Effectiveness of Gamified Rehabilitation Interventions in Patients with Post-Stroke Dysphagia: A Meta-Analysis

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Abstract

To evaluate the effects of gamified or multicomponent gamified swallowing rehabilitation on functional oral intake and bedside swallowing function in patients with post-stroke dysphagia, and to explore feedback modality, post-stroke duration, and the robustness of the main findings. This meta-analysis was conducted in accordance with the PRISMA guidelines. PubMed, EMBASE, CINAHL, Web of Science, Scopus, the Cochrane Library, CNKI, Wanfang Data, VIP Data, and SinoMed were systematically searched for randomized controlled trials published through December 22, 2025. The Functional Oral Intake Scale (FOIS) was designated as the primary outcome and the Standardized Swallowing Assessment (SSA) as the secondary outcome. All pooled analyses used random-effects models, with exploratory subgroup analyses and leave-one-out sensitivity analyses. Seven RCTs involving 340 participants were included. Gamified or multicomponent gamified swallowing rehabilitation was associated with higher FOIS scores (MD=1.53, 95% CI: 0.58-2.49, P=0.002), with very high between-study heterogeneity (I2=96%). Pooled results from four RCTs showed lower SSA scores after gamified swallowing rehabilitation (MD=- 2.44, 95% CI: - 3.84 to - 1.04, P<0.001; I2=54%). The between-subgroup difference for FOIS according to sEMG use was not statistically significant (P=0.39), whereas the SSA subgroup difference was statistically significant (P=0.01). After excluding Hou et al. (2024) in the sensitivity analysis, the direction of the FOIS effect remained unchanged (MD=1.04, 95% CI: 0.46-1.61, P=0.0004; I2=85%). Current evidence suggests that gamified swallowing rehabilitation may improve FOIS and SSA outcomes in patients with post-stroke dysphagia. However, the number of included studies and participants was limited, heterogeneity for FOIS was very high, several studies had a high risk of bias, and multiple co-intervention components made the independent effect of gamification difficult to isolate. Findings from the sEMG and post-stroke-duration subgroups should therefore be considered exploratory. Further high-quality studies are needed to optimize intervention strategies and reduce heterogeneity.

Abstract as published, via PubMed.