# Effectiveness of Gamified Swallowing Exercises in Adults With Dysphagia: Systematic Review and Meta-Analysis of Randomized Controlled Trials

## TL;DR

This study reviews and analyzes the effectiveness of gamified swallowing exercises for adults with dysphagia, finding they improve swallowing function and adherence but with limited evidence quality.

## Contribution

This is the first quantitative synthesis of the effects of gamified swallowing exercises in dysphagia rehabilitation.

## Key findings

- Gamified swallowing exercises improved swallowing performance and reduced dysphagia severity.
- Adherence to therapy increased with gamified interventions.
- No significant effects were observed on dysphagia screening or quality of life.

## Abstract

Dysphagia is a prevalent health issue affecting quality of life. Gamified swallowing exercises have the potential to enhance swallowing function and adherence in adults with dysphagia. Nevertheless, such evidence has not yet been systematically synthesized.

This study aimed to systematically evaluate the effects of gamified swallowing exercises and promote their clinical application in swallowing rehabilitation.

Eleven electronic databases were searched from inception to June 25, 2025. Randomized controlled trials (RCTs) that explored gamified swallowing exercises in adults with dysphagia, regardless of etiology, and reported on swallowing function, adherence, nutritional status, or quality of life were included. The Cochrane Risk of Bias tool 2.0 was applied to assess the methodological quality. We employed the Hartung-Knapp-Sidik-Jonkman method for random-effects model analysis to calculate effect sizes and 95% CIs. Subgroup analysis was conducted to explore potential causes of heterogeneity, and the overall quality of evidence was evaluated through GRADEpro GDT software.

Of 2400 initially identified records, 6 RCTs met the inclusion criteria, with 2 rated as low risk, 3 as some concerns, and 1 as high risk. These studies, conducted in China, South Korea, and Turkey between 2019 and 2025, enrolled a total of 330 poststroke patients with dysphagia. Interventions involved 1 to 3 games targeting the lips, tongue, and pharynx, with additional equipment. This meta-analysis indicated that gamified swallowing exercises improved swallowing function, as evidenced by enhanced swallowing performance (mean difference [MD]=1.1; 95% CI 0.9 to 1.3; I2=0; prediction interval [PI] 0.3 to 1.6), reduced dysphagia severity (standardized mean difference [SMD]=0.4; 95% CI 0.3 to 0.5; I2=0; PI 0.3 to 0.5), and increased adherence (MD=2.4; 95 % CI 1.8 to 2.9; I2=0; PI 1.2 to 2.7). However, no significant effects were observed on dysphagia screening (SMD=−1.8, 95% CI −5.4 to 1.8; I2=96.5%; PI −8.6 to 4.9) or quality of life (SMD=−2.30, 95% CI −9.6 to 5; I2=97.5%; PI −16.1 to 14.1). Overall, the quality of the included studies ranged from moderate to very low, which limits confidence in the pooled estimates.

This study provides the first quantitative synthesis of the effects of gamified swallowing exercises. The results demonstrate that gamified swallowing exercises improve swallowing function and enhance adherence, suggesting that gamified swallowing exercises are a promising method for swallowing rehabilitation. However, the overall risk of bias across included studies and the suboptimal evidence quality reduce the certainty of the current evidence. Therefore, the findings should be interpreted with caution. The small number of high-quality RCTs, reliance on additional equipment, and limited standardization of gamified interventions further limit clinical generalizability. Future research should focus on large-scale, robustly designed RCTs, while designing etiology-specific games and developing more accessible rehabilitation equipment, such as smartphones, could enhance the overall effects and facilitate the widespread adoption of these interventions in remote and home care settings.