Major Cochrane update on stroke dysphagia therapy adds 140 trials, reaffirms behavioural and electrical stimulation as first line

A major update of the Cochrane systematic review on swallowing therapy for dysphagia in acute and subacute stroke now incorporates 181 randomised controlled trials and 11,500 participants, adding 140 new trials since the previous edition Meta-analysis. Behavioural interventions and neuromuscular electrical stimulation (NMES) show moderate-certainty evidence for reducing swallowing impairment. Acupuncture and pharyngeal electrical stimulation show benefit on chest infection and decannulation outcomes specifically. Overall certainty across the review remains low to moderate.

As a Cochrane systematic review, this is by design the strongest available evidence base on stroke dysphagia therapy internationally, and the scale of this update — more than doubling the trial base since 2018 — substantially strengthens confidence in the direction of the findings, even though overall certainty ratings remain capped at moderate.

This is worth checking against current stroke speech and language therapy protocols to confirm behavioural therapy and NMES remain first-line interventions. The acupuncture and pharyngeal electrical stimulation findings are newer and narrower in scope, and carry the same low-to-moderate certainty as the rest of the evidence base, so they are better read as worth monitoring than as an immediate protocol change.