The effects of behavioral interventions for post-stroke dysarthria: a systematic review and meta-analysis of randomized controlled trials

The existing body of evidence regarding the efficacy of behavioral interventions for post-stroke dysarthria is limited. The study aims were to systematically evaluate the effects of behavioral interventions on dysarthric speech in patients with stroke. This systematic review and meta-analysis used keywords related to stroke and dysarthria to search the Scopus, Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and PsycINFO databases for randomized controlled trials (RCTs) from database inception to August 2026. The standard mean difference (SMD) with corresponding 95% confidence interval (CI) was used as the effect size. Methodological quality was assessed using the Cochrane Risk-of-Bias tool 2.0. The certainty of evidence for each outcome was evaluated using the GRADE approach. The analysis included 407 patients from 8 RCTs between 2010 and 2026. 62.5% (5 out of 8) of the RCTs exhibited a low risk of bias. In terms of immediate effects, behavioral interventions demonstrated greater improvements in activity (SMD: 0.42; 95% CI: 0.10–0.75; I 2 : 13%; Z = 2.54; P = 0.01; low-certainty evidence) and neuromuscular impairment (SMD: 0.47; 95% CI: 0.25–0.69; I 2 : 34%; Z = 4.24; P < 0.01; moderate-certainty evidence) than control groups, and sensitivity analyses confirmed the robustness of both findings. Evidence regarding persistent effects of behavioral interventions on activity, neuromuscular impairment, and participation remained inconclusive due to limited sample sizes and wide confidence intervals. Behavioral interventions demonstrate promising immediate benefits on tongue and lip control and speech intelligibility in individuals with post-stroke dysarthria. Large-scale RCTs with standardized outcome measures and extended follow-up periods are needed to evaluate whether behavioral interventions produce sustained effects over time and to strengthen the evidence base for clinical practice.