Everton Lisa F, Benfield Jacqueline K, Michou Emilia, Hamdy Shaheen, Bath Philip M
Stroke Trials Unit, Mental Health and Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
Speech and Language Therapy, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
Stroke Res Treat. 2021 Jun 7;2021:5520657. doi: 10.1155/2021/5520657. eCollection 2021.
Swallowing impairment (dysphagia) post-stroke results in poorer outcomes. Pharyngeal electrical stimulation (PES) is a potential treatment for post-stroke dysphagia. In a post hoc analysis, we investigated PES using videofluoroscopy swallow studies (VFSS) from the STEPS trial incorporating multiple measures of safety (penetration aspiration scale-PAS), speed and duration (timing), and efficiency (clearance), as opposed to the original trial which only measured PAS scores. 81 randomised participants (PES ( = 43) versus sham ( = 38)) were analysed at baseline and 2 weeks. Participants swallowed up to 6 × 5 ml and 1 × 50 ml of thin liquid barium at 40% /, images at ≥25 fps. Based on PAS, the 5 ml mode bolus (most frequently occurring PAS from 6 × 5 ml) and the worst 50 ml bolus were chosen for further analysis. Eight timing measures were performed, including stage transition duration (STD) and pharyngeal transit time (PTT). Clearance measures comprised oral and pharyngeal residue and swallows to clear. Comparisons of change of scoring outcomes between PES and sham were done at 2 weeks. Wilcoxon Signed Ranks Test was also used to evaluate longitudinal changes from both groups' combined results at two weeks. Between-group analysis showed no statistically significant differences. Issues with suboptimal image quality and frame rate acquisition affected final numbers. At two weeks, both groups demonstrated a significant improvement in most safety scores (PAS) and STD, possibly due to spontaneous recovery or a combination of spontaneous recovery and swallowing treatment and usual care. A nonsignificant trend for improvement was seen in other timing measures, including PTT. This study, which conducted additional measurements of kinematic and residue analysis on the STEPS data did not detect "missed" improvements in swallowing function that the PAS is not designed to measure. However, more studies with greater numbers are required.
中风后吞咽功能障碍（吞咽困难）会导致更差的预后。咽部电刺激（PES）是中风后吞咽困难的一种潜在治疗方法。在一项事后分析中，我们使用来自STEPS试验的视频荧光吞咽造影研究（VFSS）对PES进行了研究，该研究纳入了多种安全性指标（渗透误吸量表 - PAS）、速度和持续时间（时间）以及效率（清除率），而原始试验仅测量PAS评分。对81名随机分组的参与者（PES组（n = 43）与假刺激组（n = 38））在基线和2周时进行了分析。参与者以40%/的速度吞咽多达6×5毫升和1×50毫升的稀液状钡剂，帧率≥25帧/秒。基于PAS，选择5毫升模式的团块（6×5毫升中最常出现的PAS）和最差的50毫升团块进行进一步分析。进行了八项时间测量，包括阶段转换持续时间（STD）和咽部通过时间（PTT）。清除率指标包括口腔和咽部残留以及清除所需的吞咽次数。在2周时对PES组和假刺激组的评分结果变化进行了比较。还使用Wilcoxon符号秩检验来评估两组在两周时综合结果的纵向变化。组间分析显示无统计学显著差异。图像质量和帧率采集不理想的问题影响了最终数据量。在两周时，两组在大多数安全性评分（PAS）和STD方面均有显著改善，这可能是由于自发恢复或自发恢复与吞咽治疗及常规护理相结合的结果。在其他时间测量指标（包括PTT）中观察到了不显著的改善趋势。这项对STEPS数据进行运动学和残留分析的额外测量的研究，未发现PAS未设计测量的吞咽功能“遗漏”的改善情况。然而，需要更多的大规模研究。
