{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:48:24Z","timestamp":1791416904884,"version":"4.3.3"},"reference-count":79,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm14207180","type":"journal-article","created":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:12:29Z","timestamp":1760523149000},"page":"7180","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Evaluating Behavioural Interventions for Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-Analysis of Swallowing Manoeuvres, Exercises, and Postural Techniques"],"prefix":"10.3390","volume":"14","author":[{"given":"Silvia","family":"Silvia","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Central Military Hospital SNP Ru\u017eomberok\u2014Faculty Hospital, 03426 Ru\u017eomberok, Slovakia"},{"name":"Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2828-8897","authenticated-orcid":false,"given":"Ren\u00e9e","family":"Speyer","sequence":"additional","affiliation":[{"name":"Discipline of Speech and Language Therapy, School of Health Sciences, College of Medicine, Nursing & Health Sciences, University of Galway, H91 TK33 Galway, Ireland"},{"name":"Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9906-5300","authenticated-orcid":false,"given":"Reinie","family":"Cordier","sequence":"additional","affiliation":[{"name":"Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia"},{"name":"Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE1 8ST, UK"},{"name":"Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5504-6370","authenticated-orcid":false,"given":"Catriona","family":"Windsor","sequence":"additional","affiliation":[{"name":"Department of Special Needs Education, University of Oslo, 0318 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1957-9297","authenticated-orcid":false,"given":"\u017dofia","family":"Korim","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia"},{"name":"Department of Neurology, Faculty Hospital Trnava, 91775 Trnava, Slovakia"},{"name":"Department of Communication Disorders, Faculty of Education, Comenius University Bratislava, 83102 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3471-7195","authenticated-orcid":false,"given":"Miroslav","family":"Tedla","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Comenius University, University Hospital, 85107 Bratislava, Slovakia"},{"name":"Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2SQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0020-7489(00)00044-4","article-title":"A critical review of the Delphi technique as a research methodology for nursing","volume":"38","author":"Keeney","year":"2001","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Speyer, R., Cordier, R., Denman, D., Windsor, C., Krisciunas, G.P., Smithard, D., and Heijnen, B.J. (2022). Development of Two Patient Self-Reported Measures on Functional Health Status (FOD) and Health-Related Quality of Life (QOD) in Adults with Oropharyngeal Dysphagia Using the Delphi Technique. J. Clin. Med., 11.","DOI":"10.3390\/jcm11195920"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s00455-014-9578-x","article-title":"The influence of food texture and liquid consistency modification on swallowing physiology and function: A systematic review","volume":"30","author":"Steele","year":"2015","journal-title":"Dysphagia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.otc.2013.08.008","article-title":"Causes of dysphagia among different age groups: A systematic review of the literature","volume":"46","author":"Roden","year":"2013","journal-title":"Otolaryngol. Clin. North Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s00455-014-9584-z","article-title":"Prevalence of oropharyngeal dysphagia in the Netherlands: A telephone survey","volume":"30","author":"Kertscher","year":"2015","journal-title":"Dysphagia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1007\/s00455-016-9695-9","article-title":"A Systematic Review of the Prevalence of Oropharyngeal Dysphagia in Stroke, Parkinson\u2019s Disease, Alzheimer\u2019s Disease, Head Injury, and Pneumonia","volume":"31","author":"Takizawa","year":"2016","journal-title":"Dysphagia"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Doan, T.-N., Ho, W.-C., Wang, L.-H., Chang, F.-C., Nhu, N.T., and Chou, L.-W. (2022). Prevalence and Methods for Assessment of Oropharyngeal Dysphagia in Older Adults: A Systematic Review and Meta-Analysis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092605"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1097\/MEG.0000000000000983","article-title":"Antipsychotic medication and oropharyngeal dysphagia: Systematic review","volume":"29","year":"2017","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s00455-022-10465-x","article-title":"Prevalence of Oropharyngeal Dysphagia in Adults in Different Healthcare Settings: A Systematic Review and Meta-analyses","volume":"38","author":"Rivelsrud","year":"2023","journal-title":"Dysphagia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.2147\/NDT.S371624","article-title":"Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations","volume":"18","author":"Cheng","year":"2022","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1044\/2021_AJSLP-21-00145","article-title":"Effectiveness of Interventions for Dysphagia in Parkinson Disease: A Systematic Review","volume":"31","author":"Gandhi","year":"2022","journal-title":"Am. J. Speech-Lang. Pathol."},{"key":"ref_12","unstructured":"Groher, M.E., and Crary, M.A. (2010). Dysphagia: Clinical Management in Adults and Children, Mosby Elsevier."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Speyer, R., Cordier, R., Sutt, A.L., Remijn, L., Heijnen, B.J., Balaguer, M., Pomm\u00e9e, T., McInerney, M., and Bergstr\u00f6m, L. (2022). Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030685"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ueha, R., Cotaoco, C., Kondo, K., and Yamasoba, T. (2023). Management and Treatment for Dysphagia in Neurodegenerative Disorders. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010156"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1177\/26345161241282299","article-title":"Dilation of the Upper Esophageal Sphincter","volume":"4","author":"Belafsky","year":"2024","journal-title":"Foregut"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1007\/s00405-024-08452-z","article-title":"Swallowing improvement surgeries","volume":"281","author":"Cotaoco","year":"2024","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Jandee, S., Geeraerts, A., Geysen, H., Rommel, N., Tack, J., and Vanuytsel, T. (2021). Management of Ineffective Esophageal Hypomotility. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.638915"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"326","DOI":"10.3947\/ic.2017.49.4.326","article-title":"Guidelines for the Antibiotic Use in Adults with Acute Upper Respiratory Tract Infections","volume":"49","author":"Yoon","year":"2017","journal-title":"Infect. Chemother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1682\/JRRD.2008.08.0091","article-title":"Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part II--impact of dysphagia treatment on normal swallow function","volume":"46","author":"Ashford","year":"2009","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1007\/s40520-019-01128-3","article-title":"Sarcopenia and swallowing disorders in older people","volume":"31","author":"Azzolino","year":"2019","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.2147\/CIA.S107750","article-title":"European Society for Swallowing Disorders\u2014European Union Geriatric Medicine Society white paper: Oropharyngeal dysphagia as a geriatric syndrome","volume":"11","author":"Baijens","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00455-016-9779-6","article-title":"History of the Use and Impact of Compensatory Strategies in Management of Swallowing Disorders","volume":"32","author":"Lazarus","year":"2017","journal-title":"Dysphagia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S276","DOI":"10.1044\/1092-4388(2008\/021)","article-title":"Swallowing and dysphagia rehabilitation: Translating principles of neural plasticity into clinically oriented evidence","volume":"51","author":"Robbins","year":"2008","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1054\/bjom.2000.0482","article-title":"Swallowing rehabilitation after oro-pharyngeal resection for squamous cell carcinoma","volume":"38","author":"Zuydam","year":"2000","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s40141-013-0017-y","article-title":"Dysphagia after Stroke: An Overview","volume":"1","author":"Ottenstein","year":"2013","journal-title":"Curr. Phys. Med. Rehabil. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1007\/s00455-022-10516-3","article-title":"Expanding Rehabilitation Options for Dysphagia: Skill-Based Swallowing Training","volume":"38","author":"Huckabee","year":"2023","journal-title":"Dysphagia"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Speyer, R., Sutt, A.L., Bergstr\u00f6m, L., Hamdy, S., Heijnen, B.J., Remijn, L., Wilkes-Gillan, S., and Cordier, R. (2022). Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030776"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1589\/jpts.28.1840","article-title":"Effect of simultaneous application of postural techniques and expiratory muscle strength training on the enhancement of the swallowing function of patients with dysphagia caused by parkinson\u2019s disease","volume":"28","author":"Byeon","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00455-017-9866-3","article-title":"Effect of Body Position on Pharyngeal Swallowing Pressures Using High-Resolution Manometry","volume":"33","author":"Rosen","year":"2018","journal-title":"Dysphagia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1682\/JRRD.2008.08.0092","article-title":"Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part IV--impact of dysphagia treatment on individuals\u2019 postcancer treatments","volume":"46","author":"McCabe","year":"2009","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1177\/107327480200900505","article-title":"Evaluation and management of oropharyngeal Dysphagia in head and neck cancer","volume":"9","author":"Gaziano","year":"2002","journal-title":"Cancer Control"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/j.1365-2842.2007.01737.x","article-title":"Influences of body posture on duration of oral swallowing in normal young adults","volume":"34","author":"Inagaki","year":"2007","journal-title":"J. Oral Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00455-002-0050-y","article-title":"Supraglottic swallow, effortful swallow, and chin tuck did not alter hypopharyngeal intrabolus pressure in patients with pharyngeal dysfunction","volume":"17","author":"Olsson","year":"2002","journal-title":"Dysphagia"},{"key":"ref_34","first-page":"5781","article-title":"Smartphone-based swallowing monitoring and feedback device for mealtime assistance in nursing homes","volume":"2016","author":"Kuramoto","year":"2016","journal-title":"Annu. Int. Conf. IEEE Eng. Med. Biol. Soc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1007\/s00455-025-10821-7","article-title":"Impact of Head and Neck Posture on Swallowing Kinematics and Muscle Activation: A Systematic Review","volume":"40","year":"2025","journal-title":"Dysphagia"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1590\/2317-1782\/20162015286","article-title":"The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue","volume":"28","author":"Nagy","year":"2016","journal-title":"Codas"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1682\/JRRD.2008.08.0091","article-title":"Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part III--impact of dysphagia treatments on populations with neurological disorders","volume":"46","author":"Ashford","year":"2009","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1655","DOI":"10.1044\/2020_AJSLP-19-00132","article-title":"A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults with Normal and Disordered Swallowing","volume":"29","author":"Bahia","year":"2020","journal-title":"Am. J. Speech-Lang. Pathol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00455-020-10129-8","article-title":"Surface Electromyographic Biofeedback and the Effortful Swallow Exercise for Stroke-Related Dysphagia and in Healthy Ageing","volume":"36","author":"Archer","year":"2021","journal-title":"Dysphagia"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1310\/tsr1903-234","article-title":"Effects of Mendelsohn maneuver on measures of swallowing duration post stroke","volume":"19","author":"McCullough","year":"2012","journal-title":"Top. Stroke Rehabil."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2836","DOI":"10.1007\/s12070-023-03846-7","article-title":"Impact of Effortful Swallow with Progressive Resistance on Swallow Safety, Efficiency and Quality of Life in Individuals with Post-Stroke Dysphagia: Analysis Using DIGEST- FEES and SWAL-QOL","volume":"75","author":"Bilvashree","year":"2023","journal-title":"Indian J. Otolaryngol. Head Neck Surg."},{"key":"ref_42","first-page":"100276","article-title":"Exploring the Efficacy of the Effortful Swallow Maneuver for Improving Swallowing in People with Parkinson Disease\u2014A Pilot Study","volume":"5","author":"Gandhi","year":"2023","journal-title":"Arch. Rehabil. Res. Clin. Transl."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s00455-013-9461-1","article-title":"Effects of the Mendelsohn maneuver on extent of hyoid movement and UES opening post-stroke","volume":"28","author":"McCullough","year":"2013","journal-title":"Dysphagia"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"103827","DOI":"10.1016\/j.ijnurstu.2020.103827","article-title":"Swallowing exercises for head and neck cancer patients: A systematic review and meta-analysis of randomized control trials","volume":"114","author":"Banda","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1007\/s11357-024-01389-5","article-title":"Efficacy of swallowing rehabilitative therapies for adults with dysphagia: A network meta-analysis of randomized controlled trials","volume":"47","author":"Lee","year":"2025","journal-title":"Geroscience"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s00455-009-9239-7","article-title":"Effects of therapy in oropharyngeal dysphagia by speech and language therapists: A systematic review","volume":"25","author":"Speyer","year":"2010","journal-title":"Dysphagia"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1111\/joor.13181","article-title":"Chin tuck against resistance exercise for dysphagia rehabilitation: A systematic review","volume":"48","author":"Park","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1111\/1460-6984.12865","article-title":"Behavioural interventions for swallowing in subjects with Parkinson\u2019s disease: A mixed methods systematic review","volume":"58","author":"Winiker","year":"2023","journal-title":"Int. J. Lang. Commun. Disord."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1007\/s00134-020-06126-y","article-title":"Interventions for oropharyngeal dysphagia in acute and critical care: A systematic review and meta-analysis","volume":"46","author":"Duncan","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Govender, R., Smith, C.H., Taylor, S.A., Barratt, H., and Gardner, B. (2017). Swallowing interventions for the treatment of dysphagia after head and neck cancer: A systematic review of behavioural strategies used to promote patient adherence to swallowing exercises. BMC Cancer, 17.","DOI":"10.1186\/s12885-016-2990-x"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s13643-015-0077-4","article-title":"Identification of behaviour change components in swallowing interventions for head and neck cancer patients: Protocol for a systematic review","volume":"4","author":"Govender","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1093\/ageing\/afn064","article-title":"Dysphagia treatment post stroke: A systematic review of randomised controlled trials","volume":"37","author":"Foley","year":"2008","journal-title":"Age Ageing"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s13643-020-01542-z","article-title":"PRISMA-S: An extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews","volume":"10","author":"Rethlefsen","year":"2021","journal-title":"Syst. Rev."},{"key":"ref_55","unstructured":"National Health and Medical Research Council (2025, January 01). NHMRC Additional Levels of Evidence and Grades for Recommendations for Developers of Guidelines, Available online: https:\/\/www.mja.com.au\/sites\/default\/files\/NHMRC.levels.of.evidence.2008-09.pdf."},{"key":"ref_56","unstructured":"Kmet, L.M., Lee, R.C., and Cook, L.S. (2025, January 01). Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Available online: https:\/\/ualberta.scholaris.ca\/bitstreams\/0e6c2b8b-7765-45bd-a4fa-143d13b92a00\/download."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1177\/0962280215583568","article-title":"Random-effects meta-analysis: The number of studies matters","volume":"26","author":"Guolo","year":"2017","journal-title":"Stat. Methods Med. Res."},{"key":"ref_58","unstructured":"Borenstein, M., Hedges, L., Higgins, J., and Rothstein, H. (2014). Comprehensive Meta-Analysis, Biostat."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"101014","DOI":"10.1016\/j.imr.2023.101014","article-title":"How to understand and report heterogeneity in a meta-analysis: The difference between I-squared and prediction intervals","volume":"12","author":"Borenstein","year":"2023","journal-title":"Integrtive Med. Res."},{"key":"ref_60","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, L. Erlbaum Associates."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1037\/0033-2909.86.3.638","article-title":"The file drawer problem and tolerance for null results","volume":"86","author":"Rosenthal","year":"1979","journal-title":"Psychol. Bull."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/j.anl.2021.05.002","article-title":"Swallowing dysfunction in myasthenia gravis patients examined with high-resolution manometry","volume":"48","author":"Kumai","year":"2021","journal-title":"Auris Nasus Larynx"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00455-014-9551-8","article-title":"Chin tuck for prevention of aspiration: Effectiveness and appropriate posture","volume":"29","author":"Ra","year":"2014","journal-title":"Dysphagia"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1002\/pmrj.12093","article-title":"Kinematic Visual Biofeedback Improves Accuracy of Swallowing Maneuver Training and Accuracy of Clinician Cues During Training in Stroke Patients with Dysphagia","volume":"11","author":"Vose","year":"2019","journal-title":"PM&R"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1589\/jpts.27.3619","article-title":"Effects of neck exercises on swallowing function of patients with stroke","volume":"27","author":"Lee","year":"2015","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1044\/2021_AJSLP-19-00223","article-title":"Impact of the Chin-Down Posture on Temporal Measures of Patients with Dysphagia: A Pilot Study","volume":"30","author":"Forbes","year":"2021","journal-title":"Am. J. Speech-Lang. Pathol."},{"key":"ref_68","first-page":"142","article-title":"The Effect of Chin Down Position on Penetration-Aspiration in Adults with Dysphagia","volume":"36","author":"Fraser","year":"2012","journal-title":"Can. J. Speech-Lang. Pathol. Audiol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Gomes, L.M.S., da Silva, R.G., Pedroni, C.R., Garner, D.M., Raimundo, R.D., and Valenti, V.E. (2020). Effects of effortful swallowing on cardiac autonomic control in individuals with neurogenic dysphagia: A prospective observational analytical study. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-67903-9"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1080\/17549507.2021.1975817","article-title":"Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study","volume":"24","author":"Heslin","year":"2022","journal-title":"Int. J. Speech-Lang. Pathol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1007\/s00455-020-10238-4","article-title":"Effectiveness of Chin Tuck on Laryngeal Penetration: Quantitative Assessment","volume":"36","author":"Ko","year":"2021","journal-title":"Dysphagia"},{"key":"ref_72","first-page":"71","article-title":"Proposal for a Modified Jaw Opening Exercise for Dysphagia: A Randomized, Controlled Trial","volume":"42","author":"Koyama","year":"2017","journal-title":"Tokai J. Exp. Clin. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1111\/joor.13322","article-title":"Effects of head flexion posture in patients with dysphagia","volume":"49","author":"Nagura","year":"2022","journal-title":"J. Oral Rehabil."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1111\/j.1365-2982.2011.01869.x","article-title":"Effectiveness of chin-down posture to prevent tracheal aspiration in dysphagia secondary to acquired brain injury. A videofluoroscopy study","volume":"24","author":"Mearin","year":"2012","journal-title":"Neurogastroenterol. Motil."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1053\/gast.2002.32999","article-title":"Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening","volume":"122","author":"Shaker","year":"2002","journal-title":"Gastroenterology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.anl.2021.02.008","article-title":"Different types of dysphagia alleviated by the chin-down position","volume":"48","author":"Miyamoto","year":"2021","journal-title":"Auris Nasus Larynx"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2733","DOI":"10.1002\/hed.25508","article-title":"Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review","volume":"40","author":"Terlingen","year":"2018","journal-title":"Head Neck"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00455-021-10283-7","article-title":"White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults","volume":"37","author":"Speyer","year":"2022","journal-title":"Dysphagia"},{"key":"ref_79","unstructured":"(2025, January 4\u20137). MedTech Europe. Proceedings of the 31st Congress of the Union of the European Phoniatricians, Prague, Czech Republic."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7180\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T10:37:55Z","timestamp":1760524675000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,11]]},"references-count":79,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207180"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207180","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,11]]}}}