Intervention Review

Non-pharmacological therapies for dysphagia in Parkinson's disease

  1. Katherine Deane2,
  2. Renata Whurr3,
  3. Carl E Clarke1,*,
  4. E Diane Playford4,
  5. Yoav Ben-Shlomo5

Editorial Group: Cochrane Movement Disorders Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 21 NOV 2000

DOI: 10.1002/14651858.CD002816


How to Cite

Deane K, Whurr R, Clarke CE, Playford ED, Ben-Shlomo Y. Non-pharmacological therapies for dysphagia in Parkinson's disease. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD002816. DOI: 10.1002/14651858.CD002816.

Author Information

  1. 1

    City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Department of Neurology, Birmingham, West Midlands, UK

  2. 2

    Newcastle University, Institute of Health & Society, Newcastle-upon-Tyne, UK

  3. 3

    The National Hospital for Neurology and Neurosurgery, Therapies Services, London, UK

  4. 4

    The National Hospital for Neurology and Neurosurgery, Directorate of Musculoskeletal and Rehabilitational Services, London, UK

  5. 5

    Canynge Hall, Dept of Social Medicine, Bristol, UK

*Carl E Clarke, Department of Neurology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, West Midlands, B18 7QH, UK. c.e.clarke@bham.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Dysphagia occurs frequently in Parkinson's disease although patients themselves may be unaware of swallowing difficulties. Speech and language therapists in conjunction with nurses and dietitians use techniques that aim to improve swallowing and reduce the risk of choking, aspiration and chest infections.

Objectives

To compare the efficacy and effectiveness of non-pharmacological swallowing therapy for dysphagia versus placebo or no intervention in patients with Parkinson's disease.
To compare one form of non-pharmacological swallowing therapy for dysphagia with another in patients with Parkinson's disease.

Search methods

Relevant trials were identified by electronic searches of MEDLINE, EMBASE, CINAHL, ISI-SCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICST-EPlus, AIM, IMEMR, SIGLE, ISI-ISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR and NRR; and examination of the reference lists of identified studies and other reviews.

Selection criteria

Only randomised controlled trials (RCT) were included. We did not examine any trials using drugs or surgery to treat the dysphagia. We did not examine any trials where part of the therapist's advice was to insert a nasogastric or percutaneous gastrostomy tube.

Data collection and analysis

Not applicable.

Main results

No randomised controlled trials or controlled trials were found that examined the efficacy of non-pharmacological swallowing therapy for the treatment of dysphagia in Parkinson's disease. However there is one large RCT currently recruiting patients that will compare 'chin down' posture with thickened liquids in the treatment of dysphagia. The main outcomes will be the rates of aspiration and pneumonia.

Authors' conclusions

There is currently no evidence to support or refute the efficacy of non-pharmacological swallowing therapy for dysphagia in Parkinson's disease. Large well designed placebo-controlled RCTs are required to assess the effectiveness of swallowing therapy for dysphagia in Parkinson's disease and reported according to CONSORT guidelines. Suitable outcome measures should be chosen so that the efficacy and effectiveness of non-pharmacological swallowing therapy can be assessed and an economic analysis performed. Outcomes which have meaning to patients and carers should be used wherever possible since they need to know the value of this therapy in practical terms. The patients should be followed for at least 6 months to determine the duration of any improvement.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Dysphagia occurs frequently in Parkinson's disease although patients themselves may be unaware of swallowing difficulties. Speech and language therapists in conjunction with nurses and dietiticians use techniques that aim to improve swallowing and reduce the risk of choking and chest infections.

This review compared the benefits of swallowing therapy versus placebo (sham therapy) or no therapy for swallowing disorders in Parkinson's disease. Relevant trials were identified by electronic searches of 21 medical literature databases, various registers of clinical trials and an examination of the reference lists of identified studies and other reviews.

Only randomised controlled trials (RCT) were eligible for this review. In RCTs the patients are assigned to each of the groups in a random fashion so as to reduce the potential for bias. Either one group of patients had swallowing therapy, the other had a sham treatment or no treatment, or two forms of swallowing therapy were compared to each other.

There were no controlled trials, randomised or otherwise, in this field. Therefore there is no trial evidence to prove or disprove the benefit of swallowing therapy for the treatment of swallowing disorders in people with Parkinson's disease. It should be emphasised that this lack of evidence does not mean lack of effect.

There is one large RCT currently recruiting patients that will compare 'chin down' posture with thickened liquids in the treatment of dysphagia. The main outcomes in this study will be the rates of aspiration and pneumonia.

Large well designed placebo-controlled RCTs are needed to assess the effectiveness of swallowing therapy for swallowing disorders in Parkinson's disease. The design of the trials should minimise bias and be reported fully using CONSORT guidelines. Outcome measures with particular relevance to patients should be chosen and the patients followed for at least 6 months to determine the duration of any improvement.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

非藥物療法治療帕金森氏症的吞嚥困難

吞嚥困難經常會發生,雖然帕金森氏症病人他們自己可能未察覺到。說話和語言治療學家連合護士與營養學家使用各種方法企圖改善吞嚥問題而且減輕窒息、呼吸、胸部感染等風險。

目標

‧比較非藥物學吞嚥用以療法治療帕金森氏症病人吞嚥困難對安慰劑或者不予介入的效力與效果。 ‧比較治療帕金森氏症病人吞嚥困難的一種非藥物學吞嚥療法與另外一種療法。

搜尋策略

電子搜尋MEDLINE, EMBASE, CINAHL, ISISCI, AMED, MANTIS, REHABDATA, REHADAT, GEROLIT, Pascal, LILACS, MedCarib, JICSTEPlus, AIM, IMEMR, SIGLE, ISIISTP, DISSABS, Conference Papers Index, Aslib Index to Theses, the Cochrane Controlled Trials Register, the CentreWatch Clinical Trials listing service, the metaRegister of Controlled Trials, ClinicalTrials.gov, CRISP, PEDro, NIDRR 以及 NRR以確認有關聯的試驗,也審查了辨認過的研究和其他回顧的參考目錄。

選擇標準

只包含隨機對照試驗(RCT)。我們沒有檢閱任何使用藥物或手術來治療吞嚥困難的試驗。我們也沒有檢閱有治療師建議插入鼻胃管或著經皮胃造口管子的任何試驗。

資料收集與分析

沒有能應用的。

主要結論

隨機對照試驗或對照試驗沒有發現到檢查非藥物學吞嚥療法對治療帕金森氏症病人吞嚥困難的效力。然而最近有一個大型RCT在病人比較下巴向下的姿勢與使用濃稠液體來治療吞嚥困難。主要的結果評估是吸入性和肺炎產生的速度。

作者結論

目前沒有證據來支持或反駁非藥物學吞嚥療法治療帕金森氏症病人吞嚥困難的效力。須要大規模設計完善的安慰劑對照組RCTs來評估帕金森氏症吞嚥困難的吞嚥療法的有效率,而且根據CONSORT準則加以發表。應該選擇適當的結果評量以評估非藥物學吞嚥療法的療效和效果以及進行經濟分析。在任何可能的情況下應該使用對病人和照顧者有意義的結果,因為他們須要知道這個療法在實際運用的價值。須要追蹤病人至少六個月以判定任何症狀改善的時間長短。

翻譯人

本摘要由新光醫院吳亞縈翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

吞嚥困難經常會發生,雖然帕金森氏症病人他們自己可能未察覺到。說話和語言治療學家連合護士與營養學家使用各種方法企圖改善吞嚥問題而且減輕窒息、呼吸、胸部感染等風險。本回顧是比較帕金森氏症吞嚥困難的吞嚥療法及安慰劑(假療法)或沒治療的益處。相關試驗的確認是藉由電子搜尋21種醫學文獻數據庫、各種臨床試驗的登錄系統和審查了辨認過的研究與其他回顧的參考目錄。此篇回顧只有隨機對照試驗(RCT)是合格的。在RCTs中為了要減少偏差的可能性,病人以隨機方式被分配到每一小組。一組病人用吞嚥療法、另一組病人用假療法或不治療、或者用二種吞嚥療法,彼此之間加以比較。在此研討主題領域中,找不到隨機或不隨機的對照試驗,因此沒有試驗證據來證明或駁斥用以治療帕金森氏症病人吞嚥困難的吞嚥療法的益處。不應該強調說這種缺乏證據就表示沒有效果。最近有一項大型RCT正在病人身上比較下巴向下的姿勢與濃稠液體用以治療吞嚥困難,主要的結果評估是吸入性和肺炎產生的速度。須要大規模設計完善的安慰劑對照組RCTs來評估帕金森氏症吞嚥困難的吞嚥療法的效果。試驗的設計應該將偏差減至最少,而且根據CONSORT準則加以充分發表。應該選擇與病人有特殊關聯的結果評估,而且追蹤病人至少六個月以判定任何改善的持續期間。