基于电子游戏的干预措施用于卒中后吞咽障碍：系统评价与荟萃分析

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中文摘要

目的： 系统评价基于电子游戏的干预措施对卒中后吞咽障碍患者吞咽功能和吞咽相关生活质量的效果。
方法： 系统检索PubMed、Web of Science、Cochrane Library和Embase数据库，检索时间从建库至2026年7月13日。纳入评估基于电子游戏的训练用于卒中后吞咽障碍的随机对照试验（RCT）。主要结局为功能性经口摄食量表（FOIS）。次要结局包括标准化吞咽评估（SSA）和吞咽相关生活质量（SWAL-QOL/DHI）。采用推荐分级的评估、制定与评价（GRADE）框架评估证据确定性。
结果： 6项随机对照试验共随机分配309名参与者，其中300名参与者的数据纳入荟萃分析。基于电子游戏的干预措施显著改善FOIS评分（WMD = 0.78，95% CI [0.36, 1.21]，P = 0.0003；GRADE证据确定性低），但异质性较大（I² = 74%）。敏感性分析发现一项离群研究；排除该研究后，异质性降至零，效应仍然显著且一致（证据确定性中等）。基于电子游戏的训练还显著降低SSA评分（WMD = -2.14，95% CI [-3.55, -0.74]；GRADE证据确定性中等），并改善吞咽相关生活质量（WMD = -15.07，95% CI [-21.61, -8.52]；因不精确性，GRADE证据确定性低）。
结论： 证据表明，基于电子游戏的干预措施可改善卒中后吞咽障碍患者的吞咽功能和生活质量。然而，鉴于纳入试验数量有限，这些发现应谨慎解读。需要更大规模、设计良好的随机对照试验来证实其临床实用性，并阐明不同干预技术的差异效应。
系统评价注册： https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359653，注册号：CRD420261359653。

英文摘要

OBJECTIVE: To systematically evaluate the efficacy of video game-based interventions on swallowing function and swallowing-related quality of life in patients with post-stroke dysphagia.
METHODS: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Embase from inception to July 13th, 2026. Randomized controlled trials (RCTs) evaluating video game-based training for post-stroke dysphagia were included. The primary outcome was the Functional Oral Intake Scale (FOIS). Secondary outcomes included the Standardized Swallowing Assessment (SSA) and swallowing-related quality of life (SWAL-QOL/DHI). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS: Six randomized controlled trials randomized a total of 309 participants, of whom 300 contributed data to the meta-analysis. Video game-based interventions significantly improved FOIS scores (WMD = 0.78, 95% CI [0.36, 1.21], P = 0.0003; low GRADE certainty), though heterogeneity was substantial (I 2 = 74%). Sensitivity analysis identified one outlying study; after its exclusion, heterogeneity was reduced to zero, and the effect remained significant and consistent (moderate certainty). Video game-based training also significantly reduced SSA scores (WMD = -2.14, 95% CI [-3.55, -0.74]; moderate GRADE certainty) and improved swallowing-related quality of life (WMD = -15.07, 95% CI [-21.61, -8.52]; low GRADE certainty due to imprecision).
CONCLUSION: The evidence suggests that video game-based interventions improve swallowing function and quality of life in post-stroke dysphagia. However, given the limited number of included trials, these findings should be interpreted with caution. Larger, well-designed RCTs are warranted to confirm the clinical utility and to clarify the differential effects of intervention technologies.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359653, identifier: CRD420261359653.