Effectiveness of nape acupuncture for post-stroke dysphagia: a meta-analysis and trial sequential analysis of randomized controlled trials

Background This systematic review aimed to evaluate the efficacy and safety of nape acupuncture in improving swallowing function and quality of life in patients with post-stroke dysphagia (PSD), thereby providing evidence-based support for clinical treatment Strategies. Methods A comprehensive literature search was conducted across eight databases: CNKI, VIP, WanFang, CBM, PubMed, Web of Science, Cochrane Library, and Embase. All randomized controlled trials (RCTs) investigating nape acupuncture for PSD, published from database inception to September, 2025, were included. Methodological quality was assessed using the Cochrane Risk of Bias tool for RCTs. Statistical analyses were performed using RevMan 5.4, Stata 17.0, and TSA software, including subgroup analyses, sensitivity analyses, and trial sequential analysis to identify sources of heterogeneity and assess the robustness of results. Adverse events were collected to provide data for evaluating the safety of nape acupuncture treatment, and the GRADE approach was used to assess the quality of the results. Results A total of 21 eligible RCTs involving 1,995 participants were included in the meta-analysis. Results demonstrated that both nape acupuncture alone and nape acupuncture combined with other therapies significantly improved swallowing function in video fluoroscopic swallow study (VFSS): [Mean difference (MD) = 1.22, 95% confidence interval (CI) (0.94, 1.51), p < 0.00001], standardized swallowing assessment (SSA): [MD = −3.59, 95% CI (−4.35, −2.84), p < 0.00001], and total effective rate: [Odds ratio (OR) = 3.69, 95% CI (2.70, 5.04), p < 0.00001]. Moreover, it also exerted a positive effect on improving patients’ quality of life in swallowing quality of life questionnaire (SWAL-QOL): [MD = 13.42, 95% CI (9.46, 17.37), p < 0.00001], and barthel index (BI): [MD = 9.2, 95% CI (3.99, 14.4), p < 0.005]. TSA provides sufficient information to support the conclusion, but due to issues such as high heterogeneity, the GRADE system rates the quality of evidence as moderate to very low. Conclusion Nape acupuncture, either alone or in combination with other therapies, significantly improves swallowing function and quality of life in patients with PSD, with a favorable safety profile characterized by minimal adverse events. Systematic review registration https://www.crd.york.ac.uk/PROSPERO , identifier CRD420251089406.