We searched electronic literature for randomised and quasi-randomised trials and bibliography lists of included studies to March 2020. Study screening, data extraction, risk of bias and quality assessments were conducted independently by two reviewers. Meta-analysis used fixed effects modelling. The systematic review protocol is registered and published.
We identified 22 studies (19 stroke, 2 intensive care stroke and 1 general intensive care) testing 9 interventions and representing 1700 patients. Swallowing treatment showed no evidence of a difference in the time to return to oral intake (n = 33, MD (days) - 4.5, 95% CI - 10.6 to 1.6, 1 study, P = 0.15) (very low certainty) or in aspiration following treatment (n = 113, RR 0.79, 95% CI 0.44 to 1.45, 4 studies, I2 = 0%, P = 0.45) (low certainty). Swallowing treatment showed evidence of a reduced risk of pneumonia (n = 719, RR 0.71, 95% CI 0.56 to 0.89, 8 studies, I2 = 15%, P = 0.004) (low certainty) but no evidence of a difference in swallowing quality of life scores (n = 239, MD - 11.38, 95% CI - 23.83 to 1.08, I 2 = 78%, P = 0.07) (very low certainty).
There is limited evidence for the effectiveness of swallowing treatments in the acute and critical care setting. Clinical trials consistently measuring patient-centred outcomes are needed.
我们搜索了截至2020年3月的随机和准随机试验以及纳入研究的参考书目列表的电子文献。研究筛选,数据提取,偏倚风险和质量评估由两名评审员独立进行.Meta分析采用固定效应模型。注册并发布系统审查方案。
我们确定了22项研究(19项中风,2例重症监护中风和1例一般重症监护)测试9例干预措施,代表1700例患者。吞咽治疗没有证据表明恢复口服摄入的时间有差异(n=33,MD(天)-4.5,95%CI-10.6至1.6,1项研究,P=0.15)(非常低的确定性)或治疗后的误吸(n=113,RR0.79,95%CI0.44至1.45,4项研究,I2=0%,P=0.45)(低确定性)。吞咽治疗显示肺炎风险降低的证据(n=719,RR0.71,95%CI0.56至0.89,8项研究,I2=15%,P=0.004)(低确定性),但没有证据表明吞咽生活质量评分存在差异(n=239,MD-11.38,95%CI-23.83至1.08,I2=78%,P=0.07)(非常低的确定性)。
在急性和重症监护环境中吞咽治疗的有效性证据有限。需要持续测量以患者为中心的结果的临床试验。