Effectiveness of swallowing rehabilitation exercises in older adults with swallowing disorders: systematic review and network meta-analysis of randomized controlled trials

This study aimed to evaluate the comparative effectiveness of swallowing rehabilitation exercises in older adults with dysphagia to identify the most beneficial interventions. A systematic review and network meta-analysis were conducted using six databases (PubMed, Embase, CINAHL, Cochrane Library, PsycINFO, and Airiti Library) searched on 15 August 2024. Randomized controlled trials involving adults aged ≥65 years with dysphagia were included. Study characteristics, interventions, and outcomes were extracted, and the Risk of Bias 2.0 tool was used for quality assessment. The Masako maneuver showed the greatest improvement in dysphagia severity (<i>SMD</i> = 1.57, <i>95% CI</i>: 1.16–1.98). Expiratory muscle strength training (EMST) significantly reduced aspiration risk (<i>SMD</i> = 0.71, <i>95% C</i>I: 0.35–1.06). Tongue resistance exercises improved anterior (<i>M</i>D = 4.24) and posterior tongue strength (<i>MD</i> = 4.45). No significant effects were found for upper esophageal sphincter opening, laryngeal closure, or swallowing-related quality of life. Swallowing rehabilitation exercises offer functional benefits for older adults with dysphagia. Specific exercises target different aspects of swallowing physiology. Further studies are needed to examine long-term efficacy and optimal training combinations. This review has been registered in the PROSPERO (CRD42023409297). Swallowing rehabilitation exercises play a crucial role in improving swallowing function in older adults with dysphagia by reducing dysphagia severity, enhancing tongue strength, and decreasing aspiration risk.The Masako maneuver has been identified as the most effective exercise for strengthening posterior tongue muscles and improving self-perceived swallowing difficulties.Expiratory muscle strength training (EMST) is particularly beneficial in reducing penetration and aspiration, which are critical indicators of dysphagia severity.A combination of swallowing rehabilitation exercises tailored to individual needs may provide superior functional outcomes compared to isolated interventions. Swallowing rehabilitation exercises play a crucial role in improving swallowing function in older adults with dysphagia by reducing dysphagia severity, enhancing tongue strength, and decreasing aspiration risk. The Masako maneuver has been identified as the most effective exercise for strengthening posterior tongue muscles and improving self-perceived swallowing difficulties. Expiratory muscle strength training (EMST) is particularly beneficial in reducing penetration and aspiration, which are critical indicators of dysphagia severity. A combination of swallowing rehabilitation exercises tailored to individual needs may provide superior functional outcomes compared to isolated interventions.