| Summary: | Background Dysphagia, sometimes as part of pseudobulbar palsy, is one of the most common complications of stroke. The incidence of post-stroke dysphagia ranges widely from 29% to 81% due to different methods of diagnosis, time after stroke, and the types of lesions. Although dysphagia may naturally resolve in many patients over the first 7 days post the cerebrovascular event, around 30% of stroke patients consider dysphagia a risk, and about 10% of them may develop swallowing problems six months after stroke. Dysphagia is known to be associated with an increased risk of pneumonia, malnutrition, disability and mortality. Many dysphagia treatment options are available today, including texture-modified diets, swallowing therapy programmes, non-oral feeding, medications and physical stimulation. However, clinical evidence to establish their roles in the management of post-stroke dysphagia is limited. There clearly exists a pressing need for high-quality research to identify effective treatments for this common stroke-associated complication. Acupuncture is widely employed to treat stroke and its complications including dysphagia in China and East Asia. A systematic review that included about 35 randomized controlled trials of acupuncture for dysphagia has shown that acupuncture may have the potential to improve swallowing function. Mechanistic studies have also revealed that acupuncture is able to regulate the cortex and the swallowing centre of the reticular structure of the brain stem to control swallowing reflection and coordinate motor movement of the swallow-related muscles, as well as directly improve the recovery of the injured peripheral nerves. It has also been found that acupuncture treatment could attenuate the plasma endothelin and nitric oxide (NO) level, regulate the imbalance between prostacyclin and thromboxane A2, and improve blood viscosity, thereby collectively contributing to the therapeutic effect for post-stroke dysphagia
To critically examine the effectiveness and safety of acupuncture for the treatment of post-stroke dysphagia, we propose to conduct a pragmatic and assessor-blinded clinical trial comparing real acupuncture treatment with patients without acupuncture. The results derived from the trial would likely add new and better evidence to improve the current Clinical Guideline on Acupuncture Treatment for Pseudobulbar Palsy.
Objectives
This study aims to evaluate the effectiveness and safety of acupuncture for the treatment of dysphagia as a complication of stroke.
Results
A total of 39 participants from 46 to 89 years old were enrolled into the study. The male to female ratio is 15 : 11. The mean baseline RBHOMS scores of all 39 participants was 5.92 ± 2.234, the mean RBHOMS scores of 24 participants who were completed all 24 sessions of treatment was 6.92 ± 2.065. There is statistically significant difference (p<0.05) between baseline and the completion of treatment (p=0.006). And significant difference was found in term of swallow quality-of-life score before and after acupuncture treatment. (p<0.01) Conclusions
This pilot study provided a preliminary evidence for the effectiveness of acupuncture for poststroke dysphagia. This can be a foundation for future full-scale randomized controlled clinical trial to assess the efficacy and safety of acupuncture for poststroke dysphagia.
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