头颈癌吞咽困难康复的比较效果：一项网络荟萃分析。
Comparative effectiveness of dysphagia rehabilitation in head and neck cancer: A network meta-analysis.
文献信息
| PMID | 42775738 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Jong Mi Park |
| 作者单位 | Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. |
| 期刊 | Clinical rehabilitation |
| SCI 分区 | Q1 |
| IF | 4.1 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 采用网络荟萃分析比较头颈癌治疗后吞咽困难的康复干预措施。
数据来源： 检索PubMed/MEDLINE、EMBASE、Cochrane Library、Scopus和Web of Science，检索时间自建库至2026年7月21日。
综述方法： 纳入评估吞咽练习、神经肌肉电刺激联合练习（NMES+ex）、言语治疗联合练习（Speech+ex）或远程康复的随机对照试验。采用随机效应网络荟萃分析估计Hedges' g标准化均数差（SMDs）及四个结局领域的治疗排名。使用网络荟萃分析置信度框架评估置信度。
结果： 系统综述纳入21项试验；18项试验涉及1139名参与者纳入连接网络。与常规护理相比，练习改善了临床医生评定的吞咽功能（SMD 0.98，95%置信区间0.28至1.69）；与远程康复相比，练习改善了仪器评估的吞咽功能（SMD 1.24，0.07至2.42）。其他比较均无统计学显著性。Speech+ex在临床医生评定结局中排名最高，练习在仪器评估结局中排名最高，NMES+ex在患者报告的生活质量和症状/障碍结局中排名最高。在区分练习类型的敏感性分析中，预防性练习在仪器评估和生活质量结局中排名最高。置信度从中等到极低不等，所有患者报告比较的置信度均为极低。
结论： 康复效果因结局领域而异，没有始终优越的干预措施。练习在选定的临床医生评定和仪器评估结局中显示出获益，但网络稀疏、不精确性和不一致性限制了确定性。这些发现支持个体化干预选择以及采用标准化结局的足够把握度试验。
英文摘要
ObjectiveTo compare rehabilitation interventions for dysphagia after head and neck cancer treatment using network meta-analysis.Data sourcesPubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched from inception to 21 July 2026.Review methodsRandomised controlled trials evaluating swallowing exercise, neuromuscular electrical stimulation combined with exercise (NMES+ex), speech therapy combined with exercise (Speech+ex) or telerehabilitation were included. Random-effects network meta-analyses estimated Hedges' g standardised mean differences (SMDs) and treatment rankings across four outcome domains. Confidence was assessed using the Confidence in Network Meta-Analysis framework.ResultsTwenty-one trials were included in the systematic review; 18 trials involving 1139 participants contributed to connected networks. Exercise improved clinician-rated swallowing compared with usual care (SMD 0.98, 95% confidence interval 0.28 to 1.69) and instrumental swallowing compared with telerehabilitation (SMD 1.24, 0.07 to 2.42). No other comparisons were statistically significant. Speech+ex ranked highest for clinician-rated outcomes, exercise for instrumental outcomes and NMES+ex for patient-reported quality of life and symptom/handicap outcomes. In sensitivity analyses separating exercise types, prophylactic exercise ranked highest for instrumental and quality-of-life outcomes. Confidence ranged from moderate to very low and was very low for all patient-reported comparisons.ConclusionRehabilitation effects varied by outcome domain, with no consistently superior intervention. Exercise showed benefits for selected clinician-rated and instrumental outcomes, but sparse networks, imprecision and inconsistency limit certainty. These findings support individualised intervention selection and adequately powered trials using standardised outcomes.