游戏化康复干预对脑卒中后吞咽障碍患者的疗效：一项Meta分析
Effectiveness of Gamified Rehabilitation Interventions in Patients with Post-Stroke Dysphagia: A Meta-Analysis.
文献信息
| PMID | 42875641 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yongxin Cao |
| 作者单位 | Xuanwu Hospital Capital Medical University, No.45 Changchun Street, Beijing, 100053, China. |
| 期刊 | Dysphagia |
| SCI 分区 | Q1 |
| IF | 3.1 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 评估游戏化或多组分游戏化吞咽康复对脑卒中后吞咽障碍患者功能性经口摄食和床旁吞咽功能的影响，并探讨反馈方式、卒中后病程以及主要发现的稳健性。
方法： 本Meta分析按照PRISMA指南进行。系统检索了PubMed、EMBASE、CINAHL、Web of Science、Scopus、Cochrane Library、CNKI、万方数据、维普数据和中国生物医学文献数据库（SinoMed），纳入截至2025年12月22日发表的随机对照试验。功能性经口摄食量表（FOIS）被指定为主要结局，标准化吞咽评估（SSA）为次要结局。所有合并分析均采用随机效应模型，并进行探索性亚组分析和留一法敏感性分析。
结果： 共纳入7项随机对照试验，涉及340名参与者。游戏化或多组分游戏化吞咽康复与更高的FOIS评分相关（MD=1.53，95% CI：0.58-2.49，P=0.002），研究间异质性非常高（I2=96%）。4项随机对照试验的合并结果显示，游戏化吞咽康复后SSA评分更低（MD=-2.44，95% CI：-3.84至-1.04，P<0.001；I2=54%）。根据表面肌电（sEMG）使用情况划分的FOIS亚组间差异无统计学意义（P=0.39），而SSA亚组差异有统计学意义（P=0.01）。在敏感性分析中排除Hou等（2024）后，FOIS效应的方向保持不变（MD=1.04，95% CI：0.46-1.61，P=0.0004；I2=85%）。
结论： 当前证据提示，游戏化吞咽康复可能改善脑卒中后吞咽障碍患者的FOIS和SSA结局。然而，纳入的研究和参与者数量有限，FOIS的异质性非常高，多项研究存在高偏倚风险，且多种共同干预成分使得游戏化的独立效应难以分离。因此，sEMG和卒中后病程亚组的结果应被视为探索性。需要进一步开展高质量研究以优化干预策略并降低异质性。
英文摘要
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.