Effect of surface electromyographic biofeedback on post-stroke dysphagia: a meta-analysis.

INTRODUCTION

This study aimed to explore the efficacy of surface electromyography biofeedback (sEMG-BF) in treating post-stroke dysphagia (PSD) patients.

METHODS

PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched from database inception to April 2024. Randomized controlled trials (RCTs) investigating the effects of sEMG-BF on patients with PSD were included. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. The level of oral intake was measured by the Functional Oral Intake Scale (FOIS). The penetration and aspiration were measured by the Penetration-Aspiration Scale (PAS), and clinical efficacy rate. Meta-analysis was performed using R software with random-effects models.

RESULTS

Five RCTs involving 174 patients were included. sEMG-BF showed borderline improvement in oral intake (MD = 1.26, 95% CI: 0.03–2.48, P = 0.047). Nonetheless, due to significant heterogeneity (I2 = 62%) and the limited number of studies, it was impossible to draw definitive conclusions about optimal timing or protocol. No significant improvement in penetration and aspiration was observed (MD = -0.70, 95% CI: -1.46–0.07, P = 0.198), suggesting no consistent effect on objective swallowing safety, with low heterogeneity (I2 = 0%, P = 0.57). The clinical efficacy rate was improved (RR = 1.26, 95% CI: 0.98–1.62, P = 0.066)in the sEMG-BF group compared to the control group, with low heterogeneity (I2 = 0%, P = 0.93).

CONCLUSION

Current preliminary evidence suggests potential benefits of sEMG-BF in improving functional oral intake, though only borderline statistical significance is observed. sEMG-BF may improve swallowing function in post-stroke dysphagia. However, give few trials included and heterogeneous protocols, its definitive efficacy, optimal implementation, and generalizability need to be validated in large-scale randomized controlled trials with standardized, reproducible protocols.