A Systematic Review and Meta-Analysis on the Application of Thickened Liquids to Treat Adults With Neurogenic Dysphagia

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of oral rehabilitation Pub Date : 2025-07-22 DOI:10.1111/joor.70025

Wan-Qi Li, Ivy Cheng, Ayodele Sasegbon, Meng Dai, Shaheen Hamdy

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引用次数: 0

Abstract

Background

Thickened liquids have been one of the cornerstones of routine care to reduce aspiration for dysphagic patients in clinical practice. However, the evidence of this practice remains limited and uncertain.

Aims

This study aimed to systematically review and evaluate the effects of thickened liquid for adults with neurogenic dysphagia.

Methods

Five electronic databases were searched (Pubmed, Embase via Ovid, CINAHL, Web of Science and Cochrane Library) from each database's inception date until 30th July 2024. Search terms included a combination of database-specific controlled vocabulary terms and free-text terms relating to ‘dysphagia’ and ‘thickened food’. Study inclusion criteria focused on peer-reviewed published articles including randomised controlled trials (RCT), cohort studies, case–control studies and case series. Only studies with neurogenic data were included. Four reviewers independently performed the search, data extraction and analysis. The outcome measure was a change in (any) relevant clinical swallowing-related characteristic.

Results

A total of 2090 studies were identified, of which 16 met the inclusion criteria and were included in the review. The risk of bias of studies was moderate to low. Five studies either focused exclusively on different components of swallowing physiology or were unable to provide sufficient or reliable data for analysis and were thus excluded from data synthesis. Data analysis was conducted between groups (thin liquid vs. thickened liquid) concerning penetration (n = 5) and aspiration (n = 8), Penetration Aspiration Scale (PAS) scores (n = 4), unsafe swallowing (n = 7) and residue (n = 5). The results showed that thickened liquids improved swallowing safety, including reductions in aspiration events (([95% CI] = 0.49 [0.28, 0.88]; p = 0.02; I² = 81%) in RCTs and ([95% CI] = 0.31 [0.13, 0.71]; p = 0.006; I² = 47%) in non-RCTs), as well as improvements in unsafe swallowing ([95% CI] = 0.27 [0.14, 0.51]; p < 0.0001; I² = 88%) and PAS scores ([95% CI] = −1.99 [−2.59, −1.38]; p < 0.00001; I² = 89%). However, thickened liquids did not demonstrate a significant effect in reducing penetration events ([95% CI] = 0.40 [0.13, 1.22]; p = 0.11; I² = 88%) and were associated with increased residue in both the pharynx ([95% CI] = 1.57 [1.20, 2.06]; p = 0.001; I² = 16%) and the oral cavity ([95% CI] = 2.87 [1.88, 4.40]; p < 0.0001; I² = 45%).

Conclusion

The current evidence, based mainly on non-randomised controlled trials, suggests that thickeners may help improve swallowing safety for neurogenic dysphagia, but this evidence remains weak. Further RCT evidence is needed to validate the clinical efficacy of thickeners.

Trial Registration

INPLASY International Platform for Registered Systematic Reviews and Meta Analyses Program: INPLASY202510011

Abstract Image

查看原文本刊更多论文

加厚液体治疗成人神经源性吞咽困难的系统回顾和荟萃分析。

背景：在临床实践中，增稠液体已成为减少吞咽困难患者误吸的常规护理的基础之一。然而，这种做法的证据仍然有限和不确定。目的：本研究旨在系统回顾和评价加厚液体治疗成人神经源性吞咽困难的效果。方法：检索5个电子数据库（Pubmed、Embase via Ovid、CINAHL、Web of Science和Cochrane Library），从每个数据库建立日期到2024年7月30日。搜索词包括数据库特定的受控词汇词和与“吞咽困难”和“增稠食物”相关的自由文本词。研究纳入标准侧重于同行评审的已发表文章，包括随机对照试验（RCT）、队列研究、病例对照研究和病例系列。仅纳入具有神经源性数据的研究。四名审稿人独立进行检索、数据提取和分析。结果测量是（任何）相关临床吞咽相关特征的改变。结果：共纳入2090项研究，其中16项符合纳入标准，纳入本综述。研究的偏倚风险为中到低。五项研究要么只关注吞咽生理学的不同组成部分，要么无法提供足够或可靠的分析数据，因此被排除在数据综合之外。对两组（稀液vs增稠液）的穿透（n = 5）和误吸（n = 8）、穿透误吸量表（PAS）评分（n = 4）、不安全吞咽（n = 7）和残留（n = 5）进行数据分析。结果显示，增稠的液体提高了吞咽安全性，包括误吸事件的减少([95% CI] = 0.49 [0.28, 0.88]；p = 0.02；I2 = 81%)相关的和((95%置信区间)= 0.31 (0.13,0.71);p = 0.006；I2 = 47%)，以及不安全吞咽的改善([95% CI] = 0.27 [0.14, 0.51]；p 2 = 88%),不是分数([95% CI) = -1.99 (-2.59, -1.38);p 2 = 89%)。然而，增稠液体在减少渗透事件方面没有显着效果([95% CI] = 0.40 [0.13, 1.22]；p = 0.11；I2 = 88%)，且与两咽部残留增加相关([95% CI] = 1.57 [1.20, 2.06]；p = 0.001；I2 = 16%)和口腔((95%置信区间)= 2.87 (1.88,4.40);p 2 = 45%)。结论：目前的证据主要基于非随机对照试验，表明增稠剂可能有助于改善神经源性吞咽困难的吞咽安全性，但这一证据仍然薄弱。需要进一步的RCT证据来验证增稠剂的临床疗效。试验注册：INPLASY国际系统评价和Meta分析注册平台：INPLASY202510011。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.