Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
Speech and Language Therapy Department, St James' Hospital, James' Street, Dublin 8, D08 NHY1, Ireland.
BMC Cancer. 2022 Jan 10;22(1):53. doi: 10.1186/s12885-021-09155-y.
Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area.
Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes.
Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have 'serious' to 'critical' risk of bias.
This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.
吞咽困难在食管癌中很常见，会带来显著的临床和心理社会并发症。本研究的目的是：i）研究基于运动的吞咽困难康复对该人群的临床和生活质量结局的影响；ii）确定可能为该领域的未来研究提供信息的关键康复组成部分。
纳入了随机对照试验（RCT）、非随机对照试验、队列研究和病例系列研究。于 2020 年 11 月检索了 10 个数据库（CINAHL Complete、MEDLINE、EMBASE、Web of Science、CENTRAL 以及 ProQuest Dissertations and Theses、OpenGrey、PROSPERO、RIAN 和 SpeechBITE）、3 个临床试验注册处和相关会议摘要。两名独立作者在完成数据提取、使用 ROBINS-I 和 Downs 和 Black 清单进行质量评估之前，评估文章的入选资格，然后进行描述性数据分析。主要结局包括口服摄入、呼吸状况和生活质量。所有可比结局均在全文中作为主要和次要结局进行了组合和讨论。
纳入了 3 项涉及 311 名参与者的单中心非随机对照研究。由于研究异质性，无法进行荟萃分析。言语治疗师主导的术后吞咽困难干预可显著更早开始口服摄入，并缩短术后住院时间。没有研究发现降低吸入性肺炎发生率的情况，也没有研究纳入患者报告或生活质量结局。在所报告的次要结局中，与对照组相比，食管手术后的吞咽预康复可显著提高吞咽效率，手术后的康复可显著减少会厌谷和梨状隐窝的残留。这 3 项研究被认为存在“严重”到“关键”的偏倚风险。
本系统评价强调了支持食管癌手术后成人进行基于运动的吞咽困难康复的低数量、低质量证据。由于吞咽困难是影响生存期间生活质量的常见症状，研究结果将指导未来的研究，以确定吞咽康复是否应纳入术后强化恢复（ERAS）方案。本综述受到纳入非随机对照试验和依赖日本解释的限制，这可能导致偏倚。综述中的研究设计均较弱，报告的数据有限。
