Effects of Biofeedback on the Rehabilitation of People with Post-stroke Dysphagia: A Systematic Review and Meta-Analysis.

To evaluate the effect of adding biofeedback to standard therapy in the rehabilitation of post-stroke dysphagia through a systematic review and meta-analysis. A comprehensive literature search was conducted in MEDLINE and EMBASE using the PICO framework and adhering to PRISMA guidelines. Four independent reviewers screened and selected studies for inclusion. Only randomized controlled trials were included in the meta-analysis. Risk of bias was evaluated using the Cochrane ROB-2 tool, and the certainty of evidence was rated according to the GRADE approach. Of the 118 studies initially retrieved, five met the criteria for inclusion in the quantitative analysis. All selected trials used surface electromyography (sEMG) biofeedback alongside conventional therapy. The primary outcomes evaluated were incidence of pneumonia, nasogastric tube removal, quality of life, and dysphagia severity. While the addition of biofeedback appeared to be associated with a higher rate of tube removal and some improvement in quality of life, no statistically significant difference was found in terms of clinical severity. Most outcomes were graded as having very low certainty due to imprecision and limited sample sizes. Biofeedback may offer added value to standard post-stroke dysphagia therapy, particularly in enhancing certain clinical outcomes such as transition to oral feeding and perceived quality of life. While initial findings are promising, more robust evidence is needed to fully establish the clinical role of biofeedback in this context.