Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Oct 30;10(10):CD000323.
doi: 10.1002/14651858.CD000323.pub3.

Swallowing therapy for dysphagia in acute and subacute stroke

Philip M Bath  1 , Han Sean Lee, Lisa F Everton
Affiliations
Meta-Analysis

Swallowing therapy for dysphagia in acute and subacute stroke

Philip M Bath et al. Cochrane Database Syst Rev. .

Abstract

Background: Dysphagia (swallowing problems), which is common after stroke, is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay. Treatments provided to improve dysphagia are aimed at accelerating recovery of swallowing function and reducing these risks. This is an update of the review first published in 1999 and updated in 2012.

Objectives: To assess the effects of swallowing therapy on death or dependency among stroke survivors with dysphagia within six months of stroke onset.

Search methods: We searched the Cochrane Stroke Group Trials Register (26 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 26 June 2018), MEDLINE (26 June 2018), Embase (26 June 2018), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (26 June 2018), Web of Science Core Collection (26 June 2018), SpeechBITE (28 June 2016), ClinicalTrials.Gov (26 June 2018), and the World Health Organization International Clinical Trials Registry Platform (26 June 2018). We also searched Google Scholar (7 June 2018) and the reference lists of relevant trials and review articles.

Selection criteria: We sought to include randomised controlled trials (RCTs) of interventions for people with dysphagia and recent stroke (within six months).

Data collection and analysis: Two review authors independently applied the inclusion criteria, extracted data, assessed risk of bias, used the GRADE approach to assess the quality of evidence, and resolved disagreements through discussion with the third review author (PB). We used random-effects models to calculate odds ratios (ORs), mean differences (MDs), and standardised mean differences (SMDs), and provided 95% confidence intervals (CIs) for each.The primary outcome was functional outcome, defined as death or dependency (or death or disability), at the end of the trial. Secondary outcomes were case fatality at the end of the trial, length of inpatient stay, proportion of participants with dysphagia at the end of the trial, swallowing ability, penetration aspiration score, or pneumonia, pharyngeal transit time, institutionalisation, and nutrition.

Main results: We added 27 new studies (1777 participants) to this update to include a total of 41 trials (2660 participants).We assessed the efficacy of swallowing therapy overall and in subgroups by type of intervention: acupuncture (11 studies), behavioural interventions (nine studies), drug therapy (three studies), neuromuscular electrical stimulation (NMES; six studies), pharyngeal electrical stimulation (PES; four studies), physical stimulation (three studies), transcranial direct current stimulation (tDCS; two studies), and transcranial magnetic stimulation (TMS; nine studies).Swallowing therapy had no effect on the primary outcome (death or dependency/disability at the end of the trial) based on data from one trial (two data sets) (OR 1.05, 95% CI 0.63 to 1.75; 306 participants; 2 studies; I² = 0%; P = 0.86; moderate-quality evidence). Swallowing therapy had no effect on case fatality at the end of the trial (OR 1.00, 95% CI 0.66 to 1.52; 766 participants; 14 studies; I² = 6%; P = 0.99; moderate-quality evidence). Swallowing therapy probably reduced length of inpatient stay (MD -2.9, 95% CI -5.65 to -0.15; 577 participants; 8 studies; I² = 11%; P = 0.04; moderate-quality evidence). Researchers found no evidence of a subgroup effect based on testing for subgroup differences (P = 0.54). Swallowing therapy may have reduced the proportion of participants with dysphagia at the end of the trial (OR 0.42, 95% CI 0.32 to 0.55; 1487 participants; 23 studies; I² = 0%; P = 0.00001; low-quality evidence). Trial results show no evidence of a subgroup effect based on testing for subgroup differences (P = 0.91). Swallowing therapy may improve swallowing ability (SMD -0.66, 95% CI -1.01 to -0.32; 1173 participants; 26 studies; I² = 86%; P = 0.0002; very low-quality evidence). We found no evidence of a subgroup effect based on testing for subgroup differences (P = 0.09). We noted moderate to substantial heterogeneity between trials for these interventions. Swallowing therapy did not reduce the penetration aspiration score (i.e. it did not reduce radiological aspiration) (SMD -0.37, 95% CI -0.74 to -0.00; 303 participants; 11 studies; I² = 46%; P = 0.05; low-quality evidence). Swallowing therapy may reduce the incidence of chest infection or pneumonia (OR 0.36, 95% CI 0.16 to 0.78; 618 participants; 9 studies; I² = 59%; P = 0.009; very low-quality evidence).

Authors' conclusions: Moderate- and low-quality evidence suggests that swallowing therapy did not have a significant effect on the outcomes of death or dependency/disability, case fatality at the end of the trial, or penetration aspiration score. However, swallowing therapy may have reduced length of hospital stay, dysphagia, and chest infections, and may have improved swallowing ability. However, these results are based on evidence of variable quality, involving a variety of interventions. Further high-quality trials are needed to test whether specific interventions are effective.

PubMed Disclaimer

Conflict of interest statement

PB was chief investigator of two included trials (Bath 1997, academic; STEPS 2016, commercial ‐ funded by Phagenesis Ltd); he consults for this company and receives honoraria and expenses for this work; he did not contribute to decisions on PES studies including deciding which trials should be included and extracting outcome data. No pharmaceutical or device companies, or other commercial entities, were involved in data analysis, data interpretation, writing of this review, or comments on it.

SL: none known.

LE: none known.

Figures

1
1
Study Flow Diagram, *86 studies awaiting classification.
2
2
'Risk of bias' graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Bai 2007i {published data only}
    1. Bai J, Li B, Wang Z, Gao W, Wang L. The role of different needling manipulation in adjusting swallow period obstacle of dysphagia after stroke. Zhongguo Zhenjiu 2007;27(1):35‐7. - PubMed
Bai 2007ii {published data only}
    1. Bai J, Li B, Wang Z, Gao W, Wang L. The role of different needling manipulation in adjusting swallow period obstacle of dysphagia after stroke. Zhongguo Zhenjui 2007;27(1):35‐7. - PubMed
Bath 1997 {unpublished data only}
    1. Bath PMW, Kerr J, Collins M. Factorial trial of swallowing versus conventional therapy, and PEG versus nasogastric tube feeding, in dysphagic patients with recent stroke. Data on file 1997.
Carnaby 2006i {published and unpublished data}
    1. Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurology 2006;5:31‐7. - PubMed
    1. Mann G, Baxter K, Hankey G, Davis B, Stewart‐Wynne E. Treatment for swallowing disorders following acute stroke: a randomised controlled trial. Stroke Society of Australia Annual Scientific Meeting. 1997.
    1. Mann G, Hankey G, Davis B, Stewart‐Wynne E. Swallowing therapy after acute stroke study (STAASS): where are we now?. Journal of Clinical Neuroscience 1999;6(3):281.
Carnaby 2006ii {published data only}
    1. Carnaby G, Hankey GJ, Pizzi J. Behavioural interventions for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurology 2006;5:31‐7. - PubMed
Chan 2012 {published data only}
    1. Chan S, Or K, Sun W, Ng K, Lo S, Lee Y. Therapeutic effects of acupuncture for neurogenic dysphagia ‐ a randomized controlled trial. Journal of Traditional Chinese Medicine 2012;32(1):25‐30. - PubMed
Chen 2016a {published data only}
    1. * Chen L, Fang J, Ma R, Gu X, Chen L, Li J, et al. Additional effects of acupuncture on early comprehensive rehabilitation in patients with mild to moderate acute ischemic stroke: a multicenter randomized controlled trial. BMC Complementary and Alternative Medicine 2016;16:226. - PMC - PubMed
    1. Chen L, Fang J, Ma R, Froym R, Gu X, Li J, et al. Acupuncture for acute stroke: study protocol for a multicenter, randomized, controlled trial. Trials 2014;15:214. - PMC - PubMed
Du 2016i {published data only}
    1. Du J, Yang F, Liu L, Hu J, Cai B, Liu W, et al. Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: a randomized, double‐blind clinical trial. Clinical Neurophysiology 2016;127:2907‐13. - PubMed
Du 2016ii {published data only}
    1. Du J, Yang F, Liu L, Hu J, Cai B, Liu W, et al. Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: a randomized, double‐blind clinical trial. Clinical Neurophysiology 2016;127:2907‐13. - PubMed
Feng 2012 {published data only}
    1. Feng X, Hao W, Ding Z, Sui Q, Guo H, Fu J. Clinical study on tongyan spray for post‐stroke dysphagia patients: a randomized controlled trial. Chinese Journal of Integrative Medicine 2012;18(5):345‐9. - PubMed
Han 2004 {published data only}
    1. Han JC. An observation on the therapeutic effect of acupuncture for bulbar palsy after acute stroke. Henan Journal of Practical Nervous Diseases 2004;7(3):81‐2.
Heo 2015 {published data only}
    1. Heo SY, Kim KM. Immediate effects of kinesio taping on the movement of the hyoid bone and epiglottis during swallowing by stroke patients with dysphagia. Journal of Physical Therapy Science 2015;27:3355–7. - PMC - PubMed
Huang 2010 {published data only}
    1. Huang Z, Huang F, Yan HX, Min Y, Gao Y, Tan BD, et al. Dysphagia after stroke treated with acupuncture or electric stimulation: a randomized controlled trial. Zhongguo Zhen Jiu 2010;30(12):969‐73. - PubMed
Jayasekeran 2010a {published data only}
    1. Jayasekeran V, Singh S, Tyrrell P, Michou E, Jefferson S, Mistry S, et al. Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lesions. Gastroenterology 2010;138(5):1737‐46. - PubMed
Jayasekeran 2010b {published data only}
    1. Jayasekeran V, Singh S, Tyrrell P, Michou E, Jefferson S, Mistry S, et al. Adjunctive functional pharyngeal electrical stimulation reverses swallowing disability after brain lesions. Gastroenterology 2010;138(5):1737‐46. - PubMed
Jia 2006a {published data only}
    1. Jia H, Zhang Y. Treatment of 40 cases of post‐apoplectic dysphagia by acupuncture plus rehabilitation exercise. Journal of Acupuncture and Tuina Science 2006;4(6):336‐8.
Kang 2012 {published data only}
    1. Kang J, Park R, Lee S, Kim J, Yoon S, Jung K. The effect of bedside exercise program on stroke patients with dysphagia. Annals of Rehabilitation Medicine 2012;26:512‐20. - PMC - PubMed
Khedr 2009 {published data only}
    1. Khedr EM, Abo‐Elfetoh N, Rothwell JC. Treatment of post‐stroke dysphagia with repetitive transcranial magnetic stimulation. Acta Neurologica Scandinavica 2009;119(3):155‐61. - PubMed
Khedr 2010 {published data only}
    1. Khedr EM, Abo‐Elfetoh N. Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. Journal of Neurology Neurosurgery and Psychiatry 2010;81:495‐9. - PubMed
Kim 2012i {published data only}
    1. Kim L, Chun MH, Kim BR, Lee SJ. Effect of repetitive transcranial magnetic stimulation on patients with brain injury and dysphagia. Annals of Rehabilitation Medicine 2011;35:765‐71. - PMC - PubMed
Kim 2012ii {published data only}
    1. Kim L, Chun MH, Kim BR, Lee SJ. Effect of repetitive transcranial magnetic stimulation on patients with brain injury and dysphagia. Annals of Rehabilitation Medicine 2011;35:765‐71. - PMC - PubMed
Kumar 2011 {published data only}
    1. Kumar S, Wagner CW, Frayne C, Zhu L, Selim M, Feng W, et al. Noninvasive brain stimulation may improve stroke‐related dysphagia: a pilot study. Stroke 2011;42(4):1035‐40. - PMC - PubMed
    1. NCT01132066. Transcranial direct current stimulation (TDCS) for facilitating swallowing improvement after an acute unilateral hemispheric stroke. clinicaltrials.gov/show/NCT01132066 (first received 27 May 2010).
Lee 2014 {published data only}
    1. Lee KW, Kim SB, Lee JH, Lee SJ, Ri JW, Park JG. The effect of early neuromuscular electrical stimulation therapy in acute/subacute ischemic stroke patients with dysphagia. Annals of Rehabilitation Medicine 2014;38(2):153‐9. - PMC - PubMed
Lee 2015 {published data only}
    1. Lee JS, Chui PY, Ma HM, Auyeung TW, Kng C, Law T, et al. Does low dose angiotensin converting enzyme inhibitor prevent pneumonia in older people with neurologic dysphagia ‐ a randomized placebo‐controlled trial. Journal of the American Medical Directors Association 2015;16(8):702‐7. - PubMed
Li 2014 {published data only}
    1. Li L, Shi J, Yin J, Qiao B, Li Y, Huang R. Study of transcutaneous neuromuscular electrical stimulation (VitalStim) therapy for post‐stroke dysphagia. European Journal of Physical and Rehabilitation Medicine 2014;Jul:23. - PubMed
Lim 2009 {published data only}
    1. Lim KB, Lee HJ, Lim SS, Choi YI. Neuromuscular electrical and thermal‐tactile stimulation for dysphagia caused by stroke: a randomized controlled trial. Journal of Rehabilitation Medicine 2009;41(3):174‐8. - PubMed
Liu 2000 {published data only}
    1. Liu L. Acupuncture treatment of bulbar palsy ‐ a report of 54 cases. Journal of Traditional Chinese Medicine 2000;20(1):30‐2. - PubMed
Liu 2004 {published data only}
    1. Liu Y. Treatment of pseudobulbar paralysis by scalp acupuncture and sublingual needling. Journal of Traditional Chinese Medicine 2004;24(1):26‐7. - PubMed
Park 2012 {published data only}
    1. Park J, Kim Y, Oh J, Lee H. Effortful swallowing training combined with electrical stimulation in post‐stroke dysphagia: a randomized controlled study. Dysphagia 2012;27:521‐7. - PubMed
Park 2013 {published data only}
    1. Park J, Oh J, Lee J, Yeo J, Ryu KH. The effect of 5Hz high‐frequency rTMS over contralesional pharyngeal motor cortex in post‐stroke oropharyngeal dysphagia: a randomized controlled study. Neurogastroenterology and Motility 2013;25:324–e250. - PubMed
Park 2016a (i) {published data only}
    1. Park E, Kim MS, Chang WH, Oh SM, Kim YK, Lee A, Kim Y. Effects of bilateral repetitive transcranial magnetic stimulation on post‐stroke dysphagia. Brain Stimulation 2017;10:75‐82. - PubMed
Park 2016a (ii) {published data only}
    1. Park E, Kim MS, Chang WH, Oh SM, Kim YK, Lee A, Kim Y. Effects of bilateral repetitive transcranial magnetic stimulation on post‐stroke dysphagia. Brain Stimulation 2017;10:75‐82. - PubMed
Park 2016b {published data only}
    1. Park JS, Oh DH, Chang MY, Kim KM. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. Journal of Oral Rehabilitation 2016;43:364‐72. - PubMed
Perez 1997 {published and unpublished data}
    1. Perez I, Smithard DG, Davies H, Kalra L. Pharmacological treatment of dysphagia in stroke. Dysphagia 1998;13:12‐6. - PubMed
    1. Smithard D, Perez I, Kalra L. Pharmacological treatment of dysphagia in stroke. Age and Ageing 1997;26 Suppl 1:40. - PubMed
    1. Smithard D, Perez I, Kalra L. Pharmacological treatment of dysphagia in stroke. Cerebrovascular Diseases 1997;7 Suppl 4:36. - PubMed
Power 2006 {published data only}
    1. Power ML, Fraser DH, Hobson A, Singh S, Tyrell P, Nicholson DA, et al. Evaluating oral stimulation as a treatment for dysphagia after stroke. Dysphagia 2006;21(1):49‐55. - PubMed
Shigematsu 2013 {published data only}
    1. Shigematsu T, Fujishima I, Ohno K. Transcranial direct current stimulation improves swallowing function in stroke patients. Neurorehabilitation and Neural Repair 2013;27(4):363‐9. - PubMed
Song 2004 {published data only}
    1. Song QL. Swallowing and ingesting training and nursing in patients with swallowing disorders after stroke. Chinese Journal of Clinical Rehabilitation 2004;8(19):3722‐3.
STEPS 2016 {published data only}
    1. Bath PM, Scutt P, Love J, Clavé P, Cohen D, Dziewas R, et al. Pharyngeal electrical stimulation for treatment of dysphagia in subacute stroke: a randomized controlled trial. Stroke 2016;47:1562‐70. - PMC - PubMed
    1. Love J, Bath PMW. A multi‐centre, double blind, randomised controlled clinical investigation to validate the EPS1 device as a treatment for stroke‐induced dysphagia: a study of Swallowing Treatment using Electrical Pharyngeal Stimulation (STEPS Study). Clinical Investigational Plan. Data on file 2012.
Terre 2015 {published data only}
    1. Terre R, Mearin F. A randomized controlled study of neuromuscular electrical stimulation in oropharyngeal dysphagia secondary to acquired brain injury. European Journal of Neurology 2015;22(4):687‐e44. - PubMed
Vasant 2016 {published data only}
    1. Vasant D, Michou E, Tyrrell P, Jayasekeran V, Mistry S, O'Leary N, et al. Pharyngeal electrical stimulation (PES) In dysphagia post‐acute stroke: a double‐blind, randomised trial. Gut 2014;63(1):A31.
    1. Vasant, DH, Michou E, O'Leary N, Vail A, Mistry S, Hamdy S, et al. Pharyngeal electrical stimulation in dysphagia poststroke: a prospective, randomized single‐blinded interventional study. Neurorehabilitation and Neural Repair 2016;30(9):866‐75. - PubMed
Warusevitane 2015 {published data only}
    1. Warusevitane AB, Karunatilake DS, Sim J, Lally F, Roffe C. Safety and effect of metoclopramide to prevent pneumonia in patients with stroke fed via nasogastric tubes trial. Stroke 2015;46:454‐60. - PubMed
Wei 2005 {published data only}
    1. Wei LL. Effect of shuiti acupoint injection with stellate ganglion block on swallow dysfunction after stroke. Chinese Journal of Clinical Rehabilitation 2005;9(9):106‐7.
Xia 2011 {published data only}
    1. Xia W, Zheng C, Lei Q, Tang Z, Hua Q, Zhang Y, et al. Treatment of post‐stroke dysphagia by vitalStim therapy coupled with conventional swallowing training. Journal of Huazhong University of Science and Technology ‐ Medical Sciences 2011;31(1):73‐6. - PubMed
Xia 2016a {published data only}
    1. Xia W, Zheng C, Zhu, Tang Z. Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? A randomized controlled trial. Clinical Rehabilitation 2016;30(3):237‐46. - PMC - PubMed
Yuan 2003i {published data only}
    1. Yuan ZH, Huang LL, Chen ZL. Coagulant and enteral nutrition agents in the rehabilitation of deglutition disorders for patients with acute stroke. Chinese Journal of Clinical Rehabilitation 2003;7(28):3834‐5.
Yuan 2003ii {published data only}
    1. Yuan MZ, Huang LR, Chen ZL. Coagulant and enteral nutrition agent in the rehabilitation of deglutition disorders for patients with acute stroke. Chinese Journal of Clinical Rehabilitation 2003;7(28):3834‐5.
Zheng 2014 {published data only}
    1. Zheng L, Li Y, Liu Y. The individualized rehabilitation interventions for dysphagia: a multidisciplinary case control study of acute stroke patients. International Journal of Clinical and Experimental Medicine 2014;7(10):3789‐94. - PMC - PubMed

References to studies excluded from this review

Akamatsu 2009 {published data only}
    1. Akamatsu C, Ebihara T, Ishizuka S, Fujii M, Seki K, Arai H, et al. Improvement of swallowing reflex after electrical stimulation to lower leg acupoints in patients after stroke. Journal of the American Geriatric Society 2009;57(10):1959‐60. - PubMed
Aoki 2016 {published data only}
    1. Aoki S, Hosomi N, Hirayama J, Nakamori M, Yoshikawa M, Nezu T, et al. The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients. PLOS ONE 2016;11(5):1‐8. - PMC - PubMed
Arai 2003 {published data only}
    1. Arai T, Ekizawa K. Cabergoline and silent aspiration in elderly patients with stroke. Journal of the American Geriatrics Society 2003;51(12):1815. - PubMed
Beom 2011 {published data only}
    1. Beom J, Kim SJ, Han TR. Electrical stimulation of the suprahyoid muscles in brain‐injured patients with dysphagia: a pilot study. Annals of Rehabilitation Medicine 2011;35:322‐7. - PMC - PubMed
Beom 2015 {published data only}
    1. Beom J, Oh B, Choi KH, Kim W, Song YJ, You DS, et al. Effect of electrical stimulation of the suprahyoid muscles in brain‐injured patients with dysphagia. Dysphagia 2015;30:423‐9. - PubMed
Bülow 2008 {published data only}
    1. Bülow M, Speyer R, Baijens L, Woisard V, Ekberg O. Neuromuscular electrical stimulation (NMES) in stroke patients with oral and pharyngeal dysfunction. Dysphagia 2008;23(3):302‐9. - PubMed
Byeon 2016 {published data only}
    1. Byeon H, Koh HW. Comparison of treatment effect of neuromuscular electrical stimulation and thermal‐tactile stimulation on patients with sub‐acute dysphagia caused by stroke. Journal of Physical Therapy Science 2016;28:1809‐12. - PMC - PubMed
Cai 2015 {published data only}
    1. Cai H, Ma B, Gao X, Gao H. Tongue acupuncture in treatment of post‐stroke dysphagia. International Journal of Clinical and Experimental Medicine 2015;8(8):14090‐4. - PMC - PubMed
Chaudhuri 2006 {published data only}
    1. Chaudhuri G, Brady S, Caldwell R. Electric stimulation for dysphagia flowing stroke: pilot data. Archives of Physical Medicine and Rehabilitation 2006;87(11):e51.
Chen 2002 {published data only}
    1. Chen F, Zhang X. Tongue acupuncture therapy plus ice stimulation for treating 50 cases of dysphagia at the acute stage of sanguineous apoplexy. Henan Traditional Chinese Medicine 2002;22(2):59.
Chen 2003 {published data only}
    1. Chen Y, Li SY, Wang Y. The impression on the deglutition disorders due to pseudobulbar palsy treated with electroacupuncture integrated rehabilitation. Chinese Journal of Clinical Rehabilitation 2003;7(3):430‐1.
ChiCTR‐ONC‐17012326 {published data only}
    1. ChiCTR‐ONC‐17012326. Therapeutic effect of acupuncture and rTMS for dysphagia after unilateral hemispheric stroke of pharyngeal stage: a multi‐center cohort study. www.chictr.org.cn/showproj.aspx?proj=21029 (first received 10 August 2017).
ChiCTR‐TRC‐14005233 {published data only}
    1. ChiCTR‐TRC‐14005233. The application for telemedicine in post‐stroke rehabilitation. www.chictr.org.cn/showprojen.aspx?proj=4343 (first received 16 September 2014).
DePippo 1994 {published data only}
    1. DePippo KL, Holas MA, Reding MJ. Dysphagia therapy following stroke: a controlled trial. Neurology 1993;43:A234‐5. - PubMed
    1. DePippo KL, Holas MA, Reding MJ, Lesser ML, Mandel FS. Dysphagia therapy following stroke: a controlled trial. Neurology 1992;42:249. - PubMed
    1. DePippo KL, Holas MA, Reding MJ, Mandel FS, Lesser ML. Dysphagia therapy following stroke: a controlled trial. Neurology 1994;44:1655‐60. - PubMed
Dou 2012 {published data only}
    1. Dou Z, Zu Y, Wen H, Wan G, Jiang L, Hu Y. The effect of different catheter balloon dilatation modes on cricopharyngeal dysfunction in patients with dysphagia. Dysphagia 2012;27:514‐20. - PubMed
Ebihira 2004 {published data only}
    1. Ebihara T, Takahasi H, Ebihira S, Okazaki T, Sasaki T, Wabanto A, et al. Theophylline improved swallowing reflex in elderly nursing home patients. Jourmal of the American Geriatrics Society 2004;52(10):1787‐8. - PubMed
Ebihira 2005 {published data only}
    1. Ebihara T, Takahashi H, Ebihara S, Okazaki T, Sasaki T, Watando A. Capsaicin trouche for swallowing dysfunction in older people. Journal of American Geriatrics Society 2005;53:824‐8. - PubMed
El‐Tamawy 2015 {published data only}
    1. El‐Tamawy MS, Darwish MH, El‐Azizib HS, Abdelalim AM, Taha SI. The influence of physical therapy on oropharyngeal dysphagia in acute stroke patients. Egyptian Journal of Neurology, Psychiatry and Neurosurgery 2015;52(3):201‐5.
Fraser 2002 {published data only}
    1. Fraser C, Power M, Hamdy S, Rothwell J, Hobday D, Hollander I, et al. Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury. Neuron 2002;34(5):831‐40. - PubMed
Freed 1996 {published data only}
    1. Freed M, Christian MO, Beytas EM, Tucker H, Kotton B. Electrical stimulation of the neck: a new effective treatment for dysphagia. Dysphagia 1996;11:159.
Freed 2001 {published data only}
    1. Freed ML, Freed L, Chatburn RL, Christian M. Electrical stimulation for swallowing disorders caused by stroke. Respiratory Care 2001;46(5):466‐74. - PubMed
Hagg 2015 {published data only}
    1. Hagg M, Tibbling L. Effect of oral IQoro® and palatal plate training in post‐stroke, four‐quadrant facial dysfunction and dysphagia: a comparison study. Acta Oto‐Laryngologica 2015;135(9):962‐8. - PubMed
Inui 2017 {published data only}
    1. Inui Y, Kamakuyra Y, Fukada J, Yoneda M, Kataoka E, Usami Y, et al. Development of pyriform sinus suctioning programs for aspiration pneumonia prevention during the acute stroke. Dysphagia 2017;32:767‐76. - PubMed
ISRCTN18137204 {published data only}
    1. ISRCTN18137204. Benefit of PHAryngeal electrical STimulation for early de‐cannulation in TRACheotomised stroke patients with neurogenic dysphagia: a prospective randomized single‐blinded interventional study (PHAST TRAC study). www.isrctn.com/ISRCTN18137204 (first received 23 February 2015).
    1. Minten J, Tweel I, Dziewas R, Bath PM, Hamdy S. Benefit of PHAryngeal electrical STimulation for early de‐cannulation in TRACheotomised stroke patients with neurogenic dysphagia: a prospective randomised single‐blinded interventional study (PHAST TRAC study). Data on file 2015. - PubMed
ISRCTN97286108 {published data only}
    1. ISRCTN97286108. Non‐invasive brain stimulation for dysphagia after acute stroke. http://www.isrctn.com/ISRCTN97286108 (first received 2 April 2015).
Jin 2014a {published data only}
    1. Jin HP, Wu QY, Zhang W, Xie JJ, Chen JC. Post‐stroke dysphagia in chronic stage treated with magnetic‐ball sticking therapy at the auricular points: a randomized controlled trial. Zhongguo Zhen Jiu 2014;34(1):9‐14. - PubMed
KCT0001907 {published data only}
    1. KCT0001907. Effects of neuromuscular electrical stimulation according to electrode placement in stroke patients with dysphagia. cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=6225 (first received 4 August 2015).
Kikuchi 2014 {published data only}
    1. Kikuchi A, Seki T, Takayama S, Ishizuka S, Yaegashi N. Effect of press needles on swallowing reflex in older adults with cerebrovascular disease: a randomized double‐blind controlled trial. Journal of the American Geriatrics Society 2014;62(12):2430‐40. - PubMed
Kobayashi 1996 {published data only}
    1. Kobayashi H, Nakagawa T, Sekizawa K, Arai H, Sasaki H. Levodopa and swallowing reflex. Lancet 1996;348:1320‐1. - PubMed
Kulnik 2015 {published data only}
    1. Kulnik ST, Birring SS, Moxham J, Rafferty GF, Klara L. Does respiratory muscle training improve cough flow in acute stroke? Pilot randomized controlled trial. Stroke 2015;46:447‐53. - PubMed
Kushner 2013 {published data only}
    1. Kushner DS, Peters K, Eroglu ST, Perless‐Carroll M, Johnson‐Greene D. Neuromuscular electrical stimulation efficacy in acute stroke feeding tube‐dependent dysphagia during inpatient rehabilitation. American Journal of Physical Medicine and Rehabilitation 2013;92(6):486‐95. - PubMed
Lan 2013 {published data only}
    1. Lan Y, Xu G, Dou Z, Wan G, Yu F, Lin T. Biomechanical changes in the pharynx and upper sphincter after modified balloon dilatation in brainstem stroke patients with dysphagia. Neurogastroenterology and Motility 2013;25:821‐9. - PubMed
Logemann 2009 {published data only}
    1. Logemann JA, Rademaker A, Pauloski BR, Kelly A, Stangl‐McBreen C, Antinoja J, et al. A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study. Dysphagia 2009;24(4):403‐11. - PMC - PubMed
Ma 2014 {published data only}
    1. Ma FX, Cao GP, Li WL. Post‐stroke dysphagia treated with acupoint injection combined with neural electrical stimulation. Zhongguo Zhenjiu 2014;34(12):1169‐73. - PubMed
Ma 2015 {published data only}
    1. Ma JN, Wang ZL, Ning LN, Yang H, Xiong J. Observation on therapeutic effects of acupuncture combined with cutaneous electrical stimulation for dysphagia in patients with cerebral infarction. Chen Tzu Yen Chiu Acupuncture Research 2015;40(3):238‐41. - PubMed
Maeda 2017 {published data only}
    1. Maeda K, Koga T, Akagi J. Interferential current sensory stimulation, through the neck skin, improves airway defense and oral nutrition intake in patients with dysphagia: a double‐blind randomized controlled trial. Clinical Interventions in Aging 2017;12:1879‐86. - PMC - PubMed
Mao 2016 {published data only}
    1. Mao L, Li L, Mao Z, Han Y, Zhang X, Yao J, Li M. Therapeutic effect of acupuncture combining standard swallowing training for post‐stroke dysphagia: a prospective cohort study. Chinese Journal of Integrative Medicine 2016;22(7):525‐31. - PubMed
McCullough 2012 {published data only}
    1. McCullough GH, Kamarunas E, Mann GC, Schmidley JW, Robbins JA, Crary MA. Effects of Mendelsohn maneuver on measures of swallowing duration post‐stroke. Topics in Stroke Rehabilitation 2012;19(3):234‐43. - PMC - PubMed
McCullough 2013 {published data only}
    1. McCullough GH, Kim Y. Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post‐stroke. Dysphagia 2013;28:511‐9. - PMC - PubMed
Mepani 2009 {published data only}
    1. Mepani R, Antonik S, Massey B, Kern M, Logemann J, Pauloski B, et al. Augmentation of deglutitive thyrohyoid muscle shortening by the shaker exercise. Dysphagia 2009;24:26‐31. - PMC - PubMed
Messaggi‐Sartor 2015 {published data only}
    1. Messaggi‐Sartor M, Guillen‐Solà A, Depolo M, Duarte E, Rodríguez DA, Barrera M, et al. Inspiratory and expiratory muscle training in subacute stroke ‐ a randomized clinical trial. American Academy of Neurology 2015;85:564‐72. - PubMed
Michou 2010 {published data only}
    1. Michou E, Mistry S, Jefferson S, Singh S, Rothwell J, Hamdy S. Addressing oropharyngeal dysphagia post stroke with neurostimulation interventions: a pilot study. International Journal of Stroke 2010;5 Suppl 3:61‐2.
    1. Michou E, Mistry S, Jefferson S, Singh S, Hamdy SA. Preliminary study of neurostimulation based interventions in the treatment of chronic dysphagia post stroke. Gut 2010;59(1):A27.
Michou 2011 {published data only}
    1. Michou E, Mistry S, Jefferson S, Singh S, Rothwell J, Tyrrell P, et al. Neurostimulation techniques benefit stroke patients with chronic oropharyngeal dysphagia: preliminary results from a randomised controlled study. Cerebrovascular Diseases 2011;31(Suppl 2):58.
Nakamura 2013 {published data only}
    1. Nakamura T, Fujishima I. Usefulness of ice massage in triggering the swallow reflex. Journal of Stroke and Cerebrovascular Diseases 22;4:378‐82. - PubMed
Nakayama 1998 {published data only}
    1. Nakayama K, Sekizawa K, Sasaki H. ACE inhibitor and swallowing reflex. Chest 1998;113(5):1425. - PubMed
Nam 2012 {published data only}
    1. Nam H, Beom J, Oh BM, Han BR. Kinematic analysis of hyoid bone and vocal cord after laryngeal electrical stimulation therapy in dysphagia. Neurorehabilitation and Neural Repair 2012;26(4):433.
NCT00376506a {published data only}
    1. NCT00376506. A comparison of an implanted neuroprosthesis with sensory training for improving airway protection in chronic dysphagia. https://clinicaltrials.gov/ct2/show/NCT00376506 (first received 15 September 2006).
NCT00376506b {published data only}
    1. NCT00376506. A comparison of an implanted neuroprosthesis with sensory training for improving airway protection in chronic dysphagia. clinicaltrials.gov/ct2/show/NCT00376506 (first received 15 September 2006).
NCT01971320 {published data only}
    1. NCT01971320. Evaluation of transcutaneous electrical stimulation in post stroke dysphagia. clinicaltrials.gov/show/NCT01971320 (first received 29 October 2013).
Nishiyama 2010 {published data only}
    1. Nishiyama Y, Abe A, Ueda M, Katsura K, Katayama Y. Nicergoline increases serum substance P levels in patients with an ischaemic stroke. Cerebrovascular Diseases 2010;29(2):194‐8. - PubMed
Ortega 2016 {published data only}
    1. Ortega O, Rofes L, Martin A, Arreola V, Lo I, Clave P. A comparative study between two sensory stimulation strategies after two weeks treatment on older patients with oropharyngeal dysphagia. Dysphagia 2016;31:706‐16. - PubMed
Permsirivanich 2009 {published data only}
    1. Permsirivanich W, Tipchatyotin S, Wongchai M, Leelamanit V, Setthawatcharawanich S, Sathirapanya P, et al. Comparing the effects of rehabilitation swallowing therapy vs. neuromuscular electrical stimulation therapy among stroke patients with persistent pharyngeal dysphagia: a randomized controlled study. Journal of the Medical Association of Thailand 2009;92(2):259‐65. - PubMed
Pownall 2008 {published data only}
    1. Pownall S, Enderby P, Hendra T, Marshall M. Are thickened fluids worth the trouble? A pilot RCT of dysphagia management. Proceedings of the 3rd UK Stroke Forum Conference. Harrogate, UK: The Stroke Association, 2008:86‐7.
Pryor 2011 {published data only}
    1. Pryor J, Leonard R, Belafsky P. A prospective, randomized trial of two dysphagia therapies: neuromuscular electrical stimulation and vibrotactile stimulation. Dysphagia 2011;26(4):466.
Reidnauer 2006 {published data only}
    1. Reidnauer S, Repsher S, Stryker D, Segal M. Vital stimulation may be more effective than traditional treatment in improving swallowing after stroke. Stroke 2006;37(2):737.
Rofes 2014 {published data only}
    1. Rofes L, Arreola V, Martin A, Clave P. Effect of oral piperine on the swallow response of patients with oropharyngeal dysphagia. Journal of Gastroenterology 2014;29:1517‐23. - PubMed
Rosenbek 1991 {published data only}
    1. Rosenbek JC, Robbins J, Fishback B, Levine RL. Effects of thermal application on dysphagia after stroke. Journal Speech and Hearing Research 1991;34:1257‐68. - PubMed
Rosenbek 1996 {published data only}
    1. Rosenbek JC. Effects of thermal stimulation on dysphagia after stroke. Journal of Rehabilitation Research and Development 1990;28(1):151.
    1. Rosenbek JC, Roecker EB, Wood JL, Robbins J. Thermal application reduces the duration of stage transition in dysphagia after stroke. Dysphagia 1996;11:225‐33. - PubMed
Rosenbek 1998 {published data only}
    1. Rosenbek JC, Robbins JA, Willford WO, Kirk G, Schiltz A, Sowell TW, et al. Comparing treatment intensities of tactile‐thermal application. Dysphagia 1998;13:1‐9. - PubMed
Sdravou 2012 {published data only}
    1. Sdravou K, Walshe M. Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia. Dysphagia 2012;27:240‐50. - PubMed
Seki 2005 {published data only}
    1. Seki T, Iwasaki K, Arai H, Sasaki H, Hayashi H, Yamada S, et al. Acupuncture for dysphagia in post stroke patients: a video fluoroscopic study. Journal of the American Geriatrics Society 2005;53(6):1083‐4. - PubMed
Shaker 2002a {published data only}
    1. Easterling C, Kern M, Nitschke T, Grande B, Kazandijan M, Dikeman K, et al. Restoration of oral feeding in 17 tube fed patients by the Shaker exercise. Dysphagia 2000;15(2):105.
    1. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, et al. Rehabilitation of swallowing by exercise in tube‐fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 2002;122:1314‐21. - PubMed
She 2014 {published data only}
    1. She RP, Ge CH. Clinical observation on medulla oblongata palsy after brainstem infarction treated with electroacupuncture at eight‐neck‐occiput points. Zhongguo Zhen Jiu 2014;34(6):539‐42. - PubMed
SQACU01 2001 {published data only}
    1. Heng D. SQACU01 ‐ a randomised trial of acupuncture as adjuvant therapy for dysphagia due to recent stroke. Clinical Trials and Epidemiology Research Unit Annual Report. Singapore: Clinical Trials and Epidemiology Research Unit, 2001:41.
Steele 2016 {published data only}
    1. Steele CM. Tongue pressure profile training for dysphagia post stroke (TPPT): study protocol for an exploratory randomized controlled trial. Trials 2013; Vol. 14:126. - PMC - PubMed
    1. Steele CM, Bayley MT, Peladeau‐Pigeon M, Nagy A, Namasivayam AM, Stokely S, et al. A randomized trial comparing two tongue‐pressure resistance training protocols for post‐stroke dysphagia. Dysphagia 2016;31:452‐61. - PMC - PubMed
Sukthankar 1994 {published data only}
    1. Sukthankar SM, Reddy NP, Canilang EP, Stephenson L, Thomas R. Design and development of portable biofeedback systems for use in oral dysphagia rehabilitation. Medical Engineering and Physics 1994;16:430‐5. - PubMed
Suntrup 2015 {published data only}
    1. DRKS00005509. A single‐centre, double blind, randomised controlled clinical trial to evaluate the effect of electrical pharyngeal stimulation as a treatment for stroke‐related dysphagia in tracheotomized stroke patients. www.drks.de/DRKS00005509 (first received 15 January 2014).
    1. Suntrup S, Marian T, Schröder JB, Suttrup I, Muhle P, Oelenberg S, et al. Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial. Intensive Care Medicine 2015;41(9):1629‐37. - PubMed
Suzuki 2012 {published data only}
    1. Suzuki H, Takeda S, Nakazaki M, Sone S, Mori T. The appropriate body position during nasal‐gastric tube feeding to prevent the aspiration pneumonia in acute stroke patients. Cerebrovascular Diseases 2012;33(2):464.
Tai 2014 {published data only}
    1. Tai S, Chang Y, Chang L. On the use of the chin‐down posture for dysphagia in stroke patients. Cerebrovascular Diseases 2014;38:105.
    1. Tai S, Huang HM. The effectiveness of the chin‐down posture in the improvement of dysphagia in stroke patients. http://hdl.handle.net/10755/602716 (first received 21 March 2016).
Teramoto 2008 {published data only}
    1. Teramoto S, Yamamoto H, Yamaguchi Y, Ishii M, Hibi S, Kume H. Antiplatelet cilostazol, an inhibitor of type III phosphodiesterase, improves swallowing function in patients with a history of stroke. Journal of the American Geriatrics Society 2008;56(6):1153‐4. - PubMed
Terre 2012 {published data only}
    1. Terre R, Mearin F. Effectiveness of chin‐down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study. Neurogastroenterology and Motility 2012;24:414. - PubMed
Toyama 2014 {published data only}
    1. Toyama K, Matsumoto S, Kurasawa M, Setoguchi H, Noma T, Takenaka K, et al. Novel neuromuscular electrical stimulation system for treatment of dysphagia after brain injury. Neurologia Medico‐Chirurgica 2014;54:521‐8. - PMC - PubMed
    1. UMIN000015406. Effect of electrical stimulation in post‐stroke patients with dysphagia: a feasibility study. https://upload.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R00001... (first received 10 October 2014).
Ueda 2004 {published data only}
    1. Ueda K, Yamada Y, Toyosata A, Nomura S, Saitho E. Effects of functional training of dysphagia to prevent pneumonia for patients on tube feeding. Gerontology 2004;21:108‐11. - PubMed
Varma 2006 {published data only}
    1. Varma AK. The effect of motor control on oro‐facial dysfunctions in stroke patients under Indian conditions; 5th World Stroke Congress; 2004 Jun 23‐26; Vancouver, Canada. 2006;e319.
Wang 2016 {published data only}
    1. Wang Z, Ma J, Ning L. Clinical observation of dysphagia after cerebral infarction treated with awn‐like needle at Tiantu (CV 22). Chinese Acupuncture and Moxibustion 2016;36(10):1019‐22. - PubMed
Xia 2016 {published data only}
    1. Xia W, Zheng C, Xia J, Zhang Y. Post‐stroke dysphagia treated with acupuncture of meridian differentiation: a randomized controlled trial. Chinese Acupuncture and Moxibustion 2016;36(7):673‐8. - PubMed
Zhang 2011 {published data only}
    1. Zhang ZL, Zhao SH, Chen GH, Ji XQ, Xue L, Yang YQ, et al. Randomized controlled study on dysphagia after stroke treated with deep insertion of Chonggu (EX‐HN 27) by electroacupuncture. Zhongguo Zhen Jiu 2011;31(5):385‐90. - PubMed
Zhang 2018a {published data only}
    1. Zhang L, Xu N, Li R, Wang L. Clinical study of electroacupuncture with different frequencies at Lianquan (CV 23) and Fengfu (GV 16) for stroke dysphagia. Chinese Acupuncture and Moxibustion 2018;38(2):115‐9. - PubMed
Zhang 2018b {published data only}
    1. Zhang R, Ju X. Clinical improvement of nursing intervention in swallowing dysfunction of elderly stroke patients. Biomedical Research 2018;29(6):1099‐102.
Zhao 2015 {published data only}
    1. Zhao K, Wang Z, Cao W, Zhang Y, Song S, Kang W, et al. Therapeutic efficacy of swallowing neuromuscular electrical stimulation combined with acupuncture for post‐stroke dysphagia. World Journal of Acupuncture‐Moxibustion 2015;25(1):19‐23.

References to studies awaiting assessment

Azimov 2017 {published data only}
    1. Azimov A, Sadykov R, Rakhimbaeva G. Dopaminergic medicines can treat dysphagia in ischemic stroke. Journal of the Neurological Sciences 2017;381 Suppl 1:396.
Carnaby 2012 {published data only}
    1. Carnaby G, LaGorio L, Crary M, Miller D. A randomized double blind trial of neuromuscular electrical stimulation + McNeill dysphagia therapy (MDTP) after stroke (ANSRS). Dysphagia 2012;27:569‐620.
Chang 2014 {published data only}
    1. Chang L, He PL, Zhou ZZ, Li YH. Efficacy observation of dysphagia after acute stroke treated with acupuncture and functional electric stimulation. Zhongguo Zhenjiu 2014;34(8):737‐40. - PubMed
Chaudhuri 2008 {published data only}
    1. Chaudhuri G, Brady S, Caldwell R, Wesling M, Quill A. Neuromuscular electrical stimulation (NMES) for dysphagia treatment following acute ischaemic stroke. Dysphagia 2008;23(4):441.
Chen 2017 {published data only}
    1. Chen D, Xing H Jiang Q, Xiang Y, Guo H. Role of levetiracetam in the rehabilitation of dysphagia due to stroke. International Journal of Pharmacology 2017;13(6):603‐11.
Cheng 2005 {published data only}
    1. Cheng XL, Zhao CS, Wang H, Ma L. Effects of early throat muscle training on vertebral‐basilar artery blood flow in patients with pseudobulbar palsy. Chinese Journal of Clinical Rehabilitation 2005;9(25):17‐9.
Cheng 2014 {published data only}
    1. Cheng FX, Chen T. Efficacy observation of post‐stroke dysphagia treated with acupuncture at Lianquan (CV 23). Zhongguo Zhen Jiu 2014;34(7):627‐30. - PubMed
ChiCTR‐TRC‐07000010 {published data only}
    1. ChiCTR‐TRC‐07000010. Randomized controlled study on the acupuncture for dysphagia in convalescence phase of apoplexy. http://www.chictr.org.cn/showprojen.aspx?proj=9515 (first received 6 February 2007).
ChiCTR‐TRC‐08000463 {published data only}
    1. ChiCTR‐TRC‐08000463. Clinical evaluation of dysphagia therapeutic apparatus on cerebrovascular disease. Chinese Clinical Trial Registry (ChiCTR) www.chictr.org/ (first received 3 November 2008).
ChiCTR‐TRC‐14004235 {published data only}
    1. ChiCTR‐TRC‐14004235. Clinical research of modified Dihuang Yinzi Decoction combined swallowing rehabilitation and videofluoroscopy on post‐stroke dysphagia patients: a pilot trial. www.chictr.org/en/proj/show.aspx?proj=6601 (first received 20 January 2014).
ChiCTR‐TRC‐14004955 {published data only}
    1. ChiCTR‐TRC‐14004955. Effect of transcranial direct current stimulation on dysphagia after stroke. http://www.chictr.org.cn/showproj.aspx?proj=4618 (first received 16 July 2014).
Choi 2017 {published data only}
    1. Choi J‐B, Shim S‐H, Yang J‐E, Kim H‐D, Lee D‐H, Park J‐S. Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia. NeuroRehabilitation 2017;41(4):753‐7. - PubMed
Chu 2017 {published data only}
    1. Chu J, Liu X, Chen F, Hong F, Bao Y. Effects of GAO's neck acupuncture on swallowing function and quality of life in patients with post‐stroke pseudobulbar palsy: a randomized controlled trial. Chinese Acupuncture and Moxibustion 2017;37(7):691‐5. - PubMed
de Fraga 2017 {published data only}
    1. Fraga BFD, Almeida STD, Santana MG, Cassol M. Efficacy of myofunctional therapy associated with voice therapy in the rehabilitation of neurogenic oropharyngeal dysphagia: a pilot study. International Archives of Otorhinolaryngology 2017;DOI:10.1055/s‐0037‐1605597:[Ref 27900]. - PMC - PubMed
Eom 2017 {published data only}
    1. Eom M, Chang M, Oh D, Kim H, Han N, Park J. Effects of resistance expiratory muscle strength training in elderly patients with dysphagic stroke. Neuro Rehabilitation 2017;41(4):747‐52. - PubMed
Erfmann 2017 {published data only}
    1. Erfmann, K. Effects of expiratory muscle strength training (EMST) on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial. Journal of Clinical Practice in Speech‐Language Pathology 2017;19(2):111.
Fan 2007 {published data only}
    1. Fan C, Jiang H, Wu L. Clinical observations on acupuncture treatment of postapoplectic dysphagia. Shanghai Journal of Acupuncture and Moxibustion 2007;26:6‐7.
Feng 2016 {published data only}
    1. Feng S, Cao S, Du S, Yin T, Mai F, Chen X, et al. Acupuncture combined with swallowing training for post‐stroke dysphagia: a randomized controlled trial. Zhongguo Zhen Jiu 2016;36(4):347‐50. - PubMed
Gao 2016 {published data only}
    1. Gao J, Zhang HJ. Effects of chin tuck against resistance exercise versus Shaker exercise on dysphagia and psychological state after cerebral infarction. European Journal of Physical and Rehabilitation Medicine 2016;53(3):426‐32. - PubMed
Guillen‐Sola 2017 {published data only}
    1. * Guillén‐Solà A, Messagi Sartor M, Bofill‐Soler N, Duarte E, Barrera MC, Marco E. Respiratory muscle strength training and neuromuscular electrical stimulation in subacute dysphagic stroke patients: a randomized controlled trial. Clinical Rehabilitation 2017;31(6):761‐71. - PubMed
    1. Guillen‐Sola A, Messagi‐Sartor M, Barrera De Paz C, Bofill‐Soler N, Rodriguez DA, Duarte E, et al. Effects of neuromuscular electrostimulation and respiratory muscle training in acute/subacute dysphagic stroke patients. Retornus: a randomized control trial. Dysphagia 2015;30(2):236‐7.
Hamada 2017 {published data only}
    1. Hamada S, Yamaguchi H, Hiroyoshi H. Does sensory transcutaneous electrical stimulation prevent pneumonia in the acute stage of stroke? A preliminary study. International Journal of Rehabilitation Research 2017;40(1):94‐6. - PubMed
Hong 2011 {published data only}
    1. Hong Z, Yulin W, Qin Y. Influence of diet nursing care on the prognosis of patients with poststroke dysphagia. Chinese Nursing Research 2011;25(1C):211‐3.
Huang 2008 {published data only}
    1. Huang YL, Liang FR, Chang HS, Hu KM, He J, Li N, et al. Effect of acupuncture on quality of life in post‐ischemic stroke patients with dysphagia. Zhongguo Zhong Xi Yi Jie He Za Zhi 2008;28:505‐8. - PubMed
Huang 2014 {published data only}
    1. * Huang K, Liu T, Huang Y, Leong C, Lin W, Pong Y. Functional outcome in acute stroke patients with oropharyngeal dysphagia after swallowing therapy. Journal of Stroke and Cerebrovascular Diseases 2014;23(10):2547‐53. - PubMed
    1. NCT03048916. Dysphagia after different swallowing therapies. https://www.clinicaltrials.gov/ct2/show/record/NCT03048916 (first received 1 August 2010).
Huimin 2015 {published data only}
    1. Huimin Z, Yongchao Y, Jiang R, Li L, Yao W, Weibo S, Jie Z. Effect of surface electromyographic biofeedback on the pharyngeal phase activities in patients with dysphagia after stroke. Chinese Journal of Cerebrovascular Diseases 2015;12(11):572‐6.
Jefferson 2008 {published data only}
    1. Jefferson S, Hamdy S, Michou E, Mistry S, Singh S. Neurostimulation is able to increase cortical bulbar excitability following dysphagic stroke. Proceedings of the 3rd UK Stroke Forum Conference; 2008 Dec 2‐4. Harrogate: The Stroke Association, 2008.
Jia 2006 {published data only}
    1. Jia H‐L, Zhang Y‐C. Treatment of 40 cases of post‐apoplectic dysphagia by acupuncture plus rehabilitation exercise. Journal of Acupuncture and Tuina Science 2006;4(6):336‐8.
Jiang 2014 {published data only}
    1. Jiang W, Tan B, Zhou Y, Jia G, Wu X, Jia L, et al. Clinical study on treatment of patients with dysphagia after stroke by improved Vitalstim electroacupuncture. Journal of Shanghai Jiaotong University (Medical Science) 2014;34(9):1361‐4.
Jing 2016 {published data only}
    1. Jing Q, Yang X, Reng Q. Effect of neuromuscular electrical stimulation in patients with post‐stroke dysphagia. Medical Science Technology 2016;57:1‐5.
Ji‐Ye 2017 {published data only}
    1. Ji‐Ye L. Influence of acupoint‐injection on TXB2 and 6‐keto‐PGF1a in patients with pseudobulbar palsy: a randomized controlled trial. Journal of Acupuncture and Tuina Medicine 2017;1:22‐6.
Kim 2017 {published data only}
    1. Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS. Tongue‐to‐palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal of Oral Rehabilitation 2017;44:59–64. - PubMed
Koch 2015 {published data only}
    1. Koch I, Meneghello F, Piccione F. Preliminary data of swallowing training using sEMG as biofeedback. Journal of the Neurological Sciences 2015;357:e353.
Konecny 2018 {published data only}
    1. Konecny P, Elfmark M. Electrical stimulation of hyoid muscles in post‐stroke dysphagia. Biomedical Papers of the Medical Faculty of the University Palacky Olomouc Czechoslovakia 2018;162(1):40‐2. - PubMed
Koyama 2017 {published data only}
    1. Koyama Y, Sugimoto A, Hamano T, Kasahara T, Toyokura M, Masakado Y. Proposal for a modified jaw opening exercise for dysphagia: a randomized, controlled trial. Tokai Journal of Experimental and Clinical Medicine 2017;42(2):71‐8. - PubMed
Lee 2015b {published data only}
    1. Lee JH, Kim SB, Lee KW, Lee SJ, Lee JU. Effect of repetitive transcranial magnetic stimulation according to the stimulation site in stroke patients with dysphagia. Annals of Rehabilitation Medicine 2015;39(3):432‐9. - PMC - PubMed
Li 2008 {published data only}
    1. Li J, Li J. Acupuncture used to treat dysphagia induced by ischemic stroke. Journal of Beijing University of Traditional Chinese Medicine 2008;15:17‐9.
Li 2009 {published data only}
    1. Li H, Yue G, Liu D, Zhou H. Clinical observations on acupuncture plus rehabilitation training for improving postapoplectic dysphagia. Shanghai Journal of Acupuncture and Moxibustion 2009;28:388‐9.
Li 2016 {published data only}
    1. Li Y, Ren K, Xing R, Peng J, Zhang Z, Zhao J. Clinical research of the five needles combined with rehabilitation training treatment dysphagia after stroke. Pakistan Journal of Pharmaceutical Sciences 2016;29(5 Suppl):1745‐8. - PubMed
Liu 2018 {published data only}
    1. Liu XP, Chen FY, Chu JM, Bao YH. Effects of nape acupuncture combined with swallowing rehabilitation on dysphagia in pseudobulbar palsy. Journal of Traditional Chinese Medicine 2018;38(1):117‐24. - PubMed
Ma 2016 {published data only}
    1. Ma P, Xu S, Tian W, Duan H, Wang C, Shan Y, et al. Efficacy observation of post‐stroke pseudo‐bulbar palsy treated with quick needle insertion therapy at Aqiang point. Chinese Acupuncture and Moxibustion 2016;36(10):1027‐30. - PubMed
Malik 2017 {published data only}
    1. Malik SN, Khan MSG, Ehsaan F, Tul‐Ain Q. Effectiveness of swallow maneuvers, thermal stimulation and combination both in treatment of patients with dysphagia using functional outcome swallowing scale. Biomedical Research (India) 2017;28(4):1479‐82.
Mehndiratta 2017 {published data only}
    1. Mehndiratta MM, Gupta P, Kaur M. The effect of sensory‐level electrical stimulation of the masseter muscle in early stroke patients with dysphagia. Neurology India 2017;65(4):743‐5. - PubMed
Meng 2015 {published data only}
    1. Meng Y, Wang C, Shang S, Ning L, Zhou L, Han K. Effects of different acupuncture depths of Lianquan (CV 23) for dysphagia after stroke: a randomized controlled trial. Zhongguo Zhen Jiu 2015;35(10):990‐4. - PubMed
Meng 2018 {published data only}
    1. Meng P, Zhang S, Wang Q, Wang P, Han C, Gao J, Yue S. The effect of surface neuromuscular electrical stimulation on patients with post‐stroke dysphagia. Journal of Back & Musculoskeletal Rehabilitation 2018;31(2):363‐70. - PubMed
Moon 2017 {published data only}
    1. Moon JH, Jung J, Won YS, Cho H, Cho K. Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. Journal of Physical Therapy Science 2017;29:609‐12. - PMC - PubMed
Moon 2018 {published data only}
    1. Moon JH, Hahm SC, Won YS, Cho HY. The effects of tongue pressure strength and accuracy training on tongue pressure strength, swallowing function, and quality of life in subacute stroke patients with dysphagia: a preliminary randomized clinical trial. International Journal of Rehabilitation Research 2018; Vol. 41, issue 3:204‐10. [DOI: 10.1097/MRR.0000000000000282] - DOI - PubMed
NCT00722111 {published data only}
    1. NCT00722111. Exercise for swallowing problems after stroke. https://clinicaltrials.gov/ct2/show/NCT00722111 (first received 25 July 2008).
NCT01081444 {published data only}
    1. NCT01081444. Repetitive transcranial stimulation (rTMS) in post stroke dysphagia. clinicaltrials.gov/ct2/show/record/NCT01081444?term=NCT01081444&rank=1 (first received 5 March 2010).
NCT01085903 {published data only}
    1. NCT01085903. Identifying and treating arousal related deficits in neglect and dysphagia. https://clinicaltrials.gov/ct2/show/NCT01085903 (first received 12 March 2010).
NCT01777672 {published data only}
    1. NCT01777672. Effect of afferent oropharyngeal pharmacological and electrical stimulation on swallow response and on activation of human cortex in stroke patients with oropharyngeal dysphagia (OD). A randomized controlled trial. clinicaltrials.gov/show/NCT01777672 (first received 29 January 2013).
NCT02090231 {published data only}
    1. NCT02090231. The effect of repetitive transcranial magnetic stimulation for post‐stroke dysphagia recovery. https://clinicaltrials.gov/ct2/show/NCT02090231 (first received 18 March 2014).
NCT02379182 {published data only}
    1. NCT02379182. Randomized controlled trial to evaluate the effect of vitalstim in patients with chronic post‐stroke oropharyngeal dysphagia. clinicaltrials.gov/show/NCT02379182 (first received 4 March 2015).
Nowicki 2003 {published data only}
    1. Nowicki NC, Averill A. Acupuncture for dysphagia following stroke. Medical Acupuncture 2003;14(3):17‐9.
Oshima 2009 {published data only}
    1. Oshima F, Takezawa H, Hamanaka M, Imai K, Makino M, Oda K, et al. Usefulness of nutritional management and swallowing training during the acute phase of cerebral infarction and the incidence rate of infection. Dysphagia 2009;24:453.
Pan 2015 {published data only}
    1. Pan MZ, Chen J, Lin L. Effect of traditional Chinese medicine rehabilitation nursing on functional rehabilitation of dysphagia in stroke patients. Chinese Medicine Modern Distance Education of China 2015;13(23):107‐9.
Park 2017 {published data only}
    1. * Park JS, Hwang NK, Oh DH, Chang MY. Effect of head lift exercise on kinematic motion of the thyolaryngeal complex and aspiration in patients with dysphagic stroke. Journal of Oral Rehabilitation 2017;44:385–91. - PubMed
    1. KCT0001901. Effect of shaker exercise on motion of hyolaryngeal complex and aspiration in stroke patients with oropharyngeal dysphagia. http://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=6221 (first received 30 October 2015).
Park 2018 {published data only}
    1. Park J, An D, Oh D, Chang M. Effect of chin tuck against resistance exercise on patients with dysphagia following stroke: a randomized pilot study. NeuroRehabilitation 2018;42(2):191‐7. - PubMed
Shao 2017 {published data only}
    1. Shao W‐B, Wang Y, Jiang W‐W, Tian L, Zhang J. Clinical study of columnar balloon dilatation therapy for severe dysphagia caused by upper esophageal sphincter achalasia after stroke. Chinese Journal of Contemporary Neurology and Neurosurgery 2017;17(3):185‐91.
Su 2010 {published data only}
    1. Su X, Lai X. The clinical study on "tongdutiaoshen" (an acupuncture treatment) for treatment of dysphagia after stroke. Journal of Clinical Acupuncture and Moxibustion 2010;26:3‐6.
Sun 2008 {published data only}
    1. Sun J, Mi Z, Wang H, Xu D, Chen H. Study on therapeutic effect of acupuncture on dysphagia after stroke. Journal of Rehabilitation Medicine 2008;169 Suppl 46:Abstract PP003‐139.
Sun 2018 {published data only}
    1. Sun D, Xu W, Chen N, Li S‐M, Fu T. Clinical effectiveness of intradermal needle‐embedding therapy for swallowing function in stroke patients with dysphagia. Acupuncture Research 2018;43(2):118‐22. - PubMed
Suntrup‐Krueger 2018 {published data only}
    1. NCT01970384. Transcranial direct current stimulation for dysphagia therapy in acute stroke patients. https://clinicaltrials.gov/ct2/show/NCT01970384 (first received 28 October 2013).
    1. Suntrup‐Krueger S, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U, et al. Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Annals of Neurology 2018;83(2):328‐40. - PubMed
Tageldin 2017 {published data only}
    1. Tageldin E, Khalil M, Bahnasy W, Fouda B. Evaluation of possible role of repetitive transcranial magnetic stimulation for dysphagic patients with brain stem infarction. Neurology 2017;88(16 Suppl 1):P5.156.
Umay 2017 {published data only}
    1. Umay EK, Yaylaci A, Saylam G, Gundogdu I, Gurcay E, Akcapinar D, et al. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: a randomized controlled study. Neurology India 2017;65(4):734‐42. - PubMed
Wang 2010 {published data only}
    1. Wang Y. Clinical observation on cerebral stroke with dysphagia with treatment of combined traditional Chinese and west medicine. Heilongjiang Medicine Journal 2010;24:625‐6.
Wang 2014 {published data only}
    1. Wang Z, Song W, Qu Y, Huang X, Wang L. Efficacy of integrated swallowing function rehabilitation training in patients with nasal feeding during acute ischemic stroke. Chinese Journal of Cerebrovascular Diseases 2014;11(7):342‐6.
Wang 2015 {published data only}
    1. Wang Q. Clinical study on Tong Guan Li Qiao needling method for post‐stroke deglutition disorders. Shanghai Journal of Acupuncture and Moxibustion 2015;34:721‐3.
Wang 2017 {published data only}
    1. Wang L, Qiu X, Ye LJ. Effects of rood intervention and routine oral intervention on malnutrition in stroke patients with dysphagia. World Chinese Journal of Digestology 2017;25(21):1980‐4.
Wei 2017 {published data only}
    1. Wei X, Yu F, Dai M, Xie C, Wan G, Wang Y, et al. Change in excitability of cortical projection after modified catheter balloon dilatation therapy in brainstem stroke patients with dysphagia: a prospective controlled study. Dysphagia 2017;32:645‐56. - PMC - PubMed
Wu 2011 {published data only}
    1. Wu P, Liang F, Li Y, Yang L, Huang Y, Li A, et al. Clinical observation on acupuncture plus rehabilitation training for dysphagia after stroke ‐ a multi‐centered random‐controlled trial. Journal of Traditional Chinese Medicine 2011;52:45‐8.
Wu 2013 {published data only}
    1. Wu YL, Wang L, Tuo S, Yu X, Wang Q. Clinical study on the effects of acupuncture kinesiotherapy for dysphagia caused by pseudobulbar paralysis after stroke. Chinese Journal of Rehabilitation Medicine 2013;28(8):739‐42, 757.
Xia 2010 {published data only}
    1. Xia W, Zheng C, Zhu S, Tang Z, Wang H, Hua Q, et al. Combination of feeding swallowing training and acupuncture: an effective rehabilitation method for dysphagia post stroke. Acta Med Univ Sci Technol Huazhong Journal of Huazhong University of Science and Technology. Medical Sciences 2010;39:614‐9.
Xie 2011 {published data only}
    1. Xie Y, Liu H, Zhou W. Effect of acupuncture on dysphagia of convalescent stroke patients. Chinese Journal of Integrative Medicine 2011;31:736‐40. - PubMed
Xu 2013 {published data only}
    1. Xu JY, Zhou ZL, Wu J. Clinical observation on the treatment of post‐stroke dysphagia by Tiaoshen Tongluo Acupuncture combined with Tongue 3‐needle and acupuncturing Double Yifeng Acupoints. Journal of Zhejiang University of Traditional Chinese Medicine 2013;37(9):1117‐8, 1132.
Xue 2004 {published data only}
    1. Xue W. Early rehabilitation combined with acupuncture treatment on patients with allo‐swallowing because of pseudo‐medulla oblongata paralysis after apoplexy. Chinese Journal of Composite Clinical Medicine 2004;6(12):25‐6.
Yang 2008 {published data only}
    1. Yang C, Lee J, Joo M, Shin Y. The effect of double application of functional electrical stimulation in patients with dysphagia after stroke. Journal of Rehabilitation Medicine 2008;169(Suppl 46):169‐70 (Abstract PP003‐142).
Yang 2012 {published data only}
    1. Yang EJ, Baek SR, Shin J, Lim JY, Jang HJ, Kim YK, et al. Effects of transcranial direct current stimulation (tDCS) on post‐stroke dysphagia. Restorative Neurology and Neuroscience. 2012;30(4):303‐11. - PubMed
Zeng 2017 {published data only}
    1. Zeng Y, Yip J, Cui H, Guan L, Zhu H, Zhang W, et al. Efficacy of neuromuscular electrical stimulation in improving the negative psychological state in patients with cerebral infarction and dysphagia. Neurological Research 2018;40(6):473‐9. [DOI: 10.1080/01616412.2018.1451015] - DOI - PubMed
Zhang 2007 {published data only}
    1. Zhang J, Zhao C, Jin M, Zhou Y, Wang C, Zhao X, et al. A new effective method for larynx elevation could avoid a special abnormal swallowing mode. Stroke 2007;38(2):571.
Zhang 2015 {published data only}
    1. Zhang C. Analysis of Huoshe Liyan Decoction on treatment of 198 cases of stroke patients with dysphagia. Liaoning Journal of Traditional Chinese Medicine 2015;42:1436‐8.
Zhang 2016 {published data only}
    1. Zhang M, Tao T, Zhang ZB, Zhu X, Fan WG, Pu LJ, et al. Effectiveness of neuromuscular electrical stimulation on patients with dysphagia with medullary infarction. Archives of Physical Medicine and Rehabilitation 2016;97:355‐62. - PubMed
Zhang 2017 {published data only}
    1. Zhang SY, Liu SB, Chen YM, Liao KL, Xiang Y, Pan D. Clinical trials for treatment of stroke patients with dysphagia by Vitalstim electroacupuncture combined with swallowing rehabilitation training. Acupuncture Research 2017;42(2):168‐72. - PubMed
Zhen 2014 {published data only}
    1. Zhen H. Clinical observations of treatments of post‐stroke deglutition dysfunction with acupuncture and electric stimulation. Physical Medicine and Rehabilitation 2014;6(8S2):S115.
Zhong 2003 {published data only}
    1. Zhong C‐M, Rong G, He F‐Z, Jin H‐Y. Comparison of head and body acupuncture in the treatment of deglutition disorders in subacute period of stroke. Chinese Journal of Clinical Rehabilitation 2003;7(19):2706‐7.
Zhu 2015a {published data only}
    1. Zhu H, Yang Y, Rao J, Liu L, Wang Y, Shao W, Zhang J. Effect of surface electromyographic biofeedback on the pharyngeal phase activities in patients with dysphagia after stroke. Chinese Journal of Cerebrovascular Diseases 2015;11:572‐6.
Zhu 2015b {published data only}
    1. Zhu Z Z, Cui LL, Yin MM, Yu Y, Wang HT. Effects of swallowing training combined with low ‐frequency electrical stimulation on dysphagia after ischemic stroke. Chinese Journal of Contemporary Neurology and Neurosurgery 2015;15(4):285‐9.

References to ongoing studies

ChiCTR1800014337 {published data only}
    1. ChiCTR1800014337. High frequency repetitive transcranial magnetic stimulation in the rehabilitation of post‐stroke swallowing disorder. http://www.chictr.org.cn/showprojen.aspx?proj=23332 (first received 6 January 2018).
ChiCTR1800015837 {published data only}
    1. ChiCTR1800015837. A randomized controlled clinical study on stroke with dysphagia with treatment of combined of traditional Chinese and West medicine. http://www.chictr.org.cn/showprojen.aspx?proj=20656 (first received 24 April 2018).
ChiCTR‐ICR‐15006004 {published data only}
    1. ChiCTR‐ICR‐15006004. Clinical observation of YiShen‐TongQiao acupuncture on pharyngeal dysphagia after stroke. http://www.chictr.org.cn/showproj.aspx?proj=10470 (first received 25 February 2015).
ChiCTR‐IOR‐17010505 {published data only}
    1. ChiCTR‐IOR‐17010505. Fire needle for patients with dysphagia caused by post‐stroke pseudobulbar palsy: a randomized controlled clinical trial. http://www.chictr.org.cn/showprojen.aspx?proj=17738 (first received 23 January 2017).
ChiCTR‐IOR‐17011359 {published data only}
    1. ChiCTR‐IOR‐17011359. The study on the effect of electro‐acupuncture at Lianquan and Fengfu on one side of brain swallowing function. http://www.chictr.org.cn/showproj.aspx?proj=19078 (first received 11 May 2017).
ChiCTR‐IPC‐14005435 {published data only}
    1. ChiCTR‐IPC‐14005435. Research on mechanism of central regulation of transcranial magnetic stimulation on post‐stroke dysphagia patients. http://www.chictr.org.cn/showproj.aspx?proj=9785 (first received 17 October 2017).
ChiCTR‐ROC‐17011673 {published data only}
    1. ChiCTR‐ROC‐17011673. Neuromodulation on post‐stroke patients: a clinical control trial based on mapping swallowing musculature motor cortex. www.chictr.org.cn/showproj.aspx?proj=19921 (first received 16 June 2017).
ISRCTN14124645 {published data only}
    1. ISRCTN14124645. Metoclopramide and selective oral decontamination for avoiding pneumonia after stroke. http://www.isrctn.com/ISRCTN14124645 (first received 10 October 2016).
ISRCTN68981054 {published data only}
    1. ISRCTN68981054. Treatment of dysphagia after stroke with He's santong needling method: a prospective randomized controlled study. http://www.isrctn.com/ISRCTN68981054 (first received 25 September 2017).
NCT01758991 {published data only}
    1. NCT01758991. Improving swallowing after stroke with transcranial direct current stimulation (iSWAT). https://clinicaltrials.gov/ct2/show/NCT01758991 (first received 1 January 2013).
NCT01919112 {published data only}
    1. NCT01919112. Fostering eating after stroke with transcranial direct current stimulation. https://clinicaltrials.gov/ct2/show/record/NCT01919112 (first received 8 August 2013).
NCT02322411 {published data only}
    1. NCT02322411. Effects of device‐facilitated isometric progressive resistance oropharyngeal (I‐PRO) therapy on dysphagia related outcomes in patients post‐stroke (StrokeStrong). clinicaltrials.gov/show/NCT02322411 (first received 23 December 2014).
NCT02470078 {published data only}
    1. NCT02470078. Pharyngeal electrical stimulation for the treatment of post‐extubation dysphagia in acute stroke. https://clinicaltrials.gov/ct2/show/NCT02470078 (first posted 12 June 2015).
NCT02576470 {published data only}
    1. Humbert IA, Vose A. Kinematic visual biofeedback is best when training novel swallowing behaviors in dysphagic patients after stroke. Stroke 2018;49:ATP150.
    1. NCT02576470. Applying motor learning principles to dysphagia rehabilitation. https://clinicaltrials.gov/ct2/show/NCT02576470 (first received 15 October 2015).
NCT02960737 {published data only}
    1. NCT02960737. Dysphagia evaluation after stroke ‐ incidence and effect of oral screen intervention on swallowing dysfunction. clinicaltrials.gov/show/NCT02960737 (first received 10 November 2016).
NCT03021252 {published data only}
    1. NCT03021252. Respiratory muscle training in stroke swallowing disorders RETORNUS‐2. https://clinicaltrials.gov/ct2/show/NCT03021252 (first received 13 January 2017).
NCT03247374 {published data only}
    1. NCT03247374. Bio‐feedback treatment versus standard treatment for dysphagic post‐stroke patients: a randomized controlled trial (bio‐feedback treatment for dysphagic post‐stroke patients (BIO_DYS)). https://clinicaltrials.gov/ct2/show/NCT03247374 (first received 11 August 2017).
NCT03274947 {published data only}
    1. NCT03274947. The utility of cerebellar transcranial magnetic stimulation in the neurorehabilitation of dysphagia after stroke. https://clinicaltrials.gov/ct2/show/NCT03274947 (first received 7 September 2017).
NCT03358810 {published data only}
    1. NCT03358810. Pharyngeal electrical stimulation evaluation for dysphagia after stroke (PhEED). https://clinicaltrials.gov/ct2/show/NCT03358810 (first received 2 December 2017).
NCT03499574 {published data only}
    1. NCT03499574. Feasibility study of biofeedback in dysphagia therapy post stroke. https://www.clinicaltrials.gov/ct2/show/record/NCT03499574?id=NCT0349957... (first received 17 April 2018).
PACTR201710002724163 {published data only}
    1. PACTR201710002724163. Effect of transcutaneous electrical nerve stimulation and conventional therapy in post‐stroke dysphagic patients: a randomized controlled trial. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=PACTR201710002724163 (first received 26 October 2017).
U1111‐1188‐0335 {published data only}
    1. U1111‐1188‐0335. Program of rehabilitation with therapeutic efficacy control in oropharyngeal dysphagia after stroke. www.ensaiosclinicos.gov.br/rg/RBR‐33grwq/ (first received 26 September 2016).

Additional references

Arnold 2016
    1. Arnold M, Liesirova K, Broeg‐Morvay A, Meisterernst J, Schlager M, Mono M‐L, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS ONE 2016;11(2):e0148424. - PMC - PubMed
Ashford 2009
    1. Ashford J, McCabe D, Wheeler‐Hegland K, Frymark T, Mullen R, Musson N, et al. Evidence‐based systematic review: oropharyngeal dysphagia behavioral treatments. Part III. Impact of dysphagia treatments on populations with neurological disorders. Journal of Rehabilitation, Research and Development 2009;46(2):195‐204. - PubMed
Barer 1989
    1. Barer D. The natural history and functional consequences of dysphagia after hemisphere stroke. Journal of Neurology, Neurosurgery and Psychology 1989;52:236‐41. - PMC - PubMed
Carnaby 2006
    1. Carnaby G, Hankey GJ, Pizzi J. Behavioural intervention for dysphagia in acute stroke: a randomised controlled trial. Lancet Neurology 2006;5:31‐7. - PubMed
Chen 2016
    1. Chen YW, Chang KH, Chen HC, Liang WM, Wang YH, Lim YN. The effects of surface neuromuscular electrical stimulation on post‐stroke dysphagia: a systemic review and meta‐analysis. Clinical Rehabilitation 2016;30(1):24‐35. - PubMed
Cohen 2016
    1. Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, et al. Post stroke dysphagia: a review and design considerations for future trials. International Journal Stroke 2016;11(4):399‐411. - PubMed
Ding 2016
    1. Ding R, Ma F. Effectiveness of neuromuscular electrical stimulation on dysphagia treatment in patients with neurological impairments – a systematic review and metaanalysis. Annals of Otolaryngology and Rhinology 2016;3(12):1151.
Finestone 1996
    1. Finestone HM, Greene‐Finestone LS, Wilson ES, Teasell RW. Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients. Archives of Physical Medicine and Rehabilitation 1996;77:340‐5. - PubMed
Gordon 1987
    1. Gordon C, Langton‐Hewer R, Wade D. Dysphagia in acute stroke. BMJ 1987;295:411‐4. - PMC - PubMed
Hamdy 1998
    1. Hamdy S, Aziz Q, Rothwell JC, Power M, Singh KD, Nicholson DA, et al. Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology 1998;115(5):1104‐12. - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG. Chapter 8: Assessing risk of bias in included studies. In: Cochrane Handbook of Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hinchey 2005
    1. Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S, the Stroke Practice Improvement Network Investigators. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005;36:1972‐6. - PubMed
Krival 2008
    1. Krival K, Pelletier C, Kelchner L. Effects of carbonate vs thin and thickened liquids on swallowing in adults with stroke. Dysphagia 2008;23:428.
Lakshminarayan 2010
    1. Lakshminarayan K, Tsai AW, Tong X, Vazquez G, Peacock JM, George MG, et al. Utility of dysphagia screening results in predicting poststroke pneumonia. Stroke 2010;41(12):2849‐54. - PMC - PubMed
Lazarra 1986
    1. Lazarra G, Lazarus C, Logemann J. Impact of thermal stimulation on the triggering of the swallow reflex. Dysphagia 1986;1:73‐7.
Liao 2016
    1. Liao X, Xing G, Guo Z, Jin Y, Tang Q, He B, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke: a systematic review and meta‐analysis. Clinical Rehabilitation 2017;31(3):289‐98. - PubMed
Logemann 1991
    1. Logemann J. Approaches to management of disordered swallowing. Clinical Gastroenterology 1991;5:269‐80. - PubMed
Logemann 1993
    1. Logemann J. Non‐invasive approaches to deglutitive aspiration. Dysphagia 1993;8:331‐3. - PubMed
Long 2012
    1. Long Y‐B, Wu X‐P. A meta‐analysis of the efficacy of acupuncture in treating dysphagia in patients with a stroke. Acupuncture in Medicine 2012;00:1‐7. - PubMed
Mann 1999
    1. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999;30:744‐8. - PubMed
Mann 2000
    1. Mann G, Hankey GJ, Cameron D. Swallowing disorders following acute stroke: prevalence and diagnostic accuracy. Cerebrovascular Diseases 2000;10:380‐6. - PubMed
Martino 2005
    1. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005;36(12):2756‐63. - PubMed
Mendelsohn 1987
    1. Mendelsohn MS, McConnell FM. Function in the pharyngoesophageal segment. Laryngoscope 1987;97(4):483‐9. - PubMed
Momosaki 2016
    1. Momosaki R, Kinoshita S, Kakuda W, Yamada N, Abo M. Noninvasive brain stimulation for dysphagia after acquired brain injury. A systematic review. Journal of Medical Investigation 2016;63(3‐4):153‐8. - PubMed
Odderson 1995
    1. Odderson IR, Keaton JC, McKenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Archives of Physical Medicine and Rehabilitation 1995;76:1130‐3. - PubMed
Perry 2004
    1. Perry L. Eating and dietary intake in communication impaired stroke survivors: a cohort study from acute stage hospital admission to 6 months post stroke. Clinical Nutrition 2004;23:1333‐43. - PubMed
Pisegna 2016
    1. Pisegna JM, Kaneoka A, Pearson Jr WG, Kumar S, Langmore SE. Effects of non‐invasive brain stimulation on post‐stroke dysphagia: a systematic review and meta‐analysis of randomized controlled trials. Clinical Neurophysiology 2016;127(1):956‐68. - PMC - PubMed
Ramsey 2003
    1. Ramsey DJC, Smithard D, Kalra L. Early assessments of dysphagia and aspiration risk in acute stroke patients. Stroke 2003;34:1252‐7. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rofes 2013
    1. Rofes L, Vilardell N, Clavé P. Post‐stroke dysphagia: progress at last. Neurogastroenterology and Motility 2013;25(4):278‐82. - PubMed
Scutt 2015
    1. Scutt P, Lee HS, Hamdy S, Bath PM. Pharyngeal electrical stimulation for treatment of poststroke dysphagia: individual patient data meta‐analysis of randomised controlled trials. Stroke Research and Treatment 2015;2015:1‐8. [DOI: 10.1155/2015/429053] - DOI - PMC - PubMed
Shaker 2002
    1. Shaker R, Easterling C, Kern M, Nitschke T, Massey B, Daniels S, et al. Rehabilitation of swallowing by exercise in tube‐fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 2002;122(5):1314‐21. - PubMed
Sharma 2001
    1. Sharma JC, Fletcher S, Vassallo M, Ross I. What influences outcome after stroke ‐ pyrexia or dysphagia?. International Journal of Clinical Practice 2001;55(1):17‐20. - PubMed
Singh 2006a
    1. Singh S, Hamdy S. Dysphagia in stroke patients. Postgraduate Medical Journal 2006;82:383‐91. - PMC - PubMed
Smithard 1993
    1. Smithard D, Kenwick D, Martin D, O'Neill P. Chest infection following acute stroke: does aspiration matter?. Age and Ageing 1993;22 Suppl 3:24‐9.
Smithard 1996
    1. Smithard DG, O'Neill PA, Park C, Morris J, Wyatt R, England R, et al. Complications and outcome after acute stroke. Does dysphagia matter?. Stroke 1996;27:1200‐4. - PubMed
Smithard 1997
    1. Smithard DG, O'Neil PA, England RE, Park, CL, Wyatt, R, Martin DF, et al. The natural history of dysphagia following stroke. Dysphagia 1997;12(4):188‐93. - PubMed
Theurer 2013
    1. Theurer JA, Johnston JL, Fisher J, Darling S, Stevens RC, Taves D, et al. Proof‐of‐principle pilot study of oropharyngeal air‐pulse application in individuals with dysphagia after hemispheric stroke. Archives of Physical Medicine and Rehabilitation 2013;94(6):1088‐94. - PubMed
Wolfe 1993
    1. Wolfe C, Taub N, Woodrow J, Richardson E, Warburton F, Burney P. Patterns of acute stroke care in three districts of southern England. Journal of Epidemiology and Community Health 1993;47:144‐8. - PMC - PubMed
Wong 2012
    1. Wong ISY, Ng KF, Tsang HWH. Acupuncture for dysphagia following stroke: a systematic review. European Journal of Integrative Medicine. 2012;4(2):141‐50.
Xie 2008
    1. Xie Y, Wang L, He J, Wu T. Acupuncture for dysphagia in acute stroke. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD006076.pub2] - DOI - PubMed
Yang 2015
    1. Yang SN, Pyun S‐B, Kim HJ, Ahn HS, Rhyu BJ. Effectiveness of non‐invasive brain stimulation in dysphagia subsequent to stroke: a systematic review and meta‐analysis. Dysphagia 2015;30:383‐91. - PubMed
Yuan 2003
    1. Yuan ZH, Huang LL, Chen ZL. Coagulant and enteral nutrition agents in the rehabilitation of deglutition disorders for patients with acute stroke. Chinese Journal of Clinical Rehabilitation 2003;7(28):3834‐5.

References to other published versions of this review

Bath 1999
    1. Bath PMW, Bath FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database of Systematic Reviews 1999, Issue 4. [DOI: 10.1002/14651858.CD000323] - DOI - PubMed
Geeganage 2012
    1. Geeganage C, Beavan J, Ellender S, Bath PMW. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD000323.pub2] - DOI - PubMed

Publication types

MeSH terms