Efeitos dos dispositivos de treino muscular respiratório na disfagia orofaríngea: uma revisão sistemática e meta-análise

Abstract

OBJECTIVE: To report the evidence found in the literature, in studies with randomized clinical trials, non-randomized, quasi-randomized clinical trials, and cohort studies, developed with groups of dysphagic patients, independent of baseline disease, who used respiratory muscle training devices during the rehabilitation of dysphagia. METHODS: Systematic review was carried out, consulting five electronic bibliographic databases and three databases of gray literature, as well as manual searches of reference lists of the selected studies and consulting experts, without restriction of language and date. The risk of bias was evaluated with the aid of Review Manager v. 5.2 (The Nordic Cochrane Center, Copenhagen, Denmark). The analysis of the quality of the level of evidence was done following the criteria of Grading of Recommendations Assessment, Development, and Evaluation (GRADE). The meta-analysis was used to perform the meta-analysis. RESULTS: 1824 articles were identified in the search, and nine studies met all the eligibility criteria for the qualitative analysis. Of the studies included, 44.5% were performed with dysphagic patients after stroke, 77.8% of the studies used the EMST150 respiratory device, and the EXPIRATORY MUSCLE STRENGTH TRAINING (EMST) was applied in 88.9% of the studies. A significant improvement in coughing strength, suprahyoid muscle activity, safer swallowing in the oral phase and reduced risk of airway penetration and aspiration when applied to the Penetration and Aspiration Scale (PAS) were reported in 77, 8% of the studies. For the quantitative analysis four papers were included, the final result of the meta-analysis was a mean value of the studied effect equal to -0.89 with a 95% confidence interval. CONCLUSION: Respiratory Muscle Training has indicated promising results in dysphagic patients independent of baseline disease, providing increased strength and strengthening of respiratory muscles that directly affect swallowing. Additional studies are recommended with the use of different respiratory devices, with more representative samples, different etiologies, and training for a period of more than four / five weeks, keeping track of post-training to observe or not the results obtained.