Director Kyoto University Graduate School of Medicine Kyoto, Japan
Introduction: Dysphagia or swallowing dysfunction is common in patients with acute or critical illness. The available evidence in this study area covers a variety of illness acuity/severity and types of interventions. In this systematic review, we examined the efficacy and safety of available rehabilitation interventions aimed to treat dysphagia in patients with acute or critical illness.
Methods: We searched PubMed, ICHUSHI, and Cochrane Central Register of Controlled Trials databases from inception to October 30, 2021 for relevant randomized controlled trials. Primary outcomes included mortality, incidence of pneumonia during the study period, and health-related quality of life scores within 90 days of hospital discharge. The comparators were standard care and conventional or no dysphagia interventions. We pooled the data using a random-effects model, and classified the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation system.
Results: We included eleven randomized controlled trials involving 667 participants and six types of interventions (repetitive transcranial magnetic stimulation, pharyngeal electrical stimulation, transcranial direct current stimulation, behavioral intervention, speech therapy, and swallowing stimulation). Nine studies included patients with stroke, whereas the remaining two included patients with non-neurological disorders. Dysphagia interventions were associated with a reduced incidence of pneumonia (risk ratio, 0.60; 95% confidence interval, 0.46–0.78; low certainty), but not with reduced mortality (risk ratio, 0.99; 95% confidence interval, 0.55–1.78; very low certainty). None of the included studies examined the effects of dysphagia interventions on health-related quality of life scores.
Conclusions: Based on the available very low- or low-quality evidence, while dysphagia interventions did not reduce mortality, they might reduce the incidence of pneumonia in patients with acute or critical illness. Our review highlights the scarcity of large studies on dysphagia interventions for this patient population, with the exception of those with stroke.
