Comparative Efficacy of Non-invasive Neurostimulation Therapies for Acute and Subacute Post-Stroke Dysphagia: A Systematic Review and Network Meta-Analysis

Publication date: Available online 21 October 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Ching-Fang Chiang, Meng-Ting Lin, Ming-Yen Hsiao, Yi-Chun Yeh, Yun-Chieh Liang, Tyng-Guey Wang

Abstract

Objective

To investigate the effectiveness of non-invasive neurostimulation therapies in patients with post-stroke dysphagia.

Data Sources

Electronic databases, including EMBASE, PubMed, Scopus, and the Cochrane Library were searched up to May 31, 2018.

Study Selection

All published randomized controlled trials (RCTs) comparing neurostimulation therapies including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface neuromuscular electrical stimulation (NMES), and pharyngeal electrical stimulation (PES) in patients with acute and subacute post-stroke dysphagia were included. Nineteen RCTs were enrolled in the meta-analysis.

Data Extraction

Full texts were independently reviewed. Two independent raters assessed the risk of bias of RCTs with the Cochrane Risk of Bias Tool. The primary outcome measure was swallowing function evaluated before and after neurostimulation therapy.

Data Synthesis

Both pairwise and network meta-analysis revealed that rTMS, tDCS and surface NMES significantly improved post-stroke dysphagia compared with placebo. Differences in functional improvement between PES and placebo were not significant. Based on probability ranking, rTMS seemed the best treatment among the four neurostimulation therapies. In the network meta-analysis, rTMS showed the best efficacy compared with placebo (standardized mean difference [SMD]: 1.02, 95% confidence interval [CI]: 0.61 to 1.43).

Conclusion

Among the four non-invasive neurostimulation therapies, rTMS, tDCS and surface NMES were effective for treating post-stroke dysphagia; furthermore, rTMS may be the most effective therapy according to probability ranking.

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