Therapeutic effects of acupuncture for neurogenic dysphagia-a randomized controlled trial

OBJECTIVE:To evaluate the therapeutic effects and long-term efficacy of acupuncture for neurogenic dysphagia.METHODS:Subjects with neurogenic dysphagia undergoing routine swallowing management were randomized to receive either 20 sessions of true acupuncture(experimental group) or sham acupuncture(control group 1) for approximately one and a half months.A third group(control group 2) comprised of non-randomized subjects with neurogenic dysphagia who received routine care were recruited from separate wards.The outcomes were assessed by the Royal Brisbane Hospital Outcome Measure for Swallowing(RBHOMS),as well as by the consistencies of ingested food and fluid.RESULTS:A total of 87 subjects(experimental group,n= 20;control group 1,n=19;control group 2,n=48) were recruited into the trial.The average RBHOMS score showed a greater improvement in the experimental group and in control group 1 than in control group 2.The average levels of foodand fluid consistencies displayed greater improvement in the experimental group than in the two control groups.CONCLUSIONS:This study demonstrates that acupuncture may have therapeutic effects and long-term efficacy for neurogenic dysphagia.However,due to an insufficient sample size and the lack of follow-up for control group 2,multi-centre trials employing a larger sample size may be required to draw concrete conclusions.     

多伦多床旁吞咽筛查试验在急性期脑卒中后吞咽障碍筛查中的筛检效果评价

目的:探讨多伦多床旁吞咽筛查试验(TOR-BSST)在急性期脑卒中后吞咽障碍筛查中的筛检效果。方法:采用TOR-BSST对148例急性期脑卒中后住院患者进行筛查评估,筛查当天或24小时之内行吞咽障碍诊断金标准——视频透视检查(VFSS),以金标准为参考标准,用灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比进行筛检效果评价。结果:TOR-BSST(+)共46例(31.08%),TOR-BSST(-)共102例(68.92%),结果显示TOR-BSST判断吞咽障碍的灵敏度为61.8%,特异度为87.1%,阳性预测值为73.9%,阴性预测值79.4%,阳性似然比为4.7907,阴性似然比0.4386。结论:与TOR-BSST研发原作者的研究相比较,此研究结果显示筛检效果不够理想,两者的研究环境与使用环境均有差距,未来需要更严谨的研究方法学设计、更多的吞咽障碍评估方法的引进或开发,且加强VFSS评价的准确性是关键。