Dosages of swallowing exercises in stroke rehabilitation: current practice, challenges, and dose–response relationship

Abstract

Dysphagia after stroke is highly prevalent, and negatively affects physical and psychosocial health. Swallowing exercises can improve swallowing function after stroke, however, optimal delivery of swallowing exercises is unclear. Dosage is one key factor that could enhance swallowing exercises. However, research on dosages of swallowing exercises is scarce. This thesis explores how to optimise dosages of swallowing exercises in stroke rehabilitation.

Different methodologies were used, including systematic review, medical record audit, focus groups, interviews, and a case series study. The first study investigates dosages of swallowing exercises reported in post-stroke dysphagia studies through systematic review. The second study investigates how and what dosages of swallowing exercises are reported in clinical practice through a medical record audit. The third and fourth studies explored the perspectives and practices of speech pathologists on dosage of swallowing exercises, and on wider factors influencing dysphagia practice in stroke rehabilitation through semi-structured focus groups. The fifth study was a convergent mixed-methods study, which quantitatively assessed the impact of high dosages of swallowing exercises in patients with post-stroke dysphagia. Patients’ perspectives on swallowing exercises were concurrently explored through semi-structured qualitative interviews.

Together, these studies explore the complexity and necessity of personalised and holistic dosages of swallowing exercises. Investigating current practice indicated inconsistent reporting and prescribing of dosages of swallowing exercises. Speech pathologists’ and patients’ perspectives revealed that multiple factors influence implementation of dosages of swallowing exercises. Further, while high dosages of swallowing exercises may enhance outcomes, more research is needed investigating the dose–response relationship in swallowing.