Systematic reviews and meta-analysis of acupuncture for post-stroke dysphagia: an updated overview of the evidence

Abstract

Introduction Dysphagia is a common post-stroke complication. Acupuncture is a widely used effective treatment for post-stroke dysphagia in China. Based on our previously published overview in 2019, this study aimed to provide an update on the current evidence regarding acupuncture for post-stroke dysphagia. Specifically, this study aimed to assess the quality of systematic reviews (SRs) and meta-analyses (MAs) published in the last 5 years using the new Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) tool to provide updated evidence for clinical decision-making. Methods The following databases were searched: China National Knowledge Infrastructure, Wanfang database, Chinese Scientific Journal Database, SinoMed, PubMed, Embase and Cochrane Library from January 1, 2019 to June 30, 2025. Two researchers independently performed data extraction. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and PRISMA 2020 were used to evaluate the methodological and reporting quality of the included SRs/MA, respectively. Results Eight SRs/MA met the inclusion criteria. Additionally, one article applied the Grading of Recommendations Assessment, Development Evaluation system. Most of the evidence was of very low quality, with the primary factors for downgrading being inconsistency and publication bias. Evaluation using AMSTAR 2 indicated that there were no high-quality SRs/MA and that all studies were of critically low quality. Quality issues included failure to provide a list of excluded studies and justify their exclusion. Moreover, not all studies were randomized controlled trials (RCTs) with a low risk of bias (RoB). Additionally, if the studies were RCTs with moderate or high risk of bias, the review did not provide a discussion of the likely impact of the RoB on the results. Conclusion Acupuncture combined with rehabilitation may improve post-stroke dysphagia symptoms. However, the methodological quality of SRs/MA remains very low and has not improved over the last 5 years. Studies should be designed in line with the AMSTAR 2 and PRISMA 2020 to provide reliable, high-quality evidence for supporting clinical practice.

Keywords

acupuncture / post-stroke dysphagia / systematic review / meta-analysis / AMSTAR 2 / PRISMA / overview

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