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Exercise‐based swallowing intervention (McNeill Dysphagia Therapy) with adjunctive NMES to treat dysphagia post‐stroke: A double‐blind placebo‐controlled trial
Author(s) -
Carnaby Giselle D.,
LaGorio Lisa,
Silliman Scott,
Crary Michael
Publication year - 2020
Publication title -
journal of oral rehabilitation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.991
H-Index - 93
eISSN - 1365-2842
pISSN - 0305-182X
DOI - 10.1111/joor.12928
Subject(s) - dysphagia , medicine , swallowing , stroke (engine) , physical therapy , rehabilitation , placebo , randomized controlled trial , surgery , mechanical engineering , alternative medicine , pathology , engineering
Background Dysphagia following stroke is prevalent; however, dysphagia treatment is often applied haphazardly and outcomes unclear. Neuromuscular electrical stimulation (NMES) has received increased attention as a treatment for post‐stroke dysphagia; but application data remain conflicted. Objective This study investigated effectiveness and safety of an exercise‐based swallowing therapy (McNeill Dysphagia Therapy: MDTP) +NMES for dysphagia rehabilitation following stroke. Methods Stroke patients (n = 53, x̅ age: 66 [13.2], 47.2% male) with dysphagia admitted to sub‐acute rehabilitation hospital were randomised to MDTP + NMES [NMES], MDTP + sham NMES [MDTP] or usual care [UC] swallowing therapy groups. Patients were treated for 1 hour per day for 3 weeks and monitored to 3 months by a blinded evaluator. Outcomes included clinical swallowing ability, oral intake, weight, patient perception of swallow and occurrence of dysphagia‐related complications. Results Post‐treatment dysphagia severity and treatment response were significantly different between groups ( P ≤ .0001). MDTP demonstrated greater positive change than either NMES or UC arms, including increase in oral intake ( χ 2 = 5, P ≤ .022) and improved functional outcome by 3 months post‐stroke (RR = 1.72, 1.04‐2.84). Exploratory Cox regression revealed the MDTP group conferred the greatest benefit in time to “return to pre‐stroke diet” of 4.317 [95% CI: 1.08‐ 17.2, P < .03]. Conclusion Greater benefit (eg reduction in dysphagia severity, improved oral intake and earlier return to pre‐stroke diet) resulted from a programme of MDTP alone vs NMES or UC.