Summary of findings for the main comparison. Swallowing therapy compared to placebo for dysphagia in acute and subacute stroke.
| Swallowing therapy compared to placebo for dysphagia in acute and subacute stroke | ||||||
| Patient or population: dysphagia in acute and subacute stroke Setting: in hospital Intervention: swallowing therapy Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with swallowing therapy | |||||
| Death or dependency at end of trial | Study population | OR 1.05 (0.63 to 1.75) | 306 (2 RCTs) | ⊕⊕⊕⊝ Moderate | a | |
| 693 per 1000 | 703 per 1000 (587 to 798) | |||||
| Case fatality at end of trial | Study population | OR 1.00 (0.66 to 1.52) | 766 (14 RCTs) | ⊕⊕⊕⊝ Moderate | b | |
| 197 per 1000 | 197 per 1000 (140 to 272) | |||||
| Length of inpatient stay (days) | Mean length of inpatient stay (days) ranged from 19 to 119 | MD 2.9 lower (5.65 lower to 0.15 lower) | ‐ | 577 (8 RCTs) | ⊕⊕⊕⊝ Moderate | c |
| Proportion of participants with dysphagia at end of trial | Study population | OR 0.42 (0.32 to 0.55) | 1487 (23 RCTs) | ⊕⊕⊝⊝ Low | d | |
| 570 per 1000 | 357 per 1000 (298 to 421) | |||||
| Swallowing ability | Mean swallowing ability was 0 | SMD 0.66 lower (1.01 lower to 0.32 lower) | ‐ | 1173 (26 RCTs) | ⊕⊝⊝⊝ Very low | e |
| Penetration aspiration score | Mean penetration aspiration score was 0 | SMD 0.37 lower (0.74 lower to 0 ) | ‐ | 303 (11 RCTs) | ⊕⊕⊝⊝ Low | f |
| Adverse event: chest infection or pneumonia | Study population | OR 0.34 (0.17 to 0.71) | 676 (10 RCTs) | ⊕⊝⊝⊝ Very low | g | |
| 343 per 1000 | 151 per 100 (82 to 271) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; OR: odds ratio; RCT: randomised controlled trial. | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by one level due to lack of precision (one study split into two trials).
bDowngraded by one level for indirectness of the evidence (i.e. multiple different interventions).
cDowngraded by one level due to indirectness of the evidence (i.e. multiple different interventions). Note also that two studies had unclear blinding.
dDowngraded by two levels due to indirectness of the evidence and blinding ‐ a large number of studies did not clarify blinding status.
eDowngraded by three levels due to indirectness of the evidence (i.e. multiple different interventions), considerable heterogeneity, and fair number of studies did not clarify blinding status.
fDowngraded by two levels due to indirectness of the evidence (i.e. multiple different interventions) and moderate heterogeneity.
gDowngraded by three levels due to indirectness of the evidence (i.e. multiple different interventions), substantial heterogeneity, and fair number of studies did not clarify blinding status.