In adult patients with brainstem strokes, does dysphagia rehabilitation improve health-related outcomes compared to usual care for inpatients? A systematic review and meta-analysis

PURPOSE: This systematic review aimed to explore and synthesise the effectiveness of dysphagia rehabilitation on swallow function in inpatients with brainstem stroke. METHOD: Five electronic databases were searched using pre-specified criteria in June 2025. Independent screening, data extraction, and quality ratings were completed. Interventions were categorised into "traditional swallowing therapy" or "inclusion of devices." Studies were appraised using the Mixed Methods Appraisal Tool. Narrative synthesis was used to describe study characteristics, intervention details, and study outcomes. Meta-analyses were conducted when three or more randomised controlled trials on a single intervention were available. RESULT: Twelve studies were included with 443 participants. Five studies investigated "traditional swallowing therapy" alone, and seven investigated devices. All studies demonstrated improvement in swallowing function with low certainty. Meta-analysis of Repetitive Transcranial Magnetic Stimulation (rTMS) indicated initial improvements in swallow function immediately post-intervention compared to controls; however, findings were not maintained by 2 months post-intervention. CONCLUSION: Both traditional swallowing therapy and therapy with devices may be effective at improving swallowing function and reducing reliance on enteral feeding in inpatients with brainstem stroke. Further high-quality research is required to understand which interventions and dosages are most effective for brainstem stroke.