Abstract
Objective
To describe and systematically review the current evidence on the effects of swallow
therapy augmented by biofeedback in adults with dysphagia (PROSPERO 2016:CRD42016052942).
Data Sources
Two independent reviewers conducted searches that included MEDLINE, EMBASE, trial
registries, and gray literature up to December 2016.
Study Selection
Randomized controlled trials (RCTs) and non-RCTs were assessed, including for risk
of bias and quality.
Data Extraction
Data were extracted by 1 reviewer and verified by another on biofeedback type, measures
of swallow function, physiology and clinical outcome, and analysed using Cochrane
Review Manager (random effects models). Results are expressed as weighted mean difference
(WMD) and odds ratio (OR).
Data Synthesis
Of 675 articles, we included 23 studies (N=448 participants). Three main types of
biofeedback were used: accelerometry, surface electromyography (sEMG), and tongue
manometry. Exercises included saliva swallows, maneuvers, and strength exercises.
Dose varied between 6 and 72 sessions for 20-60 minutes. Five controlled studies (stroke
n=95; head and neck cancer n=33; mixed etiology n=10) were included in meta-analyses.
Compared to control, biofeedback augmented dysphagia therapy significantly enhanced
hyoid displacement (3 studies, WMD=0.22cm; 95% confidence interval [CI] [0.04, 0.40],
P=.02) but there was no significant difference in functional oral intake (WMD=1.10;
95% CI [-1.69, 3.89], P=.44) or dependency on tube feeding (OR =3.19; 95% CI [0.16, 62.72], P=.45). Risk of bias was high and there was significant statistical heterogeneity between
trials in measures of swallow function and number tube fed (I2 70%-94%). Several nonvalidated outcome measures were used. Subgroup analyses were
not possible due to a paucity of studies.
Conclusions
Dysphagia therapy augmented by biofeedback using sEMG and accelerometry enhances hyoid
displacement but functional improvements in swallowing are not evident. However, data
are extremely limited and further larger well-designed RCTs are warranted.
Keywords
List of abbreviations:
CI (confidence interval), FOIS (Functional Oral Intake Scale), MD (mean difference), NIHR (National Institute for Health Research), OR (odds ratio), PD (Parkinson disease), RCT (randomized controlled trial), sEMG (surface electromyography), WMD (weighted mean difference)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: May 30, 2018
Footnotes
Jacqueline K. Benfield’s PhD Studentship is funded by the National Institute for Health Research (NIHR) and Collaboration for Leadership in Applied Health Research and Care (CLAHRC). The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health. Philip M. Bath is Stroke Association Professor of Stroke Medicine and is a NIHR Senior Investigator.
Clinical Trial Registration No.: 2016:CRD42016052942.
Disclosures: Philip Bath reports financial relationships with Platelet Solutions Ltd, Diamedica, Nestle, Phagenesis Ltd, ReNeuron, Athysys, and Covidien, outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
