舌压抗阻反馈训练对吞咽障碍患者的系统评价与Meta分析

文献信息

中文摘要

目的： 系统评价舌压抗阻反馈训练（TPRFT）在卒中后吞咽障碍（PSD）患者中的疗效与安全性，并确定最有效的训练方案。
设计： 随机对照试验（RCT）的系统评价与Meta分析。
场所与参与者： 经标准化临床和/或仪器评估确诊为PSD的18岁及以上成人。
方法： 检索9个数据库自建库至2025年12月的文献，纳入以TPRFT为主要干预措施的RCT。由2名评价者独立使用Cochrane偏倚风险2工具进行研究筛选、数据提取和偏倚风险评估。使用Review Manager 5.4进行Meta分析，计算风险比（RR）或均数差及其95%CI。采用I2统计量评估异质性。
结果： 共纳入16项研究，涉及978例PSD患者。与常规吞咽康复相比，TPRFT显著改善吞咽功能（RR，1.23；95%CI，1.14-1.32；I2=0%）并减少并发症（RR，0.28；95%CI，0.14-0.54；I2=0%）。在功能结局方面，TPRFT还显著降低标准化吞咽评估评分和渗透-误吸量表评分，提高吞咽生活质量问卷评分，并增加最大舌压。亚组分析表明，中低训练强度（≤最大舌压的70%）、中期疗程（4-8周）和较长训练方案与吞咽功能和生活质量改善更大相关。
结论与意义： TPRFT可能是改善PSD患者吞咽功能并减少并发症的有前景的干预措施。当前证据支持中低强度运动持续至少4至8周的可能有益训练方案。仍需进一步高质量、多中心RCT以优化训练参数。
注册： PROSPERO CRD420251245245。

英文摘要

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 I2 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; I2 = 0%) and reduced complications (RR, 0.28; 95% CI, 0.14-0.54; I2 = 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.