Dose-Response Meta-Analysis of Neuromuscular Electrical Stimulation for Post-Stroke Dysphagia
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Objective: To clarify the dose-response relationships of neuromuscular electrical stimulation (NMES) for post-stroke dysphagia and identify the optimal protocols.Methods: A systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) was conducted under the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 (PROSPERO: CRD420251126373).Twenty-four RCTs with 1,125 stroke patients were included.Primary outcomes evaluated swallowing safety using Penetration-Aspiration Scale (PAS), hyoid movement, Functional Oral Intake Scale (FOIS), and Water Swallow Test (WST).Linear and nonlinear meta-regression were used to assess NMES parameters (dose, duration, onset timing).Results: A higher cumulative NMES dose was linearly associated with improved PAS, suggesting that ≥15 hours of stimulation may be required for meaningful airway protection.Earlier initiation yielded greater hyoid improvements, consistent with the principles of neuroplasticity recovery.Non-linear analyses showed U-shaped dose-response curves for hyoid excursion and the WST, with more potent effects at lower and higher doses.FOIS showed no consistent associations.Adverse events were rare and mild (skin irritation).Conclusion: The efficacy of NMES for post-stroke dysphagia depends on the stimulation dose, timing, and duration.Individualized protocols should align with therapeutic goals, while larger trials are needed to refine practice and inform policy.(
DOI: 10.34160/jkds.25.007
Institution: Yonsei University
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7118264666