Introduction: Dysphagia rehabilitation is used to improve swallowing function in patients with brainstem strokes. However, there is variety in types of rehabilitation exercises and delivery protocols. The aim of this systematic review was to explore and synthesise the effectiveness of dysphagia rehabilitation on swallow function in inpatients with brainstem stroke.
Methods: Five electronic databases were searched using a pre-specified criteria in November 2023. Independent screening, data extraction and quality ratings (via the Mixed Methods Appraisal Tool) were completed. Narrative synthesis was used to describe study characteristics, intervention details and study outcomes. Meta-analyses were completed when three or more randomised control trials on one intervention were available.
Results: In the 11 studies included, there were 437 participants with 250 (57.2%) males with an age range of 32 to 95 years. The most common intervention was strengthening/oromotor exercises (5 studies), however most of these were observational studies. In three studies, with 75 participants, stroke patients who received Repetitive Transcranial Magnetic Stimulation (rTMS) had large improvements in swallow function post intervention compared to controls (SMD 1.52, 95% CI,0.77 to 2.26, I2 42%).
Conclusion: rTMS improved swallow function for brainstem strokes. Further research is required in this area to further determine the optimal protocol and dosage of rTMS as well as effectiveness and dosage of non-transcranial stimulation interventions given their common use in Australian inpatient settings.
Relevance to clinical practice or patient experience: This study highlights the effectiveness of rTMS in brainstem stroke dysphagia rehabilitation