Evaluating Behavioural Interventions for Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-Analysis of Swallowing Manoeuvres, Exercises, and Postural Techniques ^†

Background/Objectives: To assess the effectiveness of the most commonly used swallowing manoeuvres, exercises, and postural strategies as standalone interventions in the behavioural management of oropharyngeal dysphagia in adults. Methods: Systematic searches of two electronic databases, Embase and PubMed, were conducted in accordance with PRISMA guidelines to identify studies with comparison groups, including (pseudo) randomised controlled trials, comparative studies with concurrent controls, and within-subject or crossover study designs. The methodological quality of the included studies was assessed using the standard quality assessment tool (QualSyst). Results: Seventeen studies met the eligibility criteria, evaluating the effects of chin tuck, effortful swallow, the Mendelsohn manoeuvre, the modified jaw opening exercise, the volitional laryngeal vestibule closure manoeuvre, and the Shaker exercise. Most studies reported positive treatment outcomes, supporting the benefits of both compensatory and rehabilitative interventions across diverse populations, mainly derived from mixed groups and individuals post stroke. However, due to the limited number and significant heterogeneity of studies, a meta-analysis was only performed for the chin tuck, which showed a moderate positive effect. Overall, the evidence is preliminary and should be interpreted with caution. Conclusions: While current findings support the benefits of standalone behavioural interventions in oropharyngeal dysphagia, future research should focus on high-quality study designs with larger populations. Such studies need to consider variability in patient characteristics, intervention protocols, and outcome measures, with the use of advanced statistical methods enabling more definitive conclusions about the effectiveness of these interventions.