Dysphagia in acute stroke: a long-awaited trial.

摘要

Carnaby and colleagues1 describe in this issue of The Lancet Neurology the results of their single centre, sing le-blind, randomised controlled trial of a standard behavioural intervention for dysphagia after stroke as "encouraging". I might even add the adjective exciting, because this trial has shown, for the first time, that an intervention can improve outcomes of patients with dysphagia. Dysphagia is more common in severe stroke, but is independently associated with poorer long-term outcomes in mild-to-moderate stroke. This trial indicates that a behavioural intervention not only improves recovery of swallowing, but also reduces the complications of dysphagia and improves long-term outcomes. This finding lends support to the notion that the association between dysphagia and poor outcomes is, at least in part, causal. Because almost half of all patients admitted to hospital with an acute stroke worldwide have dysphagia an effective treatment would be applicable to millions of patients each year, andtherefore might have huge public-health benefits. However, before we get overly excited we must consider the limitations of this study, some of which the authors describe in their discussion.