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Rodríguez-Orozco JE, Martínez-Rubio CF, Moreno-Vargas E, Peña-Ortiz A, Pizarro-Peñaranda MC, Rojo-Bustamante E, Villarreal-García DE, Bayona-Ortiz HF. Comparative global analysis of stroke rehabilitation recommendations across income levels. J Clin Epidemiol 2024; 170:111334. [PMID: 38548231 DOI: 10.1016/j.jclinepi.2024.111334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/06/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Successful implementation of stroke rehabilitation guidelines demands high-quality practice standards tailored to targeted sociodemographic contexts. The primary objective is to determine the quality differences in post-stroke rehabilitation practice guidelines (PGs), when comparing high-income countries (HIC) and low or middle-income countries (LMIC). STUDY DESIGN AND SETTING We conducted a scoping review of PGs in English or Spanish, published between 2012 and 2021, and providing recommendations on post-stroke rehabilitation. We used Search engines, databases, guideline libraries, gray literature, and references from previous reviews on post-stroke rehabilitation as sources of evidence. Quality assessment of PGs was performed using 6P's, ELSE, IOM, and AGREE II instruments. We evaluated each item using a scale between 0 to 3, based on the confidence of adherence to the standard. For AGREE II, we followed the instruction manual for scoring. At least two reviewers were independently involved in every step of the process. A cloud-based spreadsheet was used to chart data. We compared the results of PGs originating from HIC with those from LMIC. RESULTS The inclusion criteria were met by 35 documents, which were subjected to evaluation. The study included 21 documents from HIC and 14 from middle-income countries (MIC). No manuscripts from low-income countries were available for inclusion in the study. The quality of PGs from MIC was found to be lower, in terms of methodological rigor and adherence to international recommendations for guidelines development. PGs from both groups of countries failed to include all target audiences and stakeholders (according to the 6P's criteria) and integration of ethical, legal, social, and economic considerations. CONCLUSION There are gaps in the quality and availability of stroke rehabilitation guidelines worldwide, especially in LMIC. Designing and providing financial support for the implementation of high-quality guidelines will contribute to more effective implementation strategies in stroke rehabilitation programs and lead to improved patient outcomes.
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Affiliation(s)
| | - Carlos Fernando Martínez-Rubio
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia
| | - Eder Moreno-Vargas
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 #18-49, Cali, Valle del Cauca, Colombia
| | - Angélica Peña-Ortiz
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad de los Andes, Cra. 7 #116-5, Bogotá, Colombia
| | | | - Estefanía Rojo-Bustamante
- Neurology Department, Hospital Universitario Fundación Santa Fe de Bogotá, Cra. 7 #117 -15, Bogotá, Colombia; Universidad El Bosque, Ak. 9 #131a-2, Bogotá, Colombia
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Kooi-van Es M, Erasmus CE, Voet NBM, van den Engel-Hoek L, van der Wees PJ. Best practice recommendations for speech-language pathology in children with neuromuscular disorders: A Delphi-based consensus study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:45-58. [PMID: 36896919 DOI: 10.1080/17549507.2023.2181224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Speech-language pathology (SLP) is considered an essential intervention due to the high prevalence of dysphagia and dysarthria in paediatric neuromuscular disorders (pNMD). Evidence-based guidelines for SLP in pNMD are missing and children could be deprived the best of care. This study aimed to achieve consensus and present best practice recommendations on SLP intervention in pNMD. METHOD A modified Delphi technique was used with a panel of experienced Dutch speech-language pathologists. In two online survey rounds and a face-to-face consensus meeting, the SLP experts proposed intervention items for cases of four types of pNMD (congenital myopathy, Duchenne muscular dystrophy, myotonic dystrophy type 1, and spinal muscular atrophy type 2), covering symptoms of dysphagia, dysarthria, drooling, and oral hygiene problems. They rated the level of agreement. RESULT Intervention items that achieved consensus were incorporated into best practice recommendations. These recommendations cover six core intervention components (wait and see, explanation and advice, training and treatment, aids and adjustments, referral to other disciplines, and monitoring) suitable for the described symptoms. CONCLUSION Insight into treatment options is essential to facilitate speech-language pathologists in clinical decision-making. The current study led to best practice recommendations for speech-language pathologists working within the field of pNMD.
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Affiliation(s)
- Mieke Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Radboud, University Medical Centre, Department of Pediatric Neurology, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands, and
| | | | - Philip J van der Wees
- Department of Rehabilitation and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Giray E, Eyigör S, Çalık Y, Albayrak Gezer İ, Sarı A, Umay E, Akaltun MS, Tıkız C, Ünlü Z, Vural M, Aydeniz B, Karahan AY. The caregiver burden of informal caregivers for stroke patients with and without dysphagia: A multi-center, cross-sectional study in Türkiye. Turk J Phys Med Rehabil 2023; 69:453-468. [PMID: 38766582 PMCID: PMC11099854 DOI: 10.5606/tftrd.2023.11894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/10/2023] [Indexed: 05/22/2024] Open
Abstract
Objectives The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL. Patients and methods This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI). Results The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores. Conclusion Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.
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Affiliation(s)
- Esra Giray
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Istanbul, Türkiye
| | - Sibel Eyigör
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Yalkın Çalık
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Physical Treatment and Rehabilitation Training and Research Hospital, Bolu, Türkiye
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selçuk University Faculty of Medicine, Konya, Türkiye
| | - Aylin Sarı
- Department of Physical Medicine and Rehabilitation, Erenköy Physical Medicine and Rehabilitation Hospital, Istanbul, Türkiye
| | - Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Dışkapı Training and Research Hospital, Ankara, Türkiye
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Zeliha Ünlü
- Department of Physical Medicine and Rehabilitation, Manisa Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Türkiye
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Medical Faculty of Uşak University, Uşak, Türkiye
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Fu X, Li H, Yang W, Li X, Lu L, Guo H, Guo K, Huang Z. Electroacupuncture at HT5 + GB20 promotes brain remodeling and significantly improves swallowing function in patients with stroke. Front Neurosci 2023; 17:1274419. [PMID: 38027487 PMCID: PMC10656700 DOI: 10.3389/fnins.2023.1274419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background This study compared the differences in the degree of brain activation, and swallowing function scales in patients with post-stroke dysphagia after treatment. We explored the mechanism of cortical remodeling and the improvement effect of electroacupuncture on swallowing function in patients and provided a theoretical basis for the clinical application of electroacupuncture. Methods Fifty patients with post-stroke dysphagia were randomized to the control or electroacupuncture group. The control group underwent conventional swallowing rehabilitation for 30 min each time for 12 sessions. In the electroacupuncture group, electroacupuncture was performed based on conventional swallowing rehabilitation for 30 min each time for 12 sessions. Cortical activation tests and swallowing function assessments were performed before and after treatment. Statistical analyses were used to investigate the differences within and between the two groups to explore the treatment effects. Results There were no statistical differences in clinical characteristics and baseline data between the two groups before treatment. Cortical activation and swallowing function were improved to different degrees in both groups after treatment compared with before treatment. After treatment, the electroacupuncture group showed higher LPM (t = 4.0780, p < 0.001) and RPM (t = 4.4026, p < 0.0001) cortical activation and tighter functional connectivity between RS1 and LM1 (t = 2.5336, p < 0.05), RM1 and LPM (t = 3.5339, p < 0.001), RPM and LM1 (t = 2.5302, p < 0.05), and LM1 and LPM (t = 2.9254, p < 0.01) compared with the control group. Correspondingly, the improvement in swallowing function was stronger in the electroacupuncture group than in the control group (p < 0.05). Conclusion This study demonstrated that electroacupuncture based on conventional treatment activated more of the cerebral cortex associated with swallowing and promoted functional connectivity and remodeling of the brain. Accompanying the brain remodeling, patients in the electroacupuncture group also showed greater improvement in swallowing function. Clinical trial registration ClinicalTrials.gov, ChiCTR2300067457.
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Affiliation(s)
- Xuefeng Fu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hao Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Wen Yang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Xuezheng Li
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Lijun Lu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Hua Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Zhen Huang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
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Fu X, Li H, Yang W, Li X, Lu L, Guo H, Wu Z, Guo K, Xu H, Huang Z. Electroacupuncture at HT5 + GB20 produces stronger activation effect on swallowing cortex and muscle than single points. Heliyon 2023; 9:e21922. [PMID: 38034817 PMCID: PMC10682618 DOI: 10.1016/j.heliyon.2023.e21922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/25/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction This study aimed to investigate the effects of electroacupuncture on cortical activation and swallowing muscle groups. The study examined brain activation in healthy subjects performing swallowing tasks during electroacupuncture. Additionally, the study analyzed electromyographic signals of swallowing muscle groups after electroacupuncture. Methods Twenty-seven healthy subjects were randomly separated into three groups. They underwent electroacupuncture at HT5 acupoint (HT5 group), or GB20 acupoint (GB20 group), or HT5 + GB20 acupoint (HT5 + GB20 group) for 30 min of intervention. Subjects performed a swallowing task while receiving electroacupuncture. Functional near-infrared spectroscopy (fNIRS) was used to detect cortical activation and functional connectivity (FC). The mean amplitude values of the swallowing muscle groups after electroacupuncture were also measured. Statistical analysis was used to investigate the differences between the three groups. The protocol was registered with the China Clinical Trials Registry with the registration number ChiCTR2300067457. Results Compared with the HT5 group, the HT5 + GB20 group showed higher cortical activation in the LM1 (t = 2.842, P < 0.05) and a tighter FC in the RM1 and LM1 (t = 2.4629, P < 0.05) with considerably increased mean amplitude values of the swallowing muscle groups (t = 5.2474, P < 0.0001). Increased FC was found in the HT5 + GB20 group compared to the GB20 group between the RM1 and RS1 (t = 2.9997, P < 0.01), RM1 and RPM (t = 2.2116, P < 0.05), RM1 and LM1 (t = 3.2078, P < 0.01), RPM and LM1 (t = 2.7440, P < 0.05). However, there were no statistically significant differences in cortical activation or mean amplitude values of swallowing muscle groups. Conclusion This study showed that electroacupuncture at HT5 + GB20 acupoints particularly engaged the cerebral cortex related to swallowing, resulting in tighter functional connectivity and higher amplitude values of swallowing muscle groups than electroacupuncture at single acupoints. The results may reveal the mechanism of electroacupuncture for post-stroke swallowing dysphagia.
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Affiliation(s)
- Xuefeng Fu
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Hao Li
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Wen Yang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Xuezheng Li
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Lijun Lu
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Hua Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Zhehao Wu
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
| | - Haoming Xu
- South China Normal University, Guangzhou, Guangdong, 510631, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, 511400, China
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
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Zhuang Y, Wang X, Yin X, Li X, Liu W. Exploration of treatment methods for patients with post-stroke dysphagia: a network meta-analysis. Biotechnol Genet Eng Rev 2023:1-18. [PMID: 36966378 DOI: 10.1080/02648725.2023.2184044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
To compare the effects of various therapies in patients with post-stroke dysphagia. DATA SOURCES We searched databases between January 1980 and 2022. STUDY ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) on therapy for dysphagia after stroke. STUDY APPRAISAL AND SYNTHESIS METHODS The outcomes were improvement in dysphagia, case fatality, and chest infection or pneumonia, reported as OR (odd ratio), 95% CrI (confidence interval), and SUCRA (the surface under the cumulative ranking curve analysis) score. Forty-two randomized controlled trials (2,993 patients, seven therapies, and one control) were included. In the improvement of dysphagia analysis, the following therapies were superior to the control: Acupuncture, behavioral interventions, drug therapy, neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES). In the case fatality analysis, OR and 95% CrI indicated none of the therapies were superior to the control. In the chest infection or pneumonia analysis, OR values showed that no therapy was superior to the control. Our Network Meta-analysis suggests that commonly used therapies for dysphagia after stroke have equal efficacies.
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Affiliation(s)
- Yueyang Zhuang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xiaohua Wang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Xinbo Yin
- Intensive Care Unit, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Xiaoling Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Weilin Liu
- Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
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Cardoso AF, Ribeiro LE, Santos T, Pinto M, Rocha C, Magalhães J, Augusto B, Santos D, Duque FM, Fernandes BL, Sousa RC, Silva R, Ventura F, Fernandes AM, Cardoso D, Rodrigues R. Oral Hygiene in Patients with Stroke: A Best Practice Implementation Project Protocol. NURSING REPORTS 2023; 13:148-156. [PMID: 36810267 PMCID: PMC9944467 DOI: 10.3390/nursrep13010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Oral hygiene has been shown to reduce adverse events and promote the quality of life of patients with stroke. However, a stroke can result in the impairment of physical, sensory, and cognitive abilities, and comprise self-care. Although nurses recognize its benefits, there are areas for improvement in the implementation of the best evidence-based recommendations. The aim is to promote compliance with the best evidence-based recommendations on oral hygiene in patients with stroke. This project will follow the JBI Evidence Implementation approach. The JBI Practical Application of Clinical Evidence System (JBI PACES) and the Getting Research into Practice (GRiP) audit and feedback tool will be used. The implementation process will be divided into three phases: (i) establishing a project team and undertaking the baseline audit; (ii) providing feedback to the healthcare team, identifying barriers to the implementation of best practices, and co-designing and implementing strategies using GRIP, and (iii) undertaking a follow-up audit to assess the outcomes and plan for sustainability. So, the successful adoption of the best evidence-based recommendations on oral hygiene in patients with stroke will reduce the adverse events related to poor oral care and may improve patients' quality of care. This implementation project has great transferability potential to other contexts.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Correspondence:
| | - Liliana Escada Ribeiro
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Teresa Santos
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Maribel Pinto
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Cláudia Rocha
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Joana Magalhães
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Berta Augusto
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Diana Santos
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, 3000-076 Coimbra, Portugal
| | - Filipa Margarida Duque
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Beatriz Lavos Fernandes
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Hospital de Cascais Dr. José de Almeida, Av. Brigadeiro Victor Novais Gonçalves, 2755-009 Alcabideche, Portugal
| | - Rosário Caixeiro Sousa
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- Hospital da Luz, Praceta Robalo Cordeiro, 1, 3020-479 Coimbra, Portugal
| | - Rosa Silva
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Filipa Ventura
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - António Manuel Fernandes
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
| | - Rogério Rodrigues
- Nursing School of Coimbra, 3004-011 Coimbra, Portugal
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
- Health Sciences Research Unit: Nursing, Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, 3004-011 Coimbra, Portugal
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Liu J, Wang Q, Tian J, Zhou W, Gao Y, Chen X, Zhang W, Gao Y, Zhou L. Effects of chin tuck against resistance exercise on post-stroke dysphagia rehabilitation: A systematic review and meta-analysis. Front Neurol 2023; 13:1109140. [PMID: 36698882 PMCID: PMC9868925 DOI: 10.3389/fneur.2022.1109140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Chin tuck against resistance (CTAR) exercise was introduced to substitute for the commonly used Shaker exercise for dysphagia rehabilitation. The effects of CTAR exercise in stroke survivors needs to be validated. Objective To investigate the effects of Chin tuck against resistance (CTAR) exercise on the swallowing function and psychological condition in stroke survivors compared to no exercise intervention and the Shaker exercise. Materials and methods The Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL and four Chinese databases were searched for randomized controlled trails (RCTs) and quasi-RCTs from inception to February 2022. Results After screened and assessed the methodological quality of the studies, nine studies with 548 stroke survivors were included in the systematic review. 8 studies were included in the meta-analysis using RevMan 5.4 software. The mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated. The results revealed that CTAR exercise is effective in improving swallowing safety (MD, -1.43; 95% CI, -1.81 to -1.06; P < 0.0001) and oral intake ability (SMD, -1.82; 95% CI, -3.28 to -0.35; P = 0.01) compared with no exercise intervention, CTAR exercise is superior to Shaker exercise in improving swallowing safety (MD, -0.49; 95% CI, -0.83 to -0.16; P = 0.004). The psychological condition in CTAR group is significant better than the control group (MD, -5.72; 95% CI, -7.39 to -4.05; P < 0.00001) and Shaker group (MD, -2.20; 95% CI, -3.77 to -0.64; P = 0.006). Conclusions Our findings support CTAR exercise as a superior therapeutic exercise for post-stroke dysphagia rehabilitation than Shaker exercise. More high-qualities RCTs from larger multicenter are needed to analysis the effects of CTAR exercise in patients with different type and phase of stroke and explore the optimal training dose.
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Affiliation(s)
- Jing Liu
- School of Nursing, Naval Medical University, Shanghai, China
| | - Qiuyi Wang
- School of Nursing, Naval Medical University, Shanghai, China
| | - Jing Tian
- School of Nursing, Naval Medical University, Shanghai, China
| | - Wanqiong Zhou
- School of Nursing, Naval Medical University, Shanghai, China
| | - Yitian Gao
- School of Nursing, Naval Medical University, Shanghai, China
| | - Xuemei Chen
- School of Nursing, Naval Medical University, Shanghai, China
| | - Wei Zhang
- School of Nursing, Naval Medical University, Shanghai, China
| | - Yajing Gao
- Nursing School, Peking University, Beijing, China
| | - Lanshu Zhou
- School of Nursing, Naval Medical University, Shanghai, China
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9
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Shieh WY, Wang CM, Ju YY, Cheng HYK. Multi-Sensor Respiratory-Swallow Telecare System for Safe Feeding in Different Trunk Inclinations: System Development and Clinical Application. SENSORS (BASEL, SWITZERLAND) 2023; 23:642. [PMID: 36679437 PMCID: PMC9865800 DOI: 10.3390/s23020642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Proper positioning is especially important to ensure feeding and eating safely. With many nursing facilities restricting visitations and close contact during the coronavirus pandemic, there is an urgent need for remote respiratory-swallow monitoring. This study aimed to develop a semiautomatic feeding telecare system that provides instant feedback and warnings on-site and remotely. It also aimed to analyze the effects of trunk positions on respiratory-swallow coordination. A signal collector with multiple integrated sensors for real-time respiratory-swallow monitoring and warning was developed. A repeated measures design was implemented to evaluate the effects of trunk inclination angles on the swallow-related functions. Significant differences in inclination angles were discovered for swallowing apnea (p = 0.045) and total excursion time of thyroid cartilage (p = 0.037), and pairwise comparisons indicated that these differences were mostly present at 5° to 45°. Alerts were triggered successfully when undesired respiratory patterns or piecemeal occurred. The results indicated that a care recipient can swallow more easily when sitting upright (5°) than when leaning backward (45°). This telecare system provides on-site and remote respiratory-swallow monitoring and alerting for residents in care facilities and can serve as a pipeline for the early screening of swallowing dysfunction.
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Affiliation(s)
- Wann-Yun Shieh
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan 333, Taiwan
| | - Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan 333, Taiwan
- Collage of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yan-Ying Ju
- Department of Adapted Physical Education, National Taiwan Sport University, No. 250, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan
| | - Hsin-Yi Kathy Cheng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kwei-Shan, Taoyuan 333, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan 333, Taiwan
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10
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Liu W, Ge W, Murong Z, Li L, Liu J, Shen Y, Yang S, Wang S, Hao R, Wang H, Ding L, Li S, Zhuang Z, Zhao M, Wang R, Qin M, Zhang L, Fan X. Efficacy and safety of acupuncture for post-stroke dysphagia: protocol for a multicenter, single-blinded, randomized controlled trial. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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11
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Li X, Jin L, Gu C, Zhang W, Zhou X, You X. Effect of Cold Fluid Compensatory Swallowing Combined with Balloon Dilation on the Treatment of Poststroke Cricopharyngeal Achalasia: A Pilot Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4171561. [PMID: 36254140 PMCID: PMC9569196 DOI: 10.1155/2022/4171561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022]
Abstract
Objective This study is aimed at comparing the treatment efficacy between catheter balloon dilation combined with cold fluid compensatory swallowing training and catheter balloon dilation alone on poststroke cricopharyngeal achalasia (CPA). Methods We conducted a single-blind, randomized controlled trial (RCT). Poststroke patients with CPA were divided into two groups: the control group (treated with catheter balloon dilation) and the trial group (catheter balloon dilation combined with cold fluid compensatory swallowing). Videofluoroscopic swallowing study (VFSS) was performed, and functional oral intake scale (FOIS) was used to evaluate and compare the swallowing function of patients in the 2 groups before and after intervention. Posttreatment VAS pain scores and recovery time were also measured. Results VFSS and FOIS scores in the two groups were improved after treatment (P < 0.05). In the trial group, VFSS scores in the pharyngeal phase and aspiration degree were significantly higher compared with the control group (P < 0.05) but not in the oral phase (P > 0.05). The difference in FOIS scores and patients' recovery time from intervention to eating mushy food between the trial and control groups was significant (P < 0.05), but not the VAS scores (P > 0.05). Conclusion The catheter balloon dilation combined with cold fluid compensatory swallowing was superior to catheter balloon dilation alone in terms of relieving dysphagia and reducing aspiration in patients with CPA following stroke. Long-term efficacy should be followed up with more objective and quantitative indicators in future studies.
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Affiliation(s)
- Xiangwei Li
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Linna Jin
- Department of Rehabilitation, Sir Runrun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310020, China
| | - Chengxiao Gu
- Department of Nursing, Hangzhou Anatorium of People's Liberation Army, Hangzhou 310013, China
| | - Wangyuan Zhang
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Xiao Zhou
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
| | - Xiaoting You
- Department of Rehabilitation, Hangzhou No. 128 Hospital, Hangzhou 310013, China
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12
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Tarihci Cakmak E, Sen EI, Doruk C, Sen C, Sezikli S, Yaliman A. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 2022; 38:874-885. [PMID: 35986170 DOI: 10.1007/s00455-022-10512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration-aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration-aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration-aspiration and residue levels.
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13
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Farid J, Amin R, Sheikh MA, Irfan M, AlRuwaili R, Alruwaili M, Ali NH, Albarrak AM, Rahman S. Prevalence and prediction of pressure ulcers in admitted stroke patients in a tertiary care hospital. J Tissue Viability 2022; 31:768-775. [DOI: 10.1016/j.jtv.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
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14
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Burnip E, Cichero JAY. Review of the effect of amylase-resistant dysphagia products on swallowing safety. Curr Opin Otolaryngol Head Neck Surg 2022; 30:169-176. [PMID: 35635111 DOI: 10.1097/moo.0000000000000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Thickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting 'safer swallowing'. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety. RECENT FINDINGS No studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starch-based dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients. SUMMARY Despite references to the 'importance' of amylase-resistant properties of dysphagia products there is no evidence that this property improves swallowing safety. Further research is needed using objective and clinically meaningful outcome measures to allow clinicians and patients to make informed decisions for dysphagia management.
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Affiliation(s)
- E Burnip
- University of Canterbury, New Zealand
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15
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Raciti L, Raciti G, Pulejo G, Conti-Nibali V, Calabrò RS. Neurogenic Dysphagia and Nutrition in Disorder of Consciousness: An Overview with Practical Advices on an “Old” but Still Actual Clinical Problem. MEDICINES 2022; 9:medicines9020016. [PMID: 35200759 PMCID: PMC8874700 DOI: 10.3390/medicines9020016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Neurogenic dysphagia is a difficulty in swallowing food caused by disease or impairment of the nervous system, including stroke and traumatic brain injury. The most clinically apparent complication of neurogenic dysphagia is pulmonary aspiration, which may manifest itself acutely as choking or coughing, respiratory distress, wheezing, gasping or gurgling, and tachycardia. However, chronic symptoms, including weight loss, production of excessive oral secretions and aspiration pneumonia, may be also present, especially in patients with a disorder of consciousness (DOC). Usually, patients with dysphagia after the acute phase need to be treated with enteral nutrition using a feeding tube. This avoids patient malnutrition and supports the rehabilitation program. This narrative review aims to investigate dysphagia and its complications and management in patients with DOC. Clinical indications and practical advice on how to assess and treat this complex problem are also provided.
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Affiliation(s)
- Loredana Raciti
- GCA-Centro Spoke AO Cannizzaro, Catania, IRCCS Centro Neurolesi Bonino-Pulejo, 95122 Messina, Italy; (L.R.); (G.R.)
| | - Gianfranco Raciti
- GCA-Centro Spoke AO Cannizzaro, Catania, IRCCS Centro Neurolesi Bonino-Pulejo, 95122 Messina, Italy; (L.R.); (G.R.)
| | - Grazia Pulejo
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98123 Messina, Italy; (G.P.); (V.C.-N.)
| | - Valeria Conti-Nibali
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98123 Messina, Italy; (G.P.); (V.C.-N.)
| | - Rocco Salvatore Calabrò
- Neurorehabilitation Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, 98123 Messina, Italy; (G.P.); (V.C.-N.)
- Correspondence: ; Fax: +39-9060128950
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16
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Ghaddar Z, Matar N, Noujaim J, Diep AN, Tohmé A, Pétré B. Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study. Patient Prefer Adherence 2022; 16:1511-1524. [PMID: 35769338 PMCID: PMC9236548 DOI: 10.2147/ppa.s364520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). METHODS We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. RESULTS Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme "normal swallowing vs difficulty swallowing" as the highest priority. CONCLUSION This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.
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Affiliation(s)
- Zahya Ghaddar
- Department of Public Health, University of Liège, Liege, Belgium
- Doctoral School of Sciences and Health, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Correspondence: Zahya Ghaddar, Department of Public Health, University of Liège, Place du XX août 7, Liege, 4000, Belgium, Tel +961 3554813, Email ;
| | - Nayla Matar
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Joyce Noujaim
- Department of Higher Institute of Speech and Language Therapy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Anh Nguyet Diep
- Department of Public Health, University of Liège, Liege, Belgium
| | - Aline Tohmé
- Department of Internal Medicine and Clinical Immunology, University Hospital Center Hotel-Dieu de France, Affiliated to Saint-Joseph University, Beirut, Lebanon
| | - Benoit Pétré
- Department of Public Health, University of Liège, Liege, Belgium
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