Xu Fangyuan, Wang Xuepeng, Dai Fan, Ye Yu, Su Xingxing, Hu Peijia, Cheng Hongliang
The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China.
Department of Neurosurgery, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China.
Front Neurosci. 2025 Aug 28;19:1640471. doi: 10.3389/fnins.2025.1640471. eCollection 2025.
Acupuncture has been widely used in clinical rehabilitation as an adjunctive therapy for post-stroke dysphagia (PSD). Although numerous meta-analyses (MAs) have evaluated its efficacy, a comprehensive assessment of the methodological quality and evidence strength of these MAs is still lacking.
Two researchers independently searched eight databases for relevant literature, screened studies according to predefined inclusion and exclusion criteria, and extracted data from the eligible systematic reviews (SRs) and MAs. The methodological quality, reporting completeness, risk of bias, and strength of evidence were rigorously evaluated using the AMSTAR 2, PRISMA-A, ROBIS, and GRADE, respectively. In addition, the GROOVE tool was used to assess the degree of overlap among original studies by calculating corrected covered area (CCA).
This overview included 19 MAs. Based on AMSTAR 2, four studies were rated as low quality, while 14 were rated as critically low quality. In terms of reporting quality, major deficiencies were observed, including a lack of protocol registration, incomplete search strategies, inadequate risk of bias assessments, and missing funding disclosures. For risk of bias, only six studies were judged to be at low risk. Furthermore, it revealed a slight overlap among the original studies with a CCA of 2.86%. Among the 68 outcome indicators, only 11.76% were graded as moderate quality, while 50% were classified as low quality and 38.24% as critically low quality, according to the GRADE assessment. Among the moderate-quality outcomes, electroacupuncture combined with swallowing rehabilitation therapy (SRT) demonstrated superior effectiveness compared to SRT alone (OR = 5.40, 95% CI: 3.78-7.72), as did acupuncture plus SRT (RR = 1.26, 95% CI: 1.19-1.34). Significant improvements in swallowing function were also reported, as measured by scales such as the Water Swallowing Test (WMD = -0.69, 95% CI: -0.78 to -0.60) and the Penetration Aspiration Scale (MD = -1.02, 95% CI: -1.27 to -0.78).
While acupuncture appears to be a promising adjunctive treatment for PSD, the overall quality of evidence remains low. More rigorously designed and transparently reported studies are needed to strengthen the evidence base and support clinical decision-making.
针灸作为中风后吞咽困难（PSD）的辅助治疗方法已在临床康复中广泛应用。尽管众多荟萃分析（MA）已对其疗效进行评估，但对这些荟萃分析的方法学质量和证据强度仍缺乏全面评估。
两名研究人员独立检索八个数据库以获取相关文献，根据预先定义的纳入和排除标准筛选研究，并从符合条件的系统评价（SR）和荟萃分析中提取数据。分别使用AMSTAR 2、PRISMA - A、ROBIS和GRADE对方法学质量、报告完整性、偏倚风险和证据强度进行严格评估。此外，使用GROOVE工具通过计算校正覆盖面积（CCA）来评估原始研究之间的重叠程度。
本综述纳入19项荟萃分析。基于AMSTAR 2，4项研究被评为低质量，14项被评为极低质量。在报告质量方面，观察到主要缺陷，包括缺乏方案注册、搜索策略不完整、偏倚风险评估不足以及资金披露缺失。对于偏倚风险，只有6项研究被判定为低风险。此外，显示原始研究之间存在轻微重叠，CCA为2.86%。根据GRADE评估，在68个结局指标中，只有11.76%被评为中等质量，50%被归类为低质量，38.24%被归类为极低质量。在中等质量结局中，电针联合吞咽康复治疗（SRT）与单独的SRT相比显示出更好的疗效（OR = 5.40，95%CI：3.78 - 7.72），针灸加SRT也是如此（RR = 1.26，95%CI：1.19 - 1.34）。通过诸如水吞咽试验（WMD = -0.69，95%CI：-0.78至-0.60）和渗透误吸量表（MD = -1.02，95%CI：-1.27至-0.78）等量表测量，吞咽功能也有显著改善。
虽然针灸似乎是治疗PSD的一种有前景的辅助治疗方法，但证据的总体质量仍然较低。需要更严格设计和透明报告的研究来加强证据基础并支持临床决策。
