A Systematic Review and Meta-Analysis of Tongue Pressure Resistance Feedback Training on Patients With Dysphagia

Objectives To systematically evaluate the efficacy and safety of tongue pressure resistance feedback training (TPRFT) in patients with poststroke dysphagia (PSD) and to determine the most effective training protocol. Design Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting and Participants Adults aged ≥18 years with PSD confirmed by standardized clinical and/or instrumental assessment. Methods Nine databases were searched from inception to December 2025 for RCTs in which TPRFT was the primary intervention. Study selection, data extraction, and risk-of-bias assessment were conducted independently by 2 reviewers using the Cochrane Risk of Bias 2 tool. Meta-analysis was conducted using Review Manager 5.4 to calculate risk ratios (RRs) or mean differences with 95% CIs. Heterogeneity was assessed using the I 2 statistic. Results A total of 16 studies involving 978 PSD patients were included. Compared with conventional swallowing rehabilitation, TPRFT significantly improved swallowing function (RR, 1.23; 95% CI, 1.14-1.32; I 2 = 0%) and reduced complications (RR, 0.28; 95% CI, 0.14-0.54; I 2 = 0%). In terms of functional outcomes, TPRFT also significantly reduced Standardized Swallowing Assessment scores and Penetration-Aspiration Scale scores, increased Swallowing Quality of Life Questionnaire scores, and increased maximum tongue pressure. Subgroup analysis indicated that moderate-to-low training intensity (≤70% of maximum tongue pressure), medium-term duration (4-8 weeks), and longer training protocols were associated with greater improvements in swallowing function and quality of life. Conclusions and Implications TPRFT may be a promising intervention for improving swallowing function and reducing complications in patients with PSD. Current evidence supports a potentially beneficial training protocol of moderate-to-low intensity exercise sustained for at least 4 to 8 weeks. Further high-quality, multicenter RCTs are needed to optimize training parameters. Registration PROSPERO CRD420251245245.