATA ANALYSIS
Data were synthetised narratively, quality evaluation was done using an adaptation of Drummond's checklist and Grading of Recommendations Assessment, Development and Evaluation recommendations were used to assess strength of evidence.
RESULTS
A total of 166 articles were identified, of which 10 studies were included. The cost of OD during the hospitalisation was assessed in four studies. One prospective study showed an increase of US$6589 for patients requiring tube feeding. Two retrospective studies found higher costs for those patients who developed OD, (US$7329 vs US$5939) among patients with haemorrhagic stroke transferred to inpatient rehabilitation and an increase of €3000 (US$3950) and SFr14 000 (US$15 300) in hospitalisation costs. One study did not found OD as a predictor for total medical costs in the multivariate analysis. One retrospective study showed an increase of US$4510 during the first year after stroke for those patients with OD. For pneumonia, five retrospective studies showed an increase in hospitalisation costs after stroke of between US$1456 and US$27 633. One prospective study showed an increase in hospitalisation costs during 6 months after stroke in patients at high malnutrition risk. Strength of evidence was considered moderate for OD and pneumonia and low for malnutrition.
CONCLUSIONS
This systematic review shows moderate evidence towards higher costs for those patients who developed OD after stroke. The available literature is heterogeneous, and some important aspects have not been studied yet. Further studies are needed to define the specific cost of poststroke OD.
PROSPERO REGISTRATION NUMBER
CRD42018099977.
Topics: Deglutition Disorders; Health Care Costs; Humans; Malnutrition; Pneumonia; Prospective Studies; Retrospective Studies; State Medicine; Stroke
PubMed: 32784251
DOI: 10.1136/bmjopen-2019-031629 -
The Spine Journal : Official Journal of... Sep 2022Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus... (Review)
Review
BACKGROUND AND CONTEXT
Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by growing ossifications of spinal entheses and tendons, which may cause trachea and esophagus compression when located anteriorly in the cervical spine.
PURPOSE
Our previous systematic review on the epidemiological and clinical knowledge of dysphagia and airway obstruction caused by cervical DISH was updated, with a focus on (surgical) treatment and outcomes.
STUDY DESIGN
A systematic review of the literature was performed.
METHODS
Publications in Medline and EMBASE from July 2010 to June 2021 were searched. Two investigators performed data extraction and study specific quality assessment.
RESULTS
A total of 138 articles (112 case reports and 26 case series) were included, describing 419 patients with dysphagia and/or airway obstruction. The mean age of the patient group was 67.3 years (range: 35-91 years), and 85.4% was male. An evident increase of published cases was observed within the last decade. Surgical treatment was chosen for 66% of patients with the anterolateral approach most commonly used. The total complication rate after surgery was 22.1%, with 12.7% occurring within 1 month after intervention. Improvement of dysphagia was observed in 95.5% of operated patients. After a mean follow-up of 3.7 years (range: 0.4-9.0 years), dysphagia recurred in 12 surgically treated patients (4%), of which five patients had osteophyte regrowth.
CONCLUSIONS
The number of published cases of dysphagia in patients with DISH has doubled in the last decade compared to our previous review. Yet, randomized studies or guidelines on the treatment or prevention on recurrence are lacking. Surgical treatment is effective and has low (major) complication rates. Common trends established across the cases in our study may help improve our understanding and management of dysphagia and airway obstruction in cervical DISH.
Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Cervical Vertebrae; Deglutition Disorders; Female; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Male; Middle Aged; Osteophyte
PubMed: 35283294
DOI: 10.1016/j.spinee.2022.03.002