Abstract
Objective
To investigate the effectiveness of noninvasive neurostimulation therapies in patients
with poststroke dysphagia.
Data Sources
Electronic databases, including Embase, PubMed, Scopus, and the Cochrane Library,
were searched up to May 31, 2018.
Study Selection
All published randomized controlled trials (RCTs) comparing neurostimulation therapies,
including repetitive transcranial magnetic stimulation (rTMS), transcranial direct
current stimulation (tDCS), surface neuromuscular electrical stimulation (sNMES),
and pharyngeal electrical stimulation (PES), in patients with acute and subacute poststroke
dysphagia were included. Nineteen RCTs were enrolled in the meta-analysis.
Data Extraction
Full texts were independently reviewed. Two independent raters assessed the risk of
bias of RCTs with the Cochrane risk-of-bias tool. The primary outcome measure was
swallowing function evaluated before and after neurostimulation therapy.
Data Synthesis
Both pairwise and network meta-analysis revealed that rTMS, tDCS, and sNMES significantly
improved poststroke dysphagia compared with placebo. Differences in functional improvement
between PES and placebo were not significant. Based on probability ranking, rTMS seemed
the best treatment among the 4 neurostimulation therapies. In the network meta-analysis,
rTMS showed the best efficacy compared with placebo (standardized mean difference=1.02,
95% confidence interval, 0.61-1.43).
Conclusions
Among the 4 noninvasive neurostimulation therapies, rTMS, tDCS, and sNMES were effective
for treating poststroke dysphagia; furthermore, rTMS may be the most effective therapy
according to probability ranking.
Keywords
List of abbreviations:
CI (confidence interval), NIBS (noninvasive brain stimulation), PES (pharyngeal electrical stimulation), RCT (randomized controlled trial), rTMS (repetitive transcranial magnetic stimulation), SMD (standardized mean difference), sNMES (surface neuromuscular electrical stimulation), tDCS (transcranial direct current stimulation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 20, 2018
Footnotes
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
