Expiratory muscle strength training improves swallowing and respiratory outcomes in people with dysphagia: A systematic review

Ms Rebecca Lamont1, Ms Marinda Brooks1, Mrs Emma  McLaughlin2, Professor Nora Shields2,1

1Northern Health, Epping, Australia

2LaTrobe University, Melbourne, Australia


Aim: To investigate the effects of expiratory muscle strength training on communication and swallowing outcomes in adults with acquired motor based communication and/or swallowing difficulties of any aetiology. The secondary aims were to investigate the effects on respiratory and quality of life outcomes; and to describe how expiratory muscle strength training has been applied in previous studies.

Method: A systematic review was conducted. Six databases (CINAHL, MEDLINE, EMBASE, SPEECHBYTE, AMED, PUBMED) were searched from inception until June 2016. Randomised and non-randomised controlled trials and cohort studies published in English that investigated the effects of expiratory muscle strength training were included. Trial quality was assessed using the PEDro scale. Data were analysed descriptively and effect sizes and associated 95% confidence intervals were calculated. Two researchers completed study selection, risk of bias assessment and data extraction. Disagreements were resolved by consensus.

Results: The search strategy yielded 2898 potentially relevant articles. After removal of duplicates,   inclusion and exclusion criteria were applied to the titles and abstracts of 1211 studies. Full-text copies for 62 articles were retrieved and after further review seven articles were retained for inclusion in the review. These seven articles reported data from five trials. Preliminary data suggests expiratory muscle strength training improves airway safety during swallowing in people with dysphagia and increases the strength of the expiratory muscles in all patient groups. There was little evidence to suggest changes in communication outcomes after expiratory muscle strength training.

Significance to allied health: Speech pathologists might consider using expiratory muscle strength training to improve airway safety in adults with swallowing disorders.