The effectiveness of neuromuscular electrical stimulation on swallowing rehabilitation in patients with post-stroke acute and chronic dysphagia : a systematic review

Abstract

Objective: Given the increasing public health burden brought by post-stroke dysphagia in the expanding aging population in Hong Kong, researchers have been endeavoring to identify effective treatment options. This review aimed at evaluating the effectiveness of neuromuscular electrical stimulation (NMES) on swallowing rehabilitation in patients with post-stroke dysphagia and addressing the differences of the effects of NMES in patients with acute and chronic dysphagia. Methods: The literature search was performed using electronic databases PubMed, Proquest, Academic Search Premier, Science Direct, and Medline up to June 2016. Only published studies on post-stroke dysphagia and using NMES as treatment approach were included. Jadad scale was used as the quality indicator of the included studies. Results: Sixteen studies were included in the final review. Significant improvements in swallowing functions, swallowing kinematics, or swallowing-related quality of life were found in all the 12 controlled studies comparing the NMES group and the controlled group and in all the 4 case series studies comparing the treatment effects of NMES before and after treatment. Significant improvements were also found in both the acute groups and the chronic groups of patients. Conclusions: Neuromuscular electrical stimulation was found to have positive effects on swallowing rehabilitation in patients with post-stroke dysphagia, including both the acute and chronic groups. Potential differences of the treatment effects of NMES between the acute group and chronic group of patients are yet to be identified. Powerfulness of currently available studies to support the use of NMES was reduced due to methodological flaws and hence evidence should continue to be established.