Table_1_Post-stroke Dysphagia: Prognosis and Treatment–A Systematic Review of RCT on Interventional Treatments for Dysphagia Following Subacute Stroke.DOC

PurposePost-stroke dysphagia is an underdiagnosed but relevant complication, associated with worse outcome, dependency and quality of life of stroke survivors. Detailed mechanisms of post-stroke dysphagia are not very well understood, but established therapeutic concepts are needed. Different interventional studies have been published dealing with post-stroke dysphagia. This systematic review wants to collect and give an overview over the published evidence.
MethodsPubMed, Embase, Cochrane, CINAHL were searched for relevant interventional studies on post-stroke dysphagia in the (sub-)acute setting (within 3 months of stroke onset). The search has been filtered for randomized trials with an inactive control and the relevant data extracted.
ResultsAfter initially finding 2,863 trials, finally 41 trials have been included. Seven different therapeutic concepts have been evaluated (Acupuncture, behavioral/physical therapy, drug therapy, neuromuscular electrical stimulation, pharyngeal electrical stimulation, transcranial direct current stimulation and repetitive transcranial magnetic stimulation). Studies of all modalities have shown some effect on post-stroke dysphagia with several studies raising concerns about the potential bias.
ConclusionThe amount and quality of studies are not enough to suggest certain therapies. Some therapeutical concepts (intensive physical therapy, transcranial magnetic stimulation, drug therapy) seem to be good potential therapeutic options, but further research is needed.

研究目的：卒中后吞咽障碍（post-stroke dysphagia）是一类诊断不足却具有重要临床意义的并发症，与卒中幸存者的不良预后、功能依赖及生活质量下降密切相关。目前对于卒中后吞咽障碍的具体发病机制尚未完全阐明，亟需建立成熟的治疗策略。目前已有多项针对卒中后吞咽障碍的介入研究发表，本系统综述旨在收集并梳理已发表的相关证据。
研究方法：本研究检索了PubMed、Embase、Cochrane图书馆及CINAHL数据库，筛选卒中发病后3个月内的亚急性/急性期卒中后吞咽障碍介入相关研究；进一步将检索结果限定为设置空白对照的随机对照试验，并提取相关研究数据。
研究结果：初步检索共获得2863项试验，最终纳入41项符合标准的研究。本综述共评估了7种不同的治疗方案：针灸（Acupuncture）、行为/物理治疗（behavioral/physical therapy）、药物治疗（drug therapy）、神经肌肉电刺激（neuromuscular electrical stimulation）、咽部电刺激（pharyngeal electrical stimulation）、经颅直流电刺激（transcranial direct current stimulation）及重复经颅磁刺激（repetitive transcranial magnetic stimulation）。各类干预方式的研究均显示出对卒中后吞咽障碍的一定改善效果，但部分研究存在潜在偏倚风险，引发学界关注。
研究结论：现有研究的数量与质量均不足以支持推荐特定治疗方案。部分治疗策略（强化物理治疗、经颅磁刺激、药物治疗）展现出良好的应用潜力，但仍需开展更多高质量研究以进一步验证其疗效与安全性。