Sunday, November 19, 2006

Strokes and Dysphagia Research

If you could tell dysphagia researchers anything you wanted, what would it be?

Hmm. A whole lot of things, as it happens. (Not least of which would be, don't accept research funding from people who have a financial stake in your results). But one of the things that keeps popping into my head as I read dysphagia research is this:

Please stop using stroke patients to "prove" that a dysphagia treatment "works." Stroke patients are a TERRIBLE population with which to prove almost anything about dysphagia, unless, of course, you specifically want to talk about dysphagia post CVA. But it seems like almost every study on dysphagia therapy approaches that I come across includes CVA patients in the study population.

So why are they such a bad study population? Well, for one, it's not a homogenous group. You have large variations in time post onset, CVA location, previous CVA's, and comorbidities, all potentially confounding differences.

But the even bigger issue is that in the VAST MAJORITY of stroke patients, dysphagia resolves spontaneously. Too many times, studies showing that a therapy approach seems to "work" in CVA patients fail to take the possibility of spontaneous recovery into account. Of course, a properly randomized, controlled trial should be able to solve some of that . . . but hey, wait, we don't really have any of those published about dysphagia therapy.

Could some of these therapy approaches hasten recovery from the dysphagia? Sure. And that would be excellent for us to know. But I can't think of a single study I've run across that was set up to assess that accurately.

We need (lots and lots) more research in the field of swallowing disorders. But we really need well-designed and conducted studies from which to draw our conclusions for evidence-based practice.


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