Neural effects of acupuncture on patients with post-stroke dysphagia: a protocol for an activation likelihood estimation meta-analysis

Background Functional magnetic resonance imaging (fMRI) has been widely used to investigate the neuromodulatory mechanisms of acupuncture in patients with post-stroke dysphagia (PSD). However, conclusions from existing studies remain inconsistent. This review will use activation likelihood estimation (ALE) meta-analysis to assess spatial convergence in reported amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) findings from studies of acupuncture in patients with PSD. Methods Eight databases—PubMed, Web of Science, the Cochrane Library, China Science and Technology Journal Database, Embase, the China Biology Medicine, the China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform—will be searched from their inception to October 1, 2026. Eligible study designs include randomized controlled trials, nonrandomized controlled intervention studies, and uncontrolled single-arm longitudinal pre–post acupuncture studies. Methodological quality will be assessed using tools appropriate to each study design. The primary neuroimaging outcomes will be whole-brain ALFF and ReHo findings. These metrics will be synthesized in separate ALE models for within-patient pre-post acupuncture comparisons and comparisons between patients with PSD before acupuncture treatment and healthy controls, with the latter serving as an exploratory baseline pathological reference. Where sufficient data are available, the spatial overlap between these two contrast categories will be explored. ALE meta-analyses will be performed using GingerALE, and the robustness of the findings will be assessed using jackknife sensitivity analyses. Clinical outcomes will be synthesized using RevMan version 5.3 when appropriate. Reporting biases in the neuroimaging evidence will be assessed qualitatively. Funnel plots will be considered only for separate clinical outcome meta-analyses containing at least 10 comparable studies. The study report will strictly adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Conclusion This review aims to identify spatial convergence in reported resting-state fMRI findings from studies of acupuncture in patients with PSD. The findings may inform hypotheses about potential neural mechanisms and guide future research. Systematic review registration https://www.crd.york.ac.uk/PROSPERO , identifier CRD420261280623.