Abstract
OBJECTIVE: This research aimed to assess the effectiveness of electroacupuncture in treating post-stroke dysphagia (PSD) and to investigate the optimal stimulation parameters. METHODS: We conducted a comprehensive review of eight databases: PubMed, Web of Science, Cochrane Library, Embase, CBM, CNKI, Wan Fang, and VIP. Randomized controlled trials (RCTs) on electroacupuncture for the treatment of PSD published between the inception of these databases and March 19, 2025, were integrated. The treatment's effectiveness was evaluated using several outcome indicators, including the Video Fluoroscopic Swallow Study (VFSS) and the Water Swallowing Test (WST), which collectively assess swallowing function. Two independent reviewers performed risk of bias (ROB 2) evaluations, frequency of use for electroacupuncture parameter combinations through the R language (version 4.5.1), and data analysis using Review Manager (RevMan) version 5.4 and Stata SE 18. RESULTS: This analysis encompassed a total of 30 RCTs that involved 2,290 patients. The research demonstrated an overall efficiency of (RR = 1.29, 95% CI: 1.23-1.34, p < 0.0001; I(2) = 13%, fixed-effects model). The mean differences for the various scales were as follows: VFSS (MD = 1.67, 95% CI: 1.26-2.09, p < 0.01; I(2) = 57%, random effects model). WST (MD = -0.75, 95% CI: -0.93 to -0.57, p < 0.01; I(2) = 54%, random effects model). Aspiration pneumonia (RR = 0.41, 95% CI: 0.25 to 0.68, p = 0.0005; I(2) = 8%, fixed effect model). Subgroup analysis revealed significant disparities between the various waveforms (Dense-sparse wave (Ds-W): RR = 1.58, p = 0.003 < 0.01) and the distinctions among the top three combinations of electroacupuncture parameter usage frequency (≥ 30 min + Ds-W, ≥ 30 min + Continuous Wave (C-W), and ≥ 30 min + Intermittent Wave (I-W) groups) were statistically significant (≥ 30 min + Ds-W: RR = 1.55, p = 0.03 < 0.05). In addition, there were no statistically significant differences between the other electroacupuncture parameter subgroups, which included the stimulation frequency and single treatment time (p > 0.05). CONCLUSION: Electroacupuncture, in conjunction with dysphagia training, is more effective than a solitary treatment in patients with PSD. Furthermore, applying waveforms with Ds-W might enhance the effectiveness of electroacupuncture for PSD. However, the higher risk of bias (ROB) in the included trials indicates that the quality of evidence for the outcomes of these assessments may be jeopardized. Thus, further high-quality clinical trials are urgently required to evaluate the efficacy and effectiveness of electroacupuncture parameters (waveforms) in the treatment of PSD, ultimately increasing the total level of evidence (PROSPERO registration number: CRD420251014881, https://www.crd.york.ac.uk/prospero/).