Comparative effectiveness of dysphagia rehabilitation in head and neck cancer: A network meta-analysis
In brief
Exercise improved two swallowing outcomes, but no approach led across measures
Across 18 trials involving 1,139 people treated for head and neck cancer, exercise improved clinician-rated swallowing versus usual care and instrumental swallowing versus telerehabilitation. No intervention was consistently best across outcomes, and confidence was moderate to very low, especially for patient-reported outcomes; treatment choice still needs to be individualized.
- Journal
- Clinical rehabilitation (Q1)
- Published
- 23 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jong Mi Park, Seo Yeon Yoon, Sang Chul Lee, Yong Wook Kim
- PMID
- 42775738
- DOI
- 10.1177/02692155261487949
Why clinicians should know about it
- Picked for Rehabilitation (top studies of the week, 27 September 2026): High-quality evidence in a top journal
Abstract
ObjectiveTo compare rehabilitation interventions for dysphagia after head and neck cancer treatment using network meta-analysis.Data sourcesPubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched from inception to 21 July 2026.Review methodsRandomised controlled trials evaluating swallowing exercise, neuromuscular electrical stimulation combined with exercise (NMES+ex), speech therapy combined with exercise (Speech+ex) or telerehabilitation were included. Random-effects network meta-analyses estimated Hedges' g standardised mean differences (SMDs) and treatment rankings across four outcome domains. Confidence was assessed using the Confidence in Network Meta-Analysis framework.ResultsTwenty-one trials were included in the systematic review; 18 trials involving 1139 participants contributed to connected networks. Exercise improved clinician-rated swallowing compared with usual care (SMD 0.98, 95% confidence interval 0.28 to 1.69) and instrumental swallowing compared with telerehabilitation (SMD 1.24, 0.07 to 2.42). No other comparisons were statistically significant. Speech+ex ranked highest for clinician-rated outcomes, exercise for instrumental outcomes and NMES+ex for patient-reported quality of life and symptom/handicap outcomes. In sensitivity analyses separating exercise types, prophylactic exercise ranked highest for instrumental and quality-of-life outcomes. Confidence ranged from moderate to very low and was very low for all patient-reported comparisons.ConclusionRehabilitation effects varied by outcome domain, with no consistently superior intervention. Exercise showed benefits for selected clinician-rated and instrumental outcomes, but sparse networks, imprecision and inconsistency limit certainty. These findings support individualised intervention selection and adequately powered trials using standardised outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.