Scolaris Content Display Scolaris Content Display

Study flow diagram.* Further 38 studies are awaiting assessment.
Figuras y tablas -
Figure 1

Study flow diagram.* Further 38 studies are awaiting assessment.

'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.

Comparison 1 Swallowing therapy, Outcome 1 Case fatality at end of trial.
Figuras y tablas -
Analysis 1.1

Comparison 1 Swallowing therapy, Outcome 1 Case fatality at end of trial.

Comparison 1 Swallowing therapy, Outcome 2 Death or dependency at end of trial.
Figuras y tablas -
Analysis 1.2

Comparison 1 Swallowing therapy, Outcome 2 Death or dependency at end of trial.

Comparison 1 Swallowing therapy, Outcome 3 Institutionalisation.
Figuras y tablas -
Analysis 1.3

Comparison 1 Swallowing therapy, Outcome 3 Institutionalisation.

Comparison 1 Swallowing therapy, Outcome 4 Length of stay (days).
Figuras y tablas -
Analysis 1.4

Comparison 1 Swallowing therapy, Outcome 4 Length of stay (days).

Comparison 1 Swallowing therapy, Outcome 5 Chest infection or pneumonia.
Figuras y tablas -
Analysis 1.5

Comparison 1 Swallowing therapy, Outcome 5 Chest infection or pneumonia.

Comparison 1 Swallowing therapy, Outcome 6 Dysphagia at end of trial.
Figuras y tablas -
Analysis 1.6

Comparison 1 Swallowing therapy, Outcome 6 Dysphagia at end of trial.

Comparison 1 Swallowing therapy, Outcome 7 Pharyngeal transit time (seconds).
Figuras y tablas -
Analysis 1.7

Comparison 1 Swallowing therapy, Outcome 7 Pharyngeal transit time (seconds).

Comparison 1 Swallowing therapy, Outcome 8 Swallow score.
Figuras y tablas -
Analysis 1.8

Comparison 1 Swallowing therapy, Outcome 8 Swallow score.

Comparison 1 Swallowing therapy, Outcome 9 Nutritional (albumin).
Figuras y tablas -
Analysis 1.9

Comparison 1 Swallowing therapy, Outcome 9 Nutritional (albumin).

Comparison 2 Route of feeding, Outcome 1 Case fatality at end of trial.
Figuras y tablas -
Analysis 2.1

Comparison 2 Route of feeding, Outcome 1 Case fatality at end of trial.

Comparison 2 Route of feeding, Outcome 2 Death or dependency at end of trial.
Figuras y tablas -
Analysis 2.2

Comparison 2 Route of feeding, Outcome 2 Death or dependency at end of trial.

Comparison 2 Route of feeding, Outcome 3 Institutionalisation.
Figuras y tablas -
Analysis 2.3

Comparison 2 Route of feeding, Outcome 3 Institutionalisation.

Comparison 2 Route of feeding, Outcome 4 Length of stay in hospital (days).
Figuras y tablas -
Analysis 2.4

Comparison 2 Route of feeding, Outcome 4 Length of stay in hospital (days).

Comparison 2 Route of feeding, Outcome 5 Pressure sores.
Figuras y tablas -
Analysis 2.5

Comparison 2 Route of feeding, Outcome 5 Pressure sores.

Comparison 2 Route of feeding, Outcome 6 Chest infection or pneumonia.
Figuras y tablas -
Analysis 2.6

Comparison 2 Route of feeding, Outcome 6 Chest infection or pneumonia.

Comparison 2 Route of feeding, Outcome 7 Dysphagia at end of trial.
Figuras y tablas -
Analysis 2.7

Comparison 2 Route of feeding, Outcome 7 Dysphagia at end of trial.

Comparison 2 Route of feeding, Outcome 8 Treatment failure.
Figuras y tablas -
Analysis 2.8

Comparison 2 Route of feeding, Outcome 8 Treatment failure.

Comparison 2 Route of feeding, Outcome 9 Gastrointestinal bleeding.
Figuras y tablas -
Analysis 2.9

Comparison 2 Route of feeding, Outcome 9 Gastrointestinal bleeding.

Comparison 2 Route of feeding, Outcome 10 Feed delivery (%).
Figuras y tablas -
Analysis 2.10

Comparison 2 Route of feeding, Outcome 10 Feed delivery (%).

Comparison 2 Route of feeding, Outcome 11 Weight at end of trial (last value carried forward) (kg).
Figuras y tablas -
Analysis 2.11

Comparison 2 Route of feeding, Outcome 11 Weight at end of trial (last value carried forward) (kg).

Comparison 2 Route of feeding, Outcome 12 Mid‐arm circumference (last value carried forward) (cm).
Figuras y tablas -
Analysis 2.12

Comparison 2 Route of feeding, Outcome 12 Mid‐arm circumference (last value carried forward) (cm).

Comparison 2 Route of feeding, Outcome 13 Albumin (last value carried forward) (g/L).
Figuras y tablas -
Analysis 2.13

Comparison 2 Route of feeding, Outcome 13 Albumin (last value carried forward) (g/L).

Comparison 3 Timing of feeding, Outcome 1 Case fatality at end of trial.
Figuras y tablas -
Analysis 3.1

Comparison 3 Timing of feeding, Outcome 1 Case fatality at end of trial.

Comparison 3 Timing of feeding, Outcome 2 Death or disabled at end of trial.
Figuras y tablas -
Analysis 3.2

Comparison 3 Timing of feeding, Outcome 2 Death or disabled at end of trial.

Comparison 3 Timing of feeding, Outcome 3 Institutionalisation.
Figuras y tablas -
Analysis 3.3

Comparison 3 Timing of feeding, Outcome 3 Institutionalisation.

Comparison 4 Fluid supplementation, Outcome 1 Time to resolution of dysphagia (days).
Figuras y tablas -
Analysis 4.1

Comparison 4 Fluid supplementation, Outcome 1 Time to resolution of dysphagia (days).

Comparison 5 Nutritional supplementation, Outcome 1 Case fatality at end of trial.
Figuras y tablas -
Analysis 5.1

Comparison 5 Nutritional supplementation, Outcome 1 Case fatality at end of trial.

Comparison 5 Nutritional supplementation, Outcome 2 Death or dependency at end of trial.
Figuras y tablas -
Analysis 5.2

Comparison 5 Nutritional supplementation, Outcome 2 Death or dependency at end of trial.

Comparison 5 Nutritional supplementation, Outcome 3 Institutionalisation.
Figuras y tablas -
Analysis 5.3

Comparison 5 Nutritional supplementation, Outcome 3 Institutionalisation.

Comparison 5 Nutritional supplementation, Outcome 4 Length of stay in hospital (days).
Figuras y tablas -
Analysis 5.4

Comparison 5 Nutritional supplementation, Outcome 4 Length of stay in hospital (days).

Comparison 5 Nutritional supplementation, Outcome 5 Pressure sores.
Figuras y tablas -
Analysis 5.5

Comparison 5 Nutritional supplementation, Outcome 5 Pressure sores.

Comparison 5 Nutritional supplementation, Outcome 6 Energy intake (kcal/day).
Figuras y tablas -
Analysis 5.6

Comparison 5 Nutritional supplementation, Outcome 6 Energy intake (kcal/day).

Comparison 5 Nutritional supplementation, Outcome 7 Protein intake (g/day).
Figuras y tablas -
Analysis 5.7

Comparison 5 Nutritional supplementation, Outcome 7 Protein intake (g/day).

Comparison 5 Nutritional supplementation, Outcome 8 Albumin (last value carried forward).
Figuras y tablas -
Analysis 5.8

Comparison 5 Nutritional supplementation, Outcome 8 Albumin (last value carried forward).

Comparison 1. Swallowing therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Case fatality at end of trial Show forest plot

6

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Behavioural interventions

2

306

Odds Ratio (M‐H, Random, 95% CI)

0.83 [0.46, 1.51]

1.2 Drug therapy

1

17

Odds Ratio (M‐H, Random, 95% CI)

1.14 [0.06, 21.87]

1.3 Pharyngeal electrical stimulation

1

28

Odds Ratio (M‐H, Random, 95% CI)

4.31 [0.19, 98.51]

1.4 Physical stimulation (thermal, tactile)

1

19

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.16, 6.92]

1.5 Transcranial magnetic stimulation

1

26

Odds Ratio (M‐H, Random, 95% CI)

0.26 [0.01, 7.12]

2 Death or dependency at end of trial Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Behavioural interventions

2

306

Odds Ratio (M‐H, Random, 95% CI)

1.05 [0.63, 1.75]

3 Institutionalisation Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Behavioural interventions

2

306

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.39, 1.48]

4 Length of stay (days) Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Behavioural interventions

4

370

Mean Difference (IV, Random, 95% CI)

‐2.70 [‐5.68, 0.28]

5 Chest infection or pneumonia Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Behavioural interventions

5

423

Odds Ratio (M‐H, Random, 95% CI)

0.50 [0.24, 1.04]

5.2 Drug therapy

1

58

Odds Ratio (M‐H, Random, 95% CI)

0.19 [0.02, 1.67]

5.3 Pharyngeal electrical stimulation

1

28

Odds Ratio (M‐H, Random, 95% CI)

0.43 [0.06, 3.09]

6 Dysphagia at end of trial Show forest plot

13

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Acupuncture

4

256

Odds Ratio (M‐H, Random, 95% CI)

0.24 [0.13, 0.46]

6.2 Behavioural interventions

5

423

Odds Ratio (M‐H, Random, 95% CI)

0.52 [0.30, 0.88]

6.3 Drug therapy

1

17

Odds Ratio (M‐H, Random, 95% CI)

0.48 [0.07, 3.35]

6.4 Neuromuscular electrical stimulation

1

22

Odds Ratio (M‐H, Random, 95% CI)

0.43 [0.07, 2.50]

6.5 Physical stimulation (thermal, tactile)

1

7

Odds Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 11.34]

6.6 Transcranial direct current stimulation

1

14

Odds Ratio (M‐H, Random, 95% CI)

0.29 [0.01, 8.39]

7 Pharyngeal transit time (seconds) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Drug therapy

1

17

Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.91, 0.49]

7.2 Pharyngeal electrical stimulation

1

28

Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.51, 0.20]

7.3 Physical stimulation (thermal, tactile)

1

16

Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.34, ‐0.04]

8 Swallow score Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 Acupuncture

3

175

Mean Difference (IV, Random, 95% CI)

‐0.41 [‐1.53, 0.72]

8.2 Neuromuscular electrical stimulation versus behavioural interventions

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8.3 Physical stimulation (thermal, tactile)

1

16

Mean Difference (IV, Random, 95% CI)

1.40 [‐2.58, 5.38]

8.4 Transcranial direct current stimulation

1

14

Mean Difference (IV, Random, 95% CI)

1.0 [‐0.50, 2.50]

9 Nutritional (albumin) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 Behavioural interventions

2

64

Mean Difference (IV, Random, 95% CI)

0.20 [‐4.77, 5.17]

Figuras y tablas -
Comparison 1. Swallowing therapy
Comparison 2. Route of feeding

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Case fatality at end of trial Show forest plot

6

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 PEG versus NGT

5

455

Odds Ratio (M‐H, Random, 95% CI)

0.81 [0.42, 1.56]

1.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

0.60 [0.27, 1.33]

2 Death or dependency at end of trial Show forest plot

4

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 PEG versus NGT

3

400

Odds Ratio (M‐H, Random, 95% CI)

0.80 [0.12, 5.55]

2.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

0.52 [0.18, 1.57]

3 Institutionalisation Show forest plot

3

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 PEG versus NGT

2

364

Odds Ratio (M‐H, Random, 95% CI)

0.62 [0.15, 2.57]

3.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

1.73 [0.78, 3.81]

4 Length of stay in hospital (days) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 PEG versus NGT

2

384

Mean Difference (IV, Random, 95% CI)

14.32 [‐12.04, 40.68]

4.2 NGT with loop versus NGT

1

104

Mean Difference (IV, Random, 95% CI)

7.0 [‐8.48, 22.48]

5 Pressure sores Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 PEG versus NGT

1

321

Odds Ratio (M‐H, Random, 95% CI)

3.1 [0.98, 9.83]

5.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

1.04 [0.28, 3.84]

6 Chest infection or pneumonia Show forest plot

3

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 PEG versus NGT

2

93

Odds Ratio (M‐H, Random, 95% CI)

0.65 [0.23, 1.86]

6.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

0.84 [0.39, 1.84]

7 Dysphagia at end of trial Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

7.1 PEG versus NGT

2

66

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.05, 11.77]

8 Treatment failure Show forest plot

4

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

8.1 PEG versus NGT

3

72

Odds Ratio (M‐H, Random, 95% CI)

0.09 [0.01, 0.51]

8.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

1.67 [0.64, 4.34]

9 Gastrointestinal bleeding Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

9.1 PEG versus NGT

1

321

Odds Ratio (M‐H, Random, 95% CI)

0.25 [0.09, 0.69]

9.2 NGT with loop versus NGT

1

104

Odds Ratio (M‐H, Random, 95% CI)

1.63 [0.43, 6.17]

10 Feed delivery (%) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 PEG versus NGT

1

30

Mean Difference (IV, Random, 95% CI)

22.0 [16.15, 27.85]

10.2 NGT with loop versus NGT

1

104

Mean Difference (IV, Random, 95% CI)

18.0 [6.66, 29.34]

11 Weight at end of trial (last value carried forward) (kg) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

11.1 PEG versus NGT

2

34

Mean Difference (IV, Random, 95% CI)

4.08 [‐4.32, 12.48]

12 Mid‐arm circumference (last value carried forward) (cm) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

12.1 PEG versus NGT

3

58

Mean Difference (IV, Random, 95% CI)

2.29 [‐0.30, 4.89]

13 Albumin (last value carried forward) (g/L) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

13.1 PEG versus NGT

3

63

Mean Difference (IV, Random, 95% CI)

4.92 [0.19, 9.65]

Figuras y tablas -
Comparison 2. Route of feeding
Comparison 3. Timing of feeding

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Case fatality at end of trial Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Early versus late feeding

1

859

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.61, 1.04]

2 Death or disabled at end of trial Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Early versus late feeding

1

859

Odds Ratio (M‐H, Random, 95% CI)

0.94 [0.68, 1.31]

3 Institutionalisation Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Early versus late feeding

1

859

Odds Ratio (M‐H, Random, 95% CI)

1.12 [0.81, 1.56]

Figuras y tablas -
Comparison 3. Timing of feeding
Comparison 4. Fluid supplementation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Time to resolution of dysphagia (days) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Free thin fluids

1

20

Mean Difference (IV, Random, 95% CI)

‐8.10 [‐20.84, 4.64]

Figuras y tablas -
Comparison 4. Fluid supplementation
Comparison 5. Nutritional supplementation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Case fatality at end of trial Show forest plot

7

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 Sip feeding

7

4343

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.28, 1.21]

2 Death or dependency at end of trial Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Sip feeding

1

4023

Odds Ratio (M‐H, Random, 95% CI)

1.06 [0.94, 1.20]

3 Institutionalisation Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Sip feed

1

102

Odds Ratio (M‐H, Random, 95% CI)

0.48 [0.22, 1.07]

4 Length of stay in hospital (days) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Sip feeding

2

4114

Mean Difference (IV, Random, 95% CI)

1.40 [‐0.81, 3.60]

5 Pressure sores Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Sip feeding

2

4125

Odds Ratio (M‐H, Random, 95% CI)

0.56 [0.32, 0.96]

6 Energy intake (kcal/day) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Sip feeding

3

174

Mean Difference (IV, Random, 95% CI)

430.18 [141.61, 718.75]

7 Protein intake (g/day) Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Sip feeding

3

174

Mean Difference (IV, Random, 95% CI)

17.28 [1.99, 32.56]

8 Albumin (last value carried forward) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

8.1 Sip feeding

2

144

Mean Difference (IV, Random, 95% CI)

0.29 [‐0.65, 1.24]

Figuras y tablas -
Comparison 5. Nutritional supplementation