Dysphagia is a common post-stroke complication. Acupuncture is a widely used effective treatment for post-stroke dysphagia in China. Based on our previously published overview in 2019, this study aimed to provide an update on the current evidence regarding acupuncture for post-stroke dysphagia. Specifically, this study aimed to assess the quality of systematic reviews (SRs) and meta-analyses (MAs) published in the last 5 years using the new Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020) tool to provide updated evidence for clinical decision-making.

The following databases were searched: China National Knowledge Infrastructure, Wanfang database, Chinese Scientific Journal Database, SinoMed, PubMed, Embase and Cochrane Library from January 1, 2019 to June 30, 2025. Two researchers independently performed data extraction. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and PRISMA 2020 were used to evaluate the methodological and reporting quality of the included SRs/MA, respectively.

Eight SRs/MA met the inclusion criteria. Additionally, one article applied the Grading of Recommendations Assessment, Development Evaluation system. Most of the evidence was of very low quality, with the primary factors for downgrading being inconsistency and publication bias. Evaluation using AMSTAR 2 indicated that there were no high-quality SRs/MA and that all studies were of critically low quality. Quality issues included failure to provide a list of excluded studies and justify their exclusion. Moreover, not all studies were randomized controlled trials (RCTs) with a low risk of bias (RoB). Additionally, if the studies were RCTs with moderate or high risk of bias, the review did not provide a discussion of the likely impact of the RoB on the results.

Acupuncture combined with rehabilitation may improve post-stroke dysphagia symptoms. However, the methodological quality of SRs/MA remains very low and has not improved over the last 5 years. Studies should be designed in line with the AMSTAR 2 and PRISMA 2020 to provide reliable, high-quality evidence for supporting clinical practice.

Clinical practice guidelines (CPGs) set quality standards for effective and safe practices, which should be supported by robust evidence. We aimed to identify and evaluate the quality of current Chinese CPGs regarding the use of acupuncture for post-stroke dysphagia and to compare their supporting evidence.

Four Chinese databases and two websites were searched to identify relevant CPGs. Two reviewers independently screened the titles, abstracts, and full texts. Two authors assessed the quality of the identified CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE II).

After title/abstract and full-text screening, and removal of duplicates and irrelevant CPGs, 13 CPGs remained. The CPGs were published between 2011 and 2024. Moreover, ten guidelines were affiliated with hospitals/universities, while three did not indicate their authors’ affiliations. The CPGs were sponsored by the World Health Organization, professional committees, and the National Administration of Traditional Chinese Medicine. Among the 13 guidelines, four Western medicine guidelines were published by the same first author (on behalf of the Stroke Association) in 2012, 2017, 2019, and 2023. Evaluation using AGREE II revealed that the quality of the 13 CPGs varied. Specifically, five, two, and six guidelines were graded A, B, and C, respectively. The CPGs were backed by poor and often outdated evidence. Notably, only one CPG was developed by professionals with knowledge regarding acupuncture, eight CPGs were mainly developed by traditional Chinese or integrative medicine doctors, and the remaining four CPGs were developed by Western medicine doctors.

It is important to improve the quality of CPGs and their underlying evidence. Additionally, CPGs should be developed by research methodologists and appropriately qualified clinicians.