Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Interventions for dysphagia and nutritional support in acute and subacute stroke

This is not the most recent version

Information

DOI:
https://doi.org/10.1002/14651858.CD000323.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 17 October 2012see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Stroke Group

Copyright:
  1. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Article metrics

Altmetric:

Cited by:

Cited 0 times via Crossref Cited-by Linking

Collapse

Authors

  • Chamila Geeganage

    Clinical Pharmacology and Pharmacy, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

  • Jessica Beavan

    Department of Stroke Medicine, Royal Derby Hospital, Derby, UK

  • Sharon Ellender

    Division of Stroke Medicine, University of Nottingham, Nottingham, UK

  • Philip MW Bath

    Correspondence to: Division of Stroke Medicine, University of Nottingham, Nottingham, UK

    [email protected]

Contributions of authors

Chamila Geeganage: undertook searches in 2011 to 2012, data extraction, analysis and interpretation of data, and updated the review in 2012.
Jessica Beavan: undertook searches in 2007, data extraction, analysis and interpretation of data, and wrote an interim update of the review in 2007 (unpublished).
Sharon Ellender: undertook paper reviews, data extraction, analysis of data, and contributed to writing the 2007 interim update.
Philip Bath: conceived and designed the review, undertook searches, analysis of data, interpretation of data, wrote the original review, and updated it in 2007 (interim update) and 2012.

Sources of support

Internal sources

  • King's College Hospital Audit Committee, UK.

  • Division of Stroke, University of Nottingham, UK.

External sources

  • South Thames NHS Executive, UK.

  • Trent NHS Executive, UK.

  • Wolfson Foundation, UK.

  • The Stroke Association, UK.

  • Royal College of Physicians, UK.

  • Dunhill Medical Trust, UK.

  • Stroke Research Network, UK.

  • National Institutes of Health Research ‐ Cochrane Incentive Scheme, UK.

Declarations of interest

JB was co‐ordinator and author of one completed trial included in this review (Beavan 2010). PB was chief investigator of one completed, included trial (Bath 1997), principal investigator of two completed trials (FOOD 1 2005; FOOD 3 2005), and is chief investigator of one ongoing trial (STEPS 2012), which is funded by Phagenesis Ltd. He consults for this company and receives honoraria as well as expenses for this. No pharmaceutical, device or feeding companies, or other commercial entities were involved in data analysis, data interpretation, or in writing this review.

Acknowledgements

We thank Ms Jean Kerr and Ms Morwenna Collins (SLTs) for their help with the early stages of the first version of the review, and Cameron Sellars and David Smithard for their involvement in the completion of the first version (through searches, interpretation of data, and writing the review). We thank the Cochrane Stroke Group for helping identify trials, and their editors and external assessor for comments on the review. Several trialists and other interested healthcare staff reviewed the draft of the first version and made comments ‐ we thank each of them: CGMI Baeten (Netherlands), MS Dennis (UK), BR Garon (USA), GJ Hankey (Australia), GKT Holmes (UK), PR Mills (UK), B Norton (UK), C Ormiston (USA), J Rosenbek (USA), and G Vanhooren (Belgium). We also thank D Luo and G Lan who translated five of the papers from Chinese into English. Finally, we are grateful to the funding bodies that supported this research. Naturally any mistakes are our own. We would be very grateful to be informed of any other related completed or ongoing trials that are not listed in the review.

Version history

Published

Title

Stage

Authors

Version

2018 Oct 30

Swallowing therapy for dysphagia in acute and subacute stroke

Review

Philip M Bath, Han Sean Lee, Lisa F Everton

https://doi.org/10.1002/14651858.CD000323.pub3

2012 Oct 17

Interventions for dysphagia and nutritional support in acute and subacute stroke

Review

Chamila Geeganage, Jessica Beavan, Sharon Ellender, Philip MW Bath

https://doi.org/10.1002/14651858.CD000323.pub2

1999 Oct 25

Interventions for dysphagia in acute stroke

Review

Philip MW Bath, Fiona J Bath‐Hextall, David Smithard

https://doi.org/10.1002/14651858.CD000323

Differences between protocol and review

Modification of analysis methodology

The analysis methodology was changed from fixed‐effect to random‐effects models (OR, MD) since significant trial and statistical heterogeneity were present. Three studies had more than one intervention group (Yuan 2003; Carnaby 2006; Jing 2007) equating with different treatment intensities. In these cases the low‐intensity (middle) groups were divided and data from the study entered as two data sets (e.g. data set 1: medium (M), low (L), or none, and data set 2: high (H), medium (M)).

Modification of type of stroke patients

To fit the timing of interventions after stroke better, we included subacute trials so that trials enrolling patients within six months were included. (Previously, subacute trials were variably included or excluded depending on what proportions of participants were enrolled acutely.)

Addition or modification of outcome measures

We divided swallowing therapy into subcategories: acupuncture, drug therapy, NMES, PES, physical stimulation (thermal, tactile), TDCS, and TMS.

We added additional outcome measures, especially focusing on intermediate outcomes: pneumonia rates, gastrointestinal bleeding, and pressure sores. We divided swallowing therapy outcomes into relevant types of intervention (e.g. acupuncture, behavioural, drug therapy, and electrical stimulation). Outcomes related to improvement of dysphagia remained as listed with dysphagia at end of trial. However, we also included changes in some measurements on videofluoroscopy (pharyngeal transit time) and changes of swallow scores. We added food intake (as calories or volume) as an outcome measure. Discharge destination was included within the outcome 'institutionalisation'; the number of patients discharged to long‐term care.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.