Behavioural intervention for dysphasia in acute stroke: a randomised controlled trial

G. Carnaby, Graeme Hankey, J. Pizzi

Research output: Contribution to journalArticle

187 Citations (Scopus)

Abstract

BackgroundSwallowing dysfunction after stroke is common, but there is little reliable evidence for how the disorder should be managed. This study compared standard low-intensity and high-intensity behavioural interventions with usual care for dysphagia.Methods306 patients with clinical dysphagia admitted to hospital with acute stroke were randomly assigned to receive usual care (n=102), prescribed by the attending physician; standard low-intensity intervention (n=102), comprising swallowing compensation strategies and diet prescription three times weekly for up to a month; or standard high-intensity intervention and dietary prescription (n=102), at least daily for up to a month. The primary outcome measure was survival free of an abnormal diet at 6 months. Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00257764.Findings60 patients died and three patients were lost to follow up before the 6-month analysis. Of patients randomly allocated usual care, 56% (57/102) survived at 6 months free of an abnormal diet compared with 67% (136/204) allocated standard swallowing therapy (relative risk 1·19, 95% CI 0·98–1·45). Standard swallowing therapy was associated with a non-significant trend toward a reduction in death (0·80, 0·5–1·3), institutionalisation (0·69, 0·4–1·1), and dependency (1·05, 0·8–1·3); a significant reduction in swallowing-related medical complications (0·73, 0·6–0·9), chest infection (0·56, 0·4–0·8), and death or institutionalisation (0·73, 0·55–0·97); and a significant rise in the proportion of patients regaining swallowing function (1·41, 1·03–1·94) by 6 months. Compared with usual care and low-intensity therapy, high-intensity therapy was associated with an increased proportion of patients who returned to a normal diet (p=0·04) and recovered swallowing (p=0·02) by 6 months.InterpretationThese data show a consistent trend towards more favourable outcomes in dysphagic stroke patients who are assigned a standard programme of early behavioural swallowing intervention, including active therapeutic approaches and dietary modification.
Original languageEnglish
Pages (from-to)31-37
JournalThe Lancet Neurology
Volume5
Issue number1
DOIs
Publication statusPublished - 2006

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