Swallowing Rehabilitation Research Laboratory, Toronto Rehabilitation Institute-University Health Network, Ontario, Canada.
Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Ontario, Canada.
Am J Speech Lang Pathol. 2022 Jan 18;31(1):463-485. doi: 10.1044/2021_AJSLP-21-00145. Epub 2021 Dec 10.
Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD.
Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures.
Interventions were classified as follows: pharmacological ( = 11), neurostimulation ( = 8), and behavioral ( = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS ( = 17), FEES ( = 6), and EMG ( = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa.
Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD.
吞咽困难是帕金森病（PD）的常见后遗症，与营养不良、吸入性肺炎和死亡率有关。本文综述了 PD 患者吞咽困难干预措施的有效性证据。
在 Ovid MEDLINE、Embase、Cochrane 对照试验中心注册库、CINAHL 和 speechBITE 中进行电子检索。在确定的 2015 篇文章中，有 26 篇符合纳入标准：针对 PD 相关吞咽困难患者的吞咽困难干预措施的干预或观察性研究，至少有 5 名或更多参与者，使用视频透视吞咽研究（VFSS）、纤维光学吞咽评估（FEES）或肌电图（EMG）测量结果。使用证据项目工具和关于吞咽结果测量严谨性的预定标准评估偏倚风险（RoB）。
干预措施分为以下几类：药理学（ = 11）、神经刺激（ = 8）和行为（ = 7）。研究的主要结果指标各不相同，包括吞咽时间、安全性和效率，并使用 VFSS（ = 17）、FEES（ = 6）和 EMG（ = 4）进行测量。对研究结果的 RoB、方法严谨性和透明度进行批判性评估表明，大多数研究未能充分描述使用的对比剂、信号采集设置以及对时间点的评估者盲法。低确定性证据普遍表明，生物反馈和深部脑刺激（DBS）的练习可改善吞咽时间，DBS 和呼气肌力量训练可提高安全性，Lee Silverman 语音治疗和左旋多巴可提高效率。
具有较低 RoB 和更大实验严谨性的研究表明，在提高吞咽效率方面有潜在益处，但在安全性方面没有。需要进一步研究干预后吞咽生理变化的离散变化，以指导 PD 患者的吞咽困难管理。
