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Effectiveness of Combined Rehabilitation Approaches in Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis
Ibrahim M Alayaseh1,2, Ponnusamy Subramaniam1, Thanzeem Razak2
1Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Abstract:
This systematic review and meta-analysis critically examine the efficacy of combined rehabilitation strategies, specifically the integration of swallowing exercises, neuromuscular electrical stimulation (NMES), and neuromuscular taping (NMT), in the management of post-stroke dysphagia. Four databases (Scopus, ScienceDirect, Cochrane Library, and PubMed) were searched for studies published from January 1990 to December 2024. Reference lists from relevant articles were also reviewed. A total of 372 studies were identified. After screening titles, abstracts, and full texts, 18 studies met the inclusion criteria.
Population:
Adults (≥ 18 years) with post-stroke dysphagia in the acute or subacute phases.
Intervention:
Swallowing exercises, NMES, NMT, or a combination.
Comparator:
Control groups with single interventions, usual care, or traditional therapies.
Outcomes:
Primary outcomes included swallowing function, aspiration pneumonia reduction, and quality of life. Secondary outcomes examined the timing, intensity, and type of interventions. Data were extracted using a standardized form in Microsoft Excel, focusing on study characteristics, participant demographics, intervention details, and outcome measurements. This systematic review supports the effectiveness of combined intervention approaches for post-stroke dysphagia. The meta-analysis revealed a significant improvement in swallowing function, with a pooled effect size of -1.27, indicating reduced Penetration-Aspiration Scale (PAS) scores. The random-effects pooled effect size was - 1.49 (95% CI: -1.92 to -1.06). Substantial heterogeneity (I² = 67.37%) was observed, likely attributable to differences in study methodologies, intervention protocols, and participant characteristics. The findings support the efficacy of combined rehabilitation strategies for post-stroke dysphagia. Certain combined interventions, particularly those incorporating NMES, show promise of effectiveness. However, the effectiveness of other modalities, such as kinesiology taping and chin tuck against resistance, remains less consistent and requires further investigation.
Registration Number:
PROSPERO Registration ID: CRD42025645917.
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