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Abstract：
Oropharyngeal dysphagia (OD) has significant consequences for both the person with dysphagia and the society. An often-used treatment for OD is the recommendation of the texture of food and liquids. This recommendation seems to be based more on best practice than on evidence from a systematic review of existing scientific evidence. The aim of this paper was to report the result of an up-date of an original national guideline focussing on whether thickened liquids (review question 1) and modified foods (review question 2) are beneficial for adults above 17 years with OD in relation to three critical outcomes (aspiration, pneumonia and death) and seven important outcomes (dehydration, weight loss, mealtime performance, patient preferences, intervention adherence and quality of life).
Three steps were used. First: An updated systematic literature search. Second: An assessment of the quality of the evidence for each review question by means of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Third: Development of clinical recommendations based on the evidence, assessment of the risk benefit ratio, and perceived patient preferences.
The body of evidence consisted of two RCTs for review question 1 both using nectar thickened liquids or honey-thickened liquids. No evidence was found for two important outcomes, mealtime performance and quality of life. With regard to risk of pneumonia, death, aspiration, dehydration, weight loss and intervention adherence no significant differences were found. The outcome addressing patient preferences, found a non-significant increased dissatisfaction with nectar thickened liquids (RR 1.11; 95% CI 0.95-1.30) and a significant increased dissatisfaction with honey thickened liquids compared to thin liquids/chin down (RR 1.18; 95% CI 1.01-1.37). No evidence was identified for review question 2.
Based on the quality of the evidence, assessment of the risk benefit ratio, and perceived patient preferences a weak recommendation against the use of texture modified liquids and good clinical practice pointing for the use of texture modified foods in patients with OD were made.
Three steps were used. First: An updated systematic literature search. Second: An assessment of the quality of the evidence for each review question by means of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Third: Development of clinical recommendations based on the evidence, assessment of the risk benefit ratio, and perceived patient preferences.
The body of evidence consisted of two RCTs for review question 1 both using nectar thickened liquids or honey-thickened liquids. No evidence was found for two important outcomes, mealtime performance and quality of life. With regard to risk of pneumonia, death, aspiration, dehydration, weight loss and intervention adherence no significant differences were found. The outcome addressing patient preferences, found a non-significant increased dissatisfaction with nectar thickened liquids (RR 1.11; 95% CI 0.95-1.30) and a significant increased dissatisfaction with honey thickened liquids compared to thin liquids/chin down (RR 1.18; 95% CI 1.01-1.37). No evidence was identified for review question 2.
Based on the quality of the evidence, assessment of the risk benefit ratio, and perceived patient preferences a weak recommendation against the use of texture modified liquids and good clinical practice pointing for the use of texture modified foods in patients with OD were made.
摘要：
口咽吞咽困难（OD）对吞咽困难患者和社会都有重大影响。OD的常用治疗方法是推荐食物和液体的质地。该建议似乎更多地基于最佳实践，而不是对现有科学证据进行系统审查的证据。本文的目的是报告原始国家指南的最新结果，该指南着重于增稠的液体（审查问题1）和改良食品（审查问题2）是否对17岁以上的OD成年人有益三个关键结果（期望，肺炎和死亡)和七个重要结果(脱水，减肥,用餐时间表现,患者偏好,干预依从性和生活质量)。
使用三个步骤。第一：更新的系统文献检索。第二：通过评估建议的等级来评估每个审查问题的证据质量，开发和评估（等级）系统。第三：根据证据制定临床建议，风险收益比评估，和感知到的患者偏好。
证据主体由两个RCT组成，用于审查问题1，两者都使用花蜜增稠液体或蜂蜜增稠液体。没有发现两个重要结果的证据，用餐时间表现和生活质量。关于肺炎的风险，死亡,抽吸,脱水,体重减轻和干预依从性无显著差异。解决患者偏好的结果，发现与稀薄液体/下巴相比，对花蜜稠化液体的不满情绪没有显着增加（RR1.11;95％CI0.95-1.30），对蜂蜜稠化液体的不满情绪显着增加（RR1.18;95％CI1.01-1.37）。没有发现审查问题2的证据。
根据证据的质量，风险收益比评估，和感知到的患者偏好，对使用质地改良的液体的推荐较弱，并且对OD患者使用质地改良的食物提出了良好的临床实践。
使用三个步骤。第一：更新的系统文献检索。第二：通过评估建议的等级来评估每个审查问题的证据质量，开发和评估（等级）系统。第三：根据证据制定临床建议，风险收益比评估，和感知到的患者偏好。
证据主体由两个RCT组成，用于审查问题1，两者都使用花蜜增稠液体或蜂蜜增稠液体。没有发现两个重要结果的证据，用餐时间表现和生活质量。关于肺炎的风险，死亡,抽吸,脱水,体重减轻和干预依从性无显著差异。解决患者偏好的结果，发现与稀薄液体/下巴相比，对花蜜稠化液体的不满情绪没有显着增加（RR1.11;95％CI0.95-1.30），对蜂蜜稠化液体的不满情绪显着增加（RR1.18;95％CI1.01-1.37）。没有发现审查问题2的证据。
根据证据的质量，风险收益比评估，和感知到的患者偏好，对使用质地改良的液体的推荐较弱，并且对OD患者使用质地改良的食物提出了良好的临床实践。
