The State of Exercise-Based Dysphagia Intervention in the Literature: A Scoping Review.

Introduction: Exercise-based interventions for dysphagia are frequently recommended in the clinical setting. We aim to characterize the state of the dysphagia treatment literature to provide a high-level overview on four domains: Study characteristics, patient populations, exercise characteristics, and outcome measures reported. This review acts as an initial step in analyzing the proposed gap between research and clinical practice patterns. Methods: A search strategy was executed across five databases to capture publications evaluating the impact of exercise-based interventions on swallow function. After removing duplicates, 20,583 abstracts were screened for inclusion, with 505 studies eligible for full-text review. After applying exclusionary criteria, information was extracted from 204 publications. Results: Results indicate that studies are predominantly prospective (88%) and often randomized controlled trials (44%) typically completed in the outpatient setting (59%). Most studies represent homogenous patient groups (88%) with an average age of 64 years. Exercise paradigms average 40 days in length. Forty-six target exercises are reported, with Effortful Swallow being the most common (37%). Forty percent of studies evaluate the efficacy of a single exercise in isolation, followed by a combination approach of 4+ exercises (34%) and 2-3 exercises (26%). Thirty-seven different therapeutic devices are reported. Most (65%) studies use instrumental examinations to evaluate treatment efficacy, with 52 unique methods for analysis reported. Further, over 100 unique clinical outcome measures are reported. Conclusions: This scoping review highlights many relative strengths in the dysphagia treatment literature (e.g., on parameters related to study design and outcome measures). At the same time, the findings suggest that there is significantly less literature to extrapolate to typical clinical caseloads and practice patterns with respect to patient characteristics, care settings, and exercise characteristics. Level of Evidence: I, scoping review of available evidence.