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Dysphagia Dec 2022Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and...
BACKGROUND
Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date.
OBJECTIVE
This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome.
METHODS
Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form.
RESULTS
In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared.
DISCUSSION
None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
Topics: Infant; Adolescent; Child; Humans; Deglutition; Cross-Sectional Studies; Deglutition Disorders; Endoscopy; Endoscopes
PubMed: 35430715
DOI: 10.1007/s00455-022-10446-0 -
Journal of Translational Medicine Apr 2022Oropharyngeal dysphagia (OD) refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, which leads to the related clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oropharyngeal dysphagia (OD) refers to any abnormality in the physiology of swallowing in the upper gastrointestinal tract, which leads to the related clinical complications, such as malnutrition, dehydration, and sever complication, such as aspiration pneumonia, suffocation, and eventually, premature death. The previous studies indicated a various range of prevalence of OD. The present systematic review and meta-analysis aimed to standardize the global prevalence of OD in different populations.
METHODS
A systematic literature review was conducted using Embase, Scopus, PubMed, Web of Science (WoS) databases, and Google Scholar motor engine using related MeSH/Emtree and Free Text words, with no time limitation until November 2021. The heterogeneity among studies was quantified using I index and the random effects model was used, due to the high heterogeneity among the results of studies included in the meta-analysis.
RESULTS
The systematic literature search retrieved 2092 studies. After excluding the irrelevant studies, ultimately 27 articles with a sample size of 9841 were included in the meta-analysis. After combining the studies, the overall estimate of the global prevalence rate of OD was 43.8% (95% CI 33.3-54.9%) and the highest prevalence rate was estimated in Africa with 64.2% (95% CI 53.2-73.9%). Given the subgroup analysis based on the study population, the highest prevalence of OD was related to Dementia with 72.4% (95% CI 26.7-95.0%). The results of meta-regression indicated that the prevalence of OD has an increasing trend with the enhancement of year of publication and mean age.
CONCLUSION
The results of the present systematic review and meta-analysis revealed that the prevalence of OD is high in different populations and its trend has been increasing in recent years. Therefore, the appropriate strategies should be applied to reduce the prevalence of OD by finding its causation and monitoring at all levels, as well as providing feedback to hospitals.
Topics: Africa; Deglutition Disorders; Humans; Malnutrition; Prevalence
PubMed: 35410274
DOI: 10.1186/s12967-022-03380-0 -
Annals of Palliative Medicine Jul 2022The efficacy of acupuncture in the treatment of dysphagia caused by pseudobulbar paralysis after stroke is lack of evidence-based medicine. Our objective was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy of acupuncture in the treatment of dysphagia caused by pseudobulbar paralysis after stroke is lack of evidence-based medicine. Our objective was to synthesize the efficacy of acupuncture in treating dysphagia caused by pseudobulbar paralysis after stroke.
METHODS
A comprehensive literature search was performed in 9 databases [PubMed, Web of Science, Embase, Cochrane, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Science and Technology Periodicals database (VIP), and Open Grey online database] to screen eligible randomized controlled studies that evaluated the effect of acupuncture in dysphagia caused by pseudobulbar paralysis after stroke. The search time limit is from establishing the database to October 1, 2020. The random-effects model was used to calculate the significant effect size.
RESULTS
A total of 7 studies comprising 637 participants were included in our meta-analysis. The results showed that compared with rehabilitation, acupuncture had a significant effect on improving dysphagia caused by pseudobulbar paralysis after stroke [the significant effective size: risk ratio (RR)sig =1.51; 95% confidence interval (CI): 1.30-1.75; I2=0%]. In the subgroup analyses, the RRsig of acupuncture + rehabilitation vs. rehabilitation was 1.56 (95% CI: 1.30-1.87; I2=0%), and the RRsig of acupuncture vs. rehabilitation was 1.38 (95% CI: 1.08-1.76; I2=0.8%).
DISCUSSION
Acupuncture can be used as an effective treatment for dysphagia caused by pseudobulbar paralysis after stroke. Acupuncture combined with rehabilitation therapy has better effects.
Topics: Acupuncture Therapy; Deglutition Disorders; Evidence-Based Medicine; Humans; Pseudobulbar Palsy; Stroke
PubMed: 35400158
DOI: 10.21037/apm-21-3551 -
BMJ Open Mar 2022Dysphagia in childhood has important health impacts for the child and their family as well as the healthcare system. This systematic review aims to determine the...
OBJECTIVES
Dysphagia in childhood has important health impacts for the child and their family as well as the healthcare system. This systematic review aims to determine the effectiveness of neuromuscular electrical stimulation (NMES) for treatment of oropharyngeal dysphagia in children.
METHODS
A search was performed on November 2020 in MEDLINE (from 1946), EMBASE (from 1947), PsycINFO (from 1806), CINAHL (from 1937), CENTRAL (from 1996) and Scopus (from 1970) databases. Studies of children (≤18 years) diagnosed with oropharyngeal dysphagia using NMES in the throat/neck region were included. Screening, data extraction, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using the Cochrane Collaboration's tool for randomised controlled trials (RCTs) and a modified Newcastle-Ottawa assessment for observational studies. A meta-analysis was not conducted due to clinical heterogeneity in studies.
RESULTS
Ten studies were included (5 RCTs, 4 case series, 1 cohort study; including 393 children, mean or median age below 7 years, including children with neurologic impairments). In all studies, swallowing function improved after NMES treatment. The standardised mean difference (SMD) for improvement of swallowing dysfunction in treatment compared with control groups in the RCTs ranged from 0.18 (95% CI -0.7 to 1.06) to 1.49 (95% CI 0.57 to 2.41). Eight of 10 studies reported on the child's feeding ability, and, with one exception, there was improvement in feeding ability. Few studies reported on health status (N=2), impact on caregiver (N=1), adverse events and harms (N=2), and child's quality of life (N=1). In most studies, outcome follow-up was less than 6 months. The studies demonstrated moderate to high risk of bias.
CONCLUSIONS
NMES treatment may be beneficial in improving swallowing function for children with dysphagia, however, given the quality of the studies, inadequate outcome reporting, and short follow-up duration, uncertainty remains. Well-designed RCTs are needed to establish its effectiveness before its adoption in clinical practice.
PROSPERO REGISTRATION NUMBER
CRD42019147353.
Topics: Child; Cohort Studies; Deglutition Disorders; Electric Stimulation; Humans; Quality of Life
PubMed: 35338059
DOI: 10.1136/bmjopen-2021-055124 -
Archives of Physical Medicine and... Jul 2022This review aimed to systematically evaluate the effect of transcranial direct current stimulation (tDCS) on poststroke dysphagia. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This review aimed to systematically evaluate the effect of transcranial direct current stimulation (tDCS) on poststroke dysphagia.
DATA SOURCES
PubMed, Cochrane Library (CENTRAL), Web of Science, VIP, CNKI, and Wanfang databases were systematically searched up to June 2021.
STUDY SELECTION
Randomized controlled trials (RCTs) on the effects of tDCS on poststroke dysphagia.
DATA EXTRACTION
The extracted data included the author, country of publication, time of publication, key elements of bias risk assessment (such as RCTs and blind methods), sample size and basic information (age, course of disease, stroke location), intervention measures, treatment methods of tDCS (stimulation location, intensity, duration), relevant outcome indicators, and relevant data (SDs).The Cochrane Risk of Bias Assessment Tool and Physiotherapy Evidence Database Scale were used to assess the risk of bias.
DATA SYNTHESIS
Sixteen RCTs were included in this meta-analysis. Overall, the results revealed a large and statistically significant pooled effect size (0.80; confidence interval [CI], 0.45-1.14; P<.001). The subgroup that explored the course of the disease yielded a large and significant effect size for the chronic phase group (0.80; CI, 0.43-1.16; P<.001). For the stimulation intensity, 1 mA and 1.6 mA showed a moderate and significant effect sizes (0.47; CI, 0.13-0.81; P=.006 vs 1.39; CI, 0.69-2.08; P<.001). In the subgroup analyses, the affected (0.87; CI, 0.26-1.48; P=.005) vs unaffected (0.61; CI, 0.23-0.99; P=.002) hemisphere showed a significant result, and stimulation of the affected hemisphere had a more obvious effect. Subgroup analysis of stroke location showed that tDCS was effective for dysphagia after unilateral hemispheric stroke, bulbar paralysis, and brainstem stroke but not for dysphagia after ataxic and basal ganglia stroke. However, the subgroup analysis of stroke location revealed a significant result (0.81; CI, 0.44-1.18; P<.001).
CONCLUSIONS
This meta-analysis demonstrated the height and significant beneficial effect of tDCS on improving poststroke dysphagia.
Topics: Deglutition Disorders; Humans; Randomized Controlled Trials as Topic; Stroke; Stroke Rehabilitation; Transcranial Direct Current Stimulation
PubMed: 35337844
DOI: 10.1016/j.apmr.2022.03.004 -
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 -
Journal of Clinical Medicine Feb 2022To assess the effects of brain neurostimulation (i.e., repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) in people... (Review)
Review
To assess the effects of brain neurostimulation (i.e., repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) in people with oropharyngeal dysphagia (OD). Systematic literature searches were conducted in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed) to retrieve randomised controlled trials (RCTs) only. Using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), the methodological quality of included studies was evaluated, after which meta-analysis was conducted using a random-effects model. In total, 24 studies reporting on brain neurostimulation were included: 11 studies on rTMS, 9 studies on tDCS, and 4 studies on combined neurostimulation interventions. Overall, within-group meta-analysis and between-group analysis for rTMS identified significant large and small effects in favour of stimulation, respectively. For tDCS, overall within-group analysis and between-group analysis identified significant large and moderate effects in favour of stimulation, respectively. Both rTMS and tDCS show promising effects in people with oropharyngeal dysphagia. However, comparisons between studies were challenging due to high heterogeneity in stimulation protocols and experimental parameters, potential moderators, and inconsistent methodological reporting. Generalisations of meta-analyses need to be interpreted with care. Future research should include large RCTs using standard protocols and reporting guidelines as achieved by international consensus.
PubMed: 35207265
DOI: 10.3390/jcm11040993 -
Journal of Clinical Medicine Jan 2022To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal... (Review)
Review
Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation.
To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal dysphagia (OD). Systematic literature searches were conducted to retrieve randomised controlled trials in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of included studies was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). In total, 42 studies reporting on peripheral neurostimulation were included: 30 studies on NMES, eight studies on PES, and four studies on combined neurostimulation interventions. When conducting meta analyses, significant, large and significant, moderate pre-post treatment effects were found for NMES (11 studies) and PES (five studies), respectively. Between-group analyses showed small effect sizes in favour of NMES, but no significant effects for PES. NMES may have more promising effects compared to PES. However, NMES studies showed high heterogeneity in protocols and experimental variables, the presence of potential moderators, and inconsistent reporting of methodology. Therefore, only conservative generalisations and interpretation of meta-analyses could be made. To facilitate comparisons of studies and determine intervention effects, there is a need for more randomised controlled trials with larger population sizes, and greater standardisation of protocols and guidelines for reporting.
PubMed: 35160228
DOI: 10.3390/jcm11030776 -
Journal of Clinical Medicine Jan 2022To determine the effects of behavioural interventions in people with oropharyngeal dysphagia. (Review)
Review
OBJECTIVE
To determine the effects of behavioural interventions in people with oropharyngeal dysphagia.
METHODS
Systematic literature searches were conducted to retrieve randomized controlled trials in four different databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of eligible articles was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), after which meta-analyses were performed using a random-effects model.
RESULTS
A total of 37 studies were included. Overall, a significant, large pre-post interventions effect size was found. To compare different types of interventions, all behavioural interventions and conventional dysphagia treatment comparison groups were categorised into compensatory, rehabilitative, and combined compensatory and rehabilitative interventions. Overall, significant treatment effects were identified favouring behavioural interventions. In particular, large effect sizes were found when comparing rehabilitative interventions with no dysphagia treatment, and combined interventions with compensatory conventional dysphagia treatment. When comparing selected interventions versus conventional dysphagia treatment, significant, large effect sizes were found in favour of Shaker exercise, chin tuck against resistance exercise, and expiratory muscle strength training.
CONCLUSIONS
Behavioural interventions show promising effects in people with oropharyngeal dysphagia. However, due to high heterogeneity between studies, generalisations of meta-analyses need to be interpreted with care.
PubMed: 35160137
DOI: 10.3390/jcm11030685 -
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