Dysphagia leads to poor swallowing function and high risk of aspiration; swallowing rehabilitative therapies including jaw exercises, tongue exercises, chin tuck against resistance (CTAR), Shaker exercises, effortful swallow training (EST), traditional dysphagia therapy (TDT), and respiratory muscle training (RMT) including inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) are a crucial part of dysphagia rehabilitation. However, limited evidence exists on the comparative efficacy of swallowing rehabilitative therapies in adults with dysphagia. This is the first network meta-analysis (NMA) to investigate the comparative efficacy of swallowing rehabilitative therapies for adults with dysphagia. Web of Science, Embase, CINAHL, Cochrane Library, and PubMed were comprehensively searched until September, 2024. The Frequentist NMA model was performed in R-Software presenting standardized mean differences with corresponding 95% confidence interval (95% CI) for swallowing function and aspiration. Cochrane Q, τ², and I² statistics estimated heterogeneity and full design-by-treatment interaction random-effects and node-splitting models determined transitivity. Ranking of the swallowing rehabilitative therapies used the netrank function. The search yielded 7697 studies from which 25 randomized controlled trials with 1020 adults with dysphagia were included. The study findings revealed that CTAR + TDT (SMD = 3.44 [95% CI 2.42, 4.47]), EMST + TDT (SMD = 2.92 [95% CI 1.59, 4.25]), Shaker + TDT (SMD = 2.83 [95% CI 1.81, 3.84]), JE + TDT (SMD = 2.52 [95% CI 1.21, 3.83]), TE + TDT (SMD = 2.19 [95% CI 1.26, 3.12]), RMT + TDT (SMD = 2.14 [95% CI 1.36, 2.93]), and TDT (SMD = 1.92 [95% CI 1.42, 2.42]) showed very-large to huge effect in improving swallowing function. CTAR + TDT (0.93) demonstrated superior improvements for better swallowing function. Additionally, CTAR + TDT (SMD = − 1.82 [95% CI − 2.89, − 0.75]), Shaker + TDT (SMD = − 1.32 [95% CI − 2.36, − 0.27]), EMST (SMD = − 1.23 [95% CI, − 2.01, − 0.45]), and EMST + TDT (SMD = − 1.10 [95% CI − 2.15, − 0.04]) revealed very-large to large effect in preventing aspiration. CTAR + TDT (0.96) and Shaker + TDT (0.76) demonstrated superior improvements for reduced aspiration. The combination of swallowing rehabilitative therapies including CTAR + TDT and Shaker + TDT offers a more comprehensive approach for dysphagia management in adults. Study registration is PROSPERO: CRD42022321345.

吞咽困难导致吞咽功能差和误吸风险高;吞咽康复疗法包括下巴练习、舌头练习、下巴收紧抵抗力 （CTAR）、摇床练习、努力吞咽训练 （EST）、传统吞咽困难疗法 （TDT） 和呼吸肌训练 （RMT），包括吸气肌力量训练 （IMST） 和呼气肌力量训练 （EMST） 是吞咽困难康复的重要组成部分。然而，关于吞咽康复疗法对成人吞咽困难的比较疗效的证据有限。这是第一个研究吞咽康复疗法对成人吞咽困难疗效的网络荟萃分析 （NMA）。对 Web of Science、Embase、CINAHL、Cochrane Library 和 PubMed 进行了全面检索，检索截止到 2024 年 9 月。在 R-Software 中执行频率论 NMA 模型，呈现吞咽功能和误吸的标准化平均差和相应的 95% 置信区间 （95% CI）。Cochrane Q、τ² 和 I² 统计估计了异质性，并且完全通过治疗设计交互作用随机效应和节点分裂模型确定了传递性。吞咽康复疗法的排名使用 netrank 函数。检索到 7697 项研究，其中纳入了 25 项随机对照试验，涉及 1020 名患有吞咽困难的成年人。研究结果显示，CTAR + TDT（SMD = 3.44 [95% CI 2.42,4.47]）、EMST + TDT（SMD = 2.92 [95% CI 1.59,4.25]）、摇床 + TDT（SMD = 2.83 [95% CI 1.81,3.84]）、JE + TDT（SMD = 2.52 [95% CI 1.21,3.83]）、TE + TDT（SMD = 2.19 [95% CI 1.26,3.12]）、RMT + TDT（SMD = 2.14 [95% CI 1.36,2.93]）和 TDT（SMD = 1.92 [95% CI 1.42， 2.42]） 在改善吞咽功能方面显示出非常大到巨大的效果。CTAR + TDT （0.93） 显示出更好的吞咽功能。此外，CTAR + TDT （SMD = − 1.82 [95% CI − 2.89， − 0.75]）、摇床 + TDT （SMD = − 1.32 [95% CI − 2.36， − 0.27]）、EMST （SMD = − 1.23 [95% CI， − 2.01， − 0.45]）和 EMST + TDT （SMD = − 1.10 [95% CI − 2.15， − 0.04]） 在预防误吸方面显示出非常大到很大的效果。CTAR + TDT （0.96） 和摇床 + TDT （0.76） 在减少误吸方面表现出卓越的改善。吞咽康复疗法的组合，包括 CTAR + TDT 和 Shaker + TDT，为成人吞咽困难的管理提供了更全面的方法。研究注册为 PROSPERO：CRD42022321345。