Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review.
Pamela D'Netto, Anna Rumbach, Katrina Dunn and 1 others
PMID 35445366WHAT IT FOUND
Penetration or aspiration on instrumental assessment, older age, bilateral lesions, high NIHSS stroke severity, and initial low Functional Oral Intake Scale scores consistently predict persistent dysphagia after stroke.
Intubation and tracheostomy also predict poor recovery. The evidence is limited by heterogeneous definitions of recovery and mostly retrospective designs.
Key findings
01Penetration or aspiration identified on instrumental assessment (VFSS or FEES) was the strongest predictor of persistent dysphagia, supported by consensus from multiple studies.
02Older age, bilateral lesions, and higher initial stroke severity (NIHSS) were consistent predictors of poor swallowing recovery.
03Intubation and tracheostomy insertion post-stroke were negative predictors of dysphagia recovery.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Substantial heterogeneity in study design, statistical methods, and definitions of dysphagia recovery (e.g., some studies defined recovery as tube removal, others as diet upgrade or scale change). 86% of the included patients had ischaemic stroke, limiting generalizability to haemorrhagic stroke populations. The majority of included studies were retrospective, introducing risks of selection bias and inaccurate record-keeping. No consensus was found for stroke location as a predictor due to inconsistent classification systems across studies. Instrumental assessment variables did not feature in the prognostic models, possibly due to limited availability or different model structures.
Declared interests
The review was funded by The University of Queensland. The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that reperfusion treatments (thrombolysis or thrombectomy) significantly improve swallowing recovery outcomes, as they did not reach significance in this review. Additionally, avoid relying on stroke location as a definitive predictor, as findings were inconsistent across studies due to varying classification methods.