These parallel yet distinct outcomes suggest that NIBS effects are intrinsically linked to the underlying neural state, carrying significant implications for therapeutic applications16. The intact postural control system relies on sophisticated integration of visual, vestibular, and somatosensory inputs11, with NIBS showing potential to enhance this complex sensory processing12. Intriguingly, the neurophysiological response to NIBS demonstrates distinct patterns between stroke survivors and neurologically intact individuals7. The PRISMA statement and checklist (Supplementary Files S1, S2) are designed to enhance the transparency and necessity of reporting in systematic reviews. The network meta-analysis (NMA) was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and checklist (21). Additionally, its dependency on specific person environmental factors restricts its widespread application, with the method’s high costs further impeding its utility for extensive clinical screening. In recent years, the incidence of stroke has increased year by year and has become a major disease that seriously endangers national health worldwide (1). Forest plot of NIBS effects on postural control according to stimulation regions of interest (ROIs). Subgroup analysis by NIBS type (Fig. 4) revealed differential effects across modalities. Forest plot of NIBS effects on postural control in participants with and without stroke. Domain 3 (missing outcome data) displayed strong consistency, with fourteen studies (93.3%) showing low risk and only one study (6.7%) having some concerns. Therefore, our findings further corroborate Wang et al. (3) notion which suggests the potential value of negative DWI in the risk stratification of minor stroke individuals. Our pooled findings showed that among different aspects of medical history and vascular risk factors, prior history of stroke, TIA, or ischemic heart disease appeared to predispose towards DWI neutrality. Possible explanations exist for the high prevalence of DWI-negative events in minor stroke. The network diagram in this study illustrates the inclusion of nine dysphagia assessment tools, with FEES and VFSS prominently positioned as the gold standards, indicated by their central and largest nodes in the network.A total of 1908 patients were included in 16 studies.A total of 2,563 patients (15.8%) received intravenous thrombolysis (IVT), with 350 (19.6%) in the DWI-negative group and 2,213 (15.3%) in the DWI-positive group.There is a critical need for personalized screening approaches in dysphagia management post-stroke, highlighting the gap in comprehensive comparative analyses.Forest plot of sensitivity analysis for non-instrumental dysphagia screening tools.Any differences between the two primary reviewers were resolved through discussion.Anyone can have a stroke, but some things put you at higher risk.Most studies had a low risk of bias, with 15 studies enrolling consecutive cases and 19 studies avoiding a case–control design (11, 12, 14, 15, 22, 24–35, 37, 38).The original contributions presented in the study are included in the article/Supplementary materials, further inquiries can be directed to the corresponding author.In examining specific domains, Domain 1 (randomization process) showed that eight studies (53.3%) had low risk, while seven studies (46.7%) demonstrated some concerns. Stroke includes ischemic stroke and hemorrhagic stroke, and more than 80% is due to ischemic stroke . A total of 1908 patients were included in 16 studies. If you have had an ischemic stroke, you may need medicines to help lower your risk of having another stroke. An ischemic stroke occurs when fatty deposits, blood clots or other debris become lodged in the blood vessels in the brain. An ischemic stroke occurs when a blood clot, known as a thrombus, blocks or plugs an artery leading to the brain. Next, 604 references were excluded through titles and abstracts screening. We performed multiple subgroup analyses based on stroke severity and based on follow-up duration (discharge, 90-days, and 1-year). Data were pooled using a random-effects model. Conflicts were resolved through consultation with a senior reviewer. Future research should prioritize longitudinal investigations to assess the durability of NIBS-induced improvements and explore how different stimulation parameters may influence both immediate and cumulative outcomes. Limitations of this study include the predominance of short-term follow-up periods and heterogeneity in outcome measures, which complicates cross-study comparisons. The variability in efficacy across NIBS modalities documented in our analysis highlights the importance of individualized approaches53. Advances in stimulation technology and protocol design emphasize the need for precise parameter selection tailored to population-specific needs. These findings highlight the potential for multisite stimulation protocols that exploit complementary network dynamics, such as combining M1 and cerebellar stimulation for enhanced outcomes47. Second, during the event of reduced cerebral blood flow, the degree of hypoperfusion in minor stroke causes symptoms but is insufficient to induce changes visible on DWI (26). Negative scans were more common in posterior circulation stroke. In the subgroup analyses, this effect was sustained at hospital discharge and 90-days follow-up but not after 1-year of index stroke. Details of age, gender, and stroke severity distribution are summarized in Table 1. Fourteen studies (2, 3, 6–8, 15–23) satisfied our inclusion criteria. We are optimistic to see that more neuromodulation tools will be available to stroke survivors in the not-to-distant future.• This study’s insights can inform the development of tailored dysphagia screening protocols, potentially leading to revised clinical guidelines that enhance patient care and outcomes.Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings.Given the substantial heterogeneity among studies, we employed a random-effects model for the meta-analysis.In this review, we found that 11–16% of ischemic stroke patients may present with negative findings in the DWI sequence.This had no impact on the peer review process and the final decision.Due to insufficient cerebral blood supply caused by arterial stenosis and occlusion, ischemic stroke often results in the necrosis of brain tissues and severe cerebral dysfunction, followed by a series of limb paralysis and cognitive impairments.Network meta-analysis graph of comparative effectiveness among different screening tools. Comparative analysis reveals that while tools like BSST and WST are useful, they exhibit lower diagnostic accuracy compared to GUSS, MASA, and V-VST. Integrating this training into clinical practice, especially in busy or resource-limited settings, is challenging due to MASA’s detailed nature and the time investment required for its administration. Professional training, typically provided by speech pathologists, is essential for accurate administration and interpretation of MASA, which may limit its accessibility in general clinical practice (22). However, its comprehensive nature makes it detailed and time-consuming, posing challenges in fast-paced clinical settings. Moreover, studies like that by Tomoya Omura (40) report MASA’s effectiveness in aspiration detection, potentially aiding in the prevention of aspiration pneumonia. Human objects of study Specifically, VFSS is not recommended for pregnant women and children due to radiation concerns and is advised against frequent use in general patients (10). Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings. This article is part of the Research TopicThe Role of Environmental Stressors in Neurocritical Patient OutcomesView all 11 articles Research on stroke risk prediction model based on the integration of ACE2 genetic information through stroke specialized disease queue and machine learning algorithm. Alcohol consumption significantly impacts stroke prognosis across various follow-up periods and stroke types. A total of 13 studies involved NIHSS scores and included six rehabilitation treatments. We followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines when performing this systematic review and meta-analysis . Kumar concluded in a meta-analysis that stem cells were not significantly efficacious in reducing neurological deficits. In the clinical application of stem cells, the therapeutic time window is usually determined by the expected therapeutic mode of action . Non-invasive brain stimulation: current and future applications in neurology Among elements of medical history prior to index stroke, history of ischemic heart disease, prior history of stroke, and prior history of TIA were all found to be significant predictors of DWI-negative stroke. Among the included studies that reported time from stroke onset to DWI scan, there was variability in this interval. In addition, proportions of DWI-negative among patients with minor stroke defined as National Institutes of Health Stroke scale (NIHSS) less than or equal to 5 and posterior circulation were pooled separately. This meta-analysis showed that early rehabilitation can improve neurological function and quality of life in ischemic stroke patients compared with late rehabilitation, which is mainly manifested by significant improvements in NIHSS score, CSS score, BI/MBI score and FMA score. Of the patients in the included studies, there were 1908 patients with ischemic stroke 959 patients received early rehabilitation and 949 patients received late rehabilitation. The follow-up time of the studies ranged from eight weeks to seven years, and it was not possible to judge the long-term effects of stem cells on the improvement status of ischemic stroke. If you have had a transient ischemic attack (TIA), these steps can help lower your risk of a stroke. A transient ischemic attack is sometimes known as a ministroke. A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. Once your doctors can determine if you're having an ischemic or hemorrhagic stroke, they'll be able to figure out the best treatment. Two independent researchers conducted the quality assessment, with discrepancies resolved through discussion and consensus. Particular attention was paid to extracting data related to postural control outcomes, including static and dynamic balance parameters, postural sway measurements, and standardized balance assessments. Data extraction was performed using a standardized form developed specifically for this review. The results of bias risk assessment are shown in Figs. The basic features of the included research are shown in Table 1. Literature screening process and results from each step of the process The literature screening process and results are shown in Fig. False-negative diffusion-weighted imaging in acute stroke and its frequency in anterior and posterior circulation ischemia. Itemized NIHSS subsets predict positive MRI strokes in patients with mild deficits. Wang, Y, Jing, J, Pan, Y, Wang, M, Meng, X, and Wang, Y. Distribution and prognosis of acute ischaemic stroke with negative diffusion-weighted imaging. The results showed that the neurological impairment scale in the early rehabilitation group was lower than that in the late rehabilitation group, indicating that the neurological function recovery in the early rehabilitation of ischemic stroke was more effective than that in the late rehabilitation. The heterogeneity of the included studies in this study was large, and random effect model was selected for analysis. Through the sensitivity analysis of each included study, it was found that 3 studies 16,17,18,had relatively larger heterogeneity. The heterogeneity of the included references in this study was large, and random effects model was selected for analysis. Data extracted from the included studies were title, author, publication time, design type, allocation method, age, case in the early rehabilitation, case in the late rehabilitation, rehabilitation starting time, outcome assessment scale, efficacy evaluation time, and outcome indicators. Distributional validity and prognostic power of the National Institutes of Health stroke scale in US administrative claims data. European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Additionally, DWI-negative scan may serve as an imaging marker for a favorable prognosis. Sixth, strict inclusion criteria limited the analysis of some variables. 1 Search results These findings reveal differential response patterns between populations and stimulation parameters, suggesting enhanced neuroplastic potential in stroke survivors. Systematic searches were conducted across major databases (CINAHL, Embase, MEDLINE, Web of Science) for randomized controlled trials and crossover studies published from 2014 to 2024. Cummings, J, Soomans, D, O’Laughlin, J, Snapp, V, Jodoin, A, Proco, H, et al. Proportions of DWI-negative ischemic stroke were pooled. Adjunctive vagal nerve stimulation has recently received FDA approval to enhance upper limb motor recovery in chronic ischemic stroke with moderate impairment, and progress has been made to implement it in real-world practice. ST, MY will be included in the study screening to extract data and assess the risk of bias in the included studies. Prior to this systematic review, we understood that the evidence linking timing of rehabilitation (i.e., early vs. late) to stroke recovery was inconsistent in the literature. Lastly, while we aimed to provide a thorough analysis, the reliance on published data means that potential publication bias and incomplete reporting could affect the robustness of our conclusions. Future research should address limitations such as the exclusion of aspiration-specific outcomes and study heterogeneity. Despite the comprehensive nature of this network meta-analysis, several limitations should be acknowledged. This study aimed to systematically evaluate the association between alcohol consumption and stroke prognosis, across various follow-up durations and stroke subtypes.European stroke organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke.A systematic review, meta-analysis, and meta-regression.The global healthcare landscape continues to grapple with stroke as a leading cause of mortality and long-term disability.In the subgroup analyses, this effect was sustained at hospital discharge and 90-days follow-up but not after 1-year of index stroke.This network visualization underscores the central role of FEES and VFSS in dysphagia screening while highlighting the relative under representation of other tools in the literature (Figure 2).Alcohol consumption significantly impacts stroke prognosis across various follow-up periods and stroke types.Meta and meta for packages were utilized to aggregate sensitivity, specificity, positive predictive value, and negative predictive value as effect size statistics, each with their 95% confidence intervals (CIs). Domain 4 (measurement of outcome) revealed that eleven studies (73.3%) had low risk, two studies (13.3%) had some concerns, and two studies (13.3%) showed high risk. For Domain 2 (deviations from intended interventions), eleven studies (73.3%) were assessed as low risk, two studies (13.3%) had some concerns, and two studies (13.3%) showed high risk. In examining specific domains, Domain 1 (randomization process) showed that eight studies (53.3%) had low risk, while seven studies (46.7%) demonstrated some concerns. Of the 15 studies evaluated, five studies (33.3%) were assessed as having an overall low risk of bias, four studies (26.7%) had some concerns, and six studies (40%) were determined to have a high risk of bias (Fig. 2). DWI abnormalities in posterior circulation tend to appear later in the acute phase compared to anterior circulation stroke (2). Our results provide further evidence supporting the association between posterior circulation ischemia and DWI -ve stroke (5, 16, 17). Emboli from cardiac sources, including those raised from atrial fibrillation, can have varying sizes and often cause acute severe strokes contributing to higher rates of positive DWI lesions (27). Several articles provide insight into neuroimaging (Zheng et al.; Huang et al.; Yoshimoto; Cheng et al.) and serum markers (Liu Y. et al.) that might help with patient selection and treatment monitoring in acute stroke. Stroke constitutes a significant global health challenge, with 12.2 million new strokes per year worldwide, a mortality of 6.5 million, and a cumulative disability of 143 million disability-adjusted life years DALYs; (1). Serious adverse events after stem cell transplantation have been of widespread concern to clinical practitioners. BMMNC consist of a mixed cell population of multiple components, including BMSC, PC, and hematopoietic stem cells . Stem cell types were not linked in the included studies to injection method, injection dose, and injection time, which could be potential risks that could affect the final outcome. You have full access to this open access article Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). • This study provides a direct comparison of 6 non-instrumental bedside dysphagia screening tools, revealing specific strengths and weaknesses in acute stroke settings. Dysphagia is a prevalent and serious complication in stroke patients, necessitating early and accurate screening to improve outcomes. First, our study focused on dysphagia screening tools, excluding studies that specifically validated scales with aspiration as the primary patient outcome. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. This had no impact on the peer review process and the final decision. The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article. We hope that it will help clinicians and scientists in the field of stroke and foster translational progress. Meta and meta for packages were utilized to aggregate sensitivity, specificity, positive predictive value, and negative predictive value as effect size statistics, each with their 95% confidence intervals (CIs). Statistical analysis was conducted using R version 4.3.2. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was utilized for evaluating the quality of each study. Accurate early screening for dysphagia is crucial to avoid complications and improve patient quality of life. Future studies should more fully explore the effect of alcohol consumption on stroke prognosis in different populations and under different regions. When categorizing strokes into ischemic and hemorrhagic types, alcohol consumption poses significant risks. We included 58 studies and evaluated their methodological quality using the Newcastle-Ottawa Scale (NOS). We systematically searched multiple databases, including PubMed, Web of Science, Embase and others, for relevant studies published from inception to January 2024. By broadening patient outcomes and standardizing methodologies, future studies can improve the effectiveness of dysphagia screening tools, enhancing patient care and reducing complications. Second, since many of the original studies included did not specify whether they included patients with language disorders, this may increase heterogeneity and may lead to some differences in our findings. Tools like the GUSS, V-VST, MASA and WST offer unique advantages, particularly for acute stroke patients. However, DWI may fail to detect ischemic lesions in a proportion of patients. Adjunctive neuromodulation to rehabilitation therapy is a promising avenue for promoting post-stroke recovery and decreasing the overall burden of disability. MRI-guided tDCS studies in subacute and chronic post-stroke aphasia showed promising benefits for picture-naming recovery. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Due to insufficient cerebral blood supply caused by arterial stenosis and occlusion, ischemic stroke often results in the necrosis of brain tissues and severe cerebral dysfunction, followed by a series of limb paralysis and cognitive impairments. However, acknowledging the limitations of funnel plot analysis with small sample sizes, this assessment would only be conducted if ten or more studies were available for analysis, as fewer studies would not provide sufficient power to distinguish chance from real asymmetry60. After removing duplicates, the remaining studies underwent title and abstract screening, followed by full-text assessment against the predefined eligibility criteria. To ensure comprehensive yet focused results, search filters were applied to restrict studies to those published between 2014 and 2024, written in English, involving human participants aged 18–64 years, and published as peer-reviewed articles. We extend our deepest gratitude to Professor HJ and Professor YL for their invaluable guidance throughout this study. The author(s) declare financial support was received for the research, authorship, and/or publication of this article. GUSS, MASA, and V-VST emerged as the most reliable, demonstrating superior sensitivity and specificity, suitable for diverse clinical settings. Future research should aim to address these limitations by including more diverse patient outcomes and ensuring consistency in study designs and reporting standards. Most studies had a low risk of bias, with 15 studies enrolling consecutive cases and 19 studies avoiding a case–control design (11, 12, 14, 15, 22, 24–35, 37, 38). Sensitivity and specificity of the various assessment tools ranged from 0.21 to 1.00 and 0.41 to 0.98, respectively. MASA and SLP were used as comparative baselines in some studies (14, 15, 23, 25, 26, 32). There are 15 studies utilized VFSS or FEES as gold standards for sensitivity and specificity (11, 12, 22, 24, 27–31, 33–38). As an important part of the body’s immune cells, monocytes are rapidly recruited and migrate to the site of inflammation to play an anti-inflammatory role after inflammation occurs . After the occurrence of cerebral infarction, ischemic brain tissue energy is rapidly consumed and causes the release of inflammatory mediators, causing irreversible damage to neurons. Daily living ability and the degree of prognosis are closely related to the level of motor function improvement after stroke. The results of our network meta-analysis showed the best efficacy in terms of improving mRS, MBI, and FMA. No datasets were generated or analysed during the current study. As a multidimensional assessment scale, the NIHSS demonstrates particular sensitivity of the subdomains of motor, language and consciousness to UBMSC-mediated neuroprotective mechanisms and inflammation regulation, which may be the basis for the observed significant improvement in scores. UBMSC have the potential for self-renewal and can regulate the microenvironment of local injury sites after cerebral ischemia by secreting anti-inflammatory factors or lowering interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) as a means of repairing ischemic sites 46,47,48,49,50. Concluded that the combined effect of BMMNC may be better, which provides support for a higher level of evidence for individualized stem cell therapy selection. Study quality was assessed using the Risk of Bias 2 tool, with treatment effects analyzed through standardized mean differences in a random-effects model. Future research should integrate patient-specific outcomes and standardize methodologies to enhance dysphagia screening tools, ultimately improving patient care and reducing complications. The random-effects model was particularly utilized due to observed heterogeneity in study data. The study employed both fixed-effect and random-effects models to analyze sensitivity, specificity, positive predictive value (PPV), and Negative Predictive Value (NPV), each with 95% confidence intervals. Stroke-specific analysis (Fig. 8d) demonstrated reasonable symmetry despite some scatter in lower-precision studies. Examination by stimulation regions of interest (Fig. 8c) revealed balanced distribution for M1 and cerebellar stimulation studies. The distribution pattern suggests that both positive and negative findings were represented in the literature, with no strong evidence of systematic publication bias. This pattern suggests possible selective reporting of positive outcomes in iTBS interventions, though the limited number of studies (n Examination by stimulation regions of interest (Fig. 8c) revealed balanced distribution for M1 and cerebellar stimulation studies. Non-instrumental bedside assessment tools remain the primary method for screening and diagnosing dysphagia in clinical settings, particularly for early evaluation of swallowing disorders. In the current landscape of post-stroke dysphagia evaluation, the primary methods encompass instrumental examinations and clinical scale assessments. Accurate diagnosis and management of dysphagia are crucial for preventing these complications and improving the quality of life for stroke patients. The radar chart delineates the performance metrics of various non-instrumental dysphagia assessment tools, bench marked against the gold-standard diagnostic methods VFSS and FEES. Network meta-analysis graph of comparative effectiveness among different screening tools. This network visualization underscores the central role of FEES and VFSS in dysphagia screening while highlighting the relative under representation of other tools in the literature (Figure 2). The funnel plots for sensitivity, specificity, and accuracy exhibit a symmetrical distribution around the mean effect size, indicating minimal publication bias across the included studies. The importance of getting evidence into practice Chinese language databases, such as CNKI, Wanfang and VIP, and English language databases, such as PubMed, Web of Science, and The Cochrane Library were searched to collect RCT data related to early and late ischemic stroke rehabilitation from the establishment of the databases up to October 2023. Post-stroke rehabilitations are commonly used to help the stroke patients to regain their abilities in their daily lives . Limb motor dysfunction after ischemic stroke is often manifested as limb weakness, poor joint flexion and extension, and complete immobility of limbs, which poses a serious threat to patients’ normal life and brings a heavy burden to family and society . Chinese language databases such as CNKI, Wanfang, and VIP, and English language databases such as Embase, PubMed, Web of Science, and The Cochrane Library were searched, and RCT related to early and late rehabilitation of ischemic stroke from the establishment of the database to October 2023 was collected. This study conducted a meta-analysis on the influence of intervention in early and late ischemic stroke rehabilitation. Jaillard and Chen conducted a meta-analysis on the use of stem cells in the early recovery of stroke patients, with the results showing that stem cells have safe and significant efficacy in terms of improving neurological function and daily living ability in stroke patients. Several studies have now systematically evaluated the ability of stem cells to improve neurological function and daily living for stroke patients. A clinical trial of stem cell transplantation in chronic phase stroke also demonstrated that stem cells provide neuroprotective and regenerative mechanisms, with significant effects on patients’ neurological function scores . NIBS techniques offer promising benefits for stroke rehabilitation, with significant potential to enhance functional recovery and quality of life. However, the findings show the need for long-term safety data, cost-effectiveness studies, and strategies to address accessibility barriers in clinical settings. The review aims to critically evaluate the efficacy of NIBS in enhancing motor, cognitive, and language recovery, while identifying challenges and opportunities for its clinical integration. Dual antiplatelet therapy reduced stroke risk in transient ischemic attack with positive diffusion weighted imaging. Publication bias A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke.A random-effects model was employed to account for anticipated heterogeneity among studies57.Nevertheless, there is a scarcity of efficacy data comparing IVT, DAPT, and single antiplatelet therapy (SAPT) in the context of DWI-negative stroke.Our results on the therapeutic effects of stem cell are largely consistent with those reported in previous meta-analytic studies 42, 43.Kumar concluded in a meta-analysis that stem cells were not significantly efficacious in reducing neurological deficits.The aim of the current study was not to question the pivotal role of DWI imaging in the settings of ischemic stroke.These findings highlight the robustness and reliability of MASA and V-VST as superior tools for dysphagia screening in stroke patients, offering consistent performance across diverse study settings.Second, since many of the original studies included did not specify whether they included patients with language disorders, this may increase heterogeneity and may lead to some differences in our findings.The heterogeneity analysis of sensitivity for the GUSS, V-VST, and MASA dysphagia screening tools revealed minimal variability across the five studies evaluated. This study aimed to systematically evaluate the association between alcohol consumption and stroke prognosis, across various follow-up durations and stroke subtypes. Future research should focus on refining stimulation protocols, conducting large-scale clinical trials, and exploring the ethical and economic dimensions of NIBS to support its integration into routine stroke care. Giraldo, EA, Khalid, A, and Zand, R. Safety of intravenous thrombolysis within 4.5 h of symptom onset in patients with negative post-treatment stroke imaging for cerebral infarction. In-hospital clinical outcomes in diffusion weighted imaging-negative stroke treated with intravenous thrombolysis. This deluge of literature highlights the necessity for meta-analyses and systematic reviews, which aggregate and synthesize a large body of evidence from multiple studies using comprehensive and systematic approaches. However, limited by the small amounts of included studies, the disease duration and intervention cycle did not get more reliable conclusions, and the differences in side-by-side comparisons between different factors affecting the effect of stem cell intervention still need to be further studied and explored. Our results on the therapeutic effects of stem cell are largely consistent with those reported in previous meta-analytic studies 42, 43. UBMSC has a stronger potential for regeneration, has significant anti-inflammatory and neuroprotective effects, and may be more suitable for reducing nerve damage. Additionally, UBMSC can secrete trophic factors to promote the recovery of neurological function of is chemically damaged areas in a short period of time, this is an ideal starting point for early recovery in clinical practice 37, 51. In clinical practice, UBMSC have better differentiation potential than other MSCs. A network meta-analysis showed that UBMSC had the best efficacy in improving NIHSS. Detailed information about the studies included in the NMA can be found in Table 1. The research involved both cross-sectional and case–control studies, including a multi-center observational study (11, 12, 14, 15, 22–38). Further full-text review led to the exclusion of an additional 282 studies. Through title and abstract screening, 3,886 studies were excluded. Sorry, a shareable link is not currently available for this article. Were involved in reviewing, editing, and final approval of the manuscript. All data generated or analysed during this study are available to readers upon request to the corresponding authors, Sangha Cha () and Kang Hee Cho (). The assessment of heterogeneity utilized both the chi-square test and I2 statistic, with I2 values above 75% indicating high heterogeneity and values below 40% suggesting low heterogeneity58. Furthermore, the prevalence of DWI-negative events was more pronounced in milder stroke cases (24%). The difference in the percentages may stem from the variable proportion of minor stroke cases, geographical distribution, and statistical pooling approaches. Table 2 demonstrates the pooled analysis of stroke outcomes. Characteristics of included studies. The median time ranged from 2 h (17) to 6 days (8) for DWI-negative patients, compared to 1.81 h (17) to 4 days (8) for DWI-positive patients. Overall, the heterogeneity in the screening effectiveness of BSST and DNTA is high, likely due to the lack of consistent assessment protocols and the use of varied innovative approaches by different researchers. Additionally, differences in the administrators and managers of WST validation studies and the diverse patient populations included in these studies could contribute to the significant variability in outcomes. In contrast, tools like BSST, WST, and DNTA show inconsistent results across different versions and upgraded evaluation tools for dysphagia screening. The results showed that, compared with late rehabilitation, early rehabilitation improved clinical efficacy. However, there is still controversy about the duration of interventional rehabilitation after stroke. There is a golden plastic period after stroke, during which timely and safe intervention and rehabilitation therapy can effectively improve the disability status. Artificial intelligence for decision support in acute stroke — current roles and potential No funding was received for this study. The authors wish to thank Dr. Emmanuel Egbunu for reviewing their manuscript. Instant access to the full article PDF. However, challenges such as protocol optimization, patient-specific personalization, and feasibility of widespread clinical application need to be addressed. Recent advances highlight the potential for tailored stimulation protocols and combined therapies to optimize outcomes. Most investigations (86.7%) incorporated conventional rehabilitation or specific exercise protocols alongside NIBS applications. Control conditions universally employed sham stimulation matching experimental parameters. This selection process followed the PRISMA 2020 guidelines, with independent assessment conducted by two researchers and any disagreements resolved through consensus. While we acknowledge that some neurologically intact individuals may experience peripheral injuries affecting postural stability, the underlying neural processing of postural control remains fundamentally different from those with central nervous system lesions. Despite these advances, a comprehensive comparative analysis of NIBS effects on postural control between stroke survivors and neurologically intact individuals remains notably absent from the literature. In stroke rehabilitation, NIBS has demonstrated capacity to enhance postural recovery13, while studies in healthy individuals reveal improvements in postural stability and dynamic balance performance14,15. Dysphagia risk assessment in acute left-hemispheric middle cerebral artery stroke. However, this meta-analysis also has some limitations. On the other hand, it may be due to the increased sense of self-efficacy that brings patients greater confidence. This finding provides evidence against too early intervention in rehabilitation. This may be related to very early initiation of rehabilitation combined with high doses of rehabilitation training. Meta-analysis results of China Stroke Scale MASA and V-VST demonstrate the best overall performance for diagnosing dysphagia and screening healthy individuals, though further research is needed on V-VST’s comparison to gold standards to support its clinical adoption. The results of this study highlight the robustness and reliability of GUSS, MASA, and V-VST as primary tools for dysphagia screening. Forest plot of specificity analysis for non-instrumental dysphagia screening tools. Forest plot of sensitivity analysis for non-instrumental dysphagia screening tools. The network diagram in this study illustrates the inclusion of nine dysphagia assessment tools, with FEES and VFSS prominently positioned as the gold standards, indicated by their central and largest nodes in the network. You've likely heard the term stroke before.Research on stroke risk prediction model based on the integration of ACE2 genetic information through stroke specialized disease queue and machine learning algorithm.When heterogeneity is high, subgroup analysis and sensitivity analysis were used to explore its source.Deep brain stimulation or stent-based neuromodulation has yet to be further tested regarding safety and efficacy.Concluded that the combined effect of BMMNC may be better, which provides support for a higher level of evidence for individualized stem cell therapy selection.These factors can limit MASA’s practicality in some healthcare environments, necessitating consideration of the healthcare setting’s capacity when choosing to implement MASA for dysphagia assessment. The longer a stroke goes untreated, the greater the potential for brain damage and disability. Seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely. Some treatments are most effective when given soon after a stroke begins. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Therefore, it is hoped that there will be more multi-centered high-quality RCTs in the future to discuss related issues of early stroke rehabilitation to better determine the optimal time and dosage of early rehabilitation. In addition, fewer studies were included, and differences in intervention protocols were inevitable. Our results suggest that early rehabilitation within 2 weeks after stroke is beneficial to neurological function and quality of life, compared with late rehabilitation, which starts 2 weeks after stroke. In the three studies, there were 221 cases in the early rehabilitation and 221 in the late rehabilitation. We reported a slightly higher prevalence of negative DWI findings in routine stroke patients, including minor and non-minor stroke subsets. The aim of the current study was not to question the pivotal role of DWI imaging in the settings of ischemic stroke. Among variables of medical history and vascular risk factors prior to index stroke, clinical history of stroke, TIA, or ischemic heart disease can increase the odds of negative DWI findings. Risk assessment of bias in the included studies Hence, the present study concludes that the application of different types of stem cells to ischemic stroke patients is safe. Hence, the present study concludes that the application of different types of stem cells to ischemic stroke patients is safe.The main shortcomings of this study are as follows. We also analyze and rank the stem cells according to the outcome indexes, with the aim of providing an evidence-based basis for the clinical application of stem cells in improving the dysfunction of ischemic stroke patients. A computerized search of the Cochrane Library, PubMed, Web of Science, Google Scholar, CNKI, and Wanfang Database was performed to collect randomized controlled clinical studies published from the time of library construction to December 2024, on the use of stem cells to improve function in patients with ischemic stroke. In conclusion, this meta-analysis revealed that DWI-negative ischemic stroke represents a prevalent phenomenon, particularly among minor stroke patients. The anatomical specificity of NIBS effects reveals a hierarchical organization of motor recovery networks. Notably, the consistency of this effect across diverse stroke populations indicates a robust mechanism underlying recovery-oriented neuroplasticity37. This finding aligns with evidence demonstrating that prolonged subthreshold stimulation facilitates synaptic plasticity and promotes reorganization at the network level.36. Unlike neurologically intact individuals, who possess optimized neural networks with limited capacity for further enhancement, stroke survivors exhibit disrupted circuits that provide a greater opportunity for reorganization32. The enhanced response to NIBS observed in stroke survivors is likely attributed to the unique neurophysiological characteristics of the post-stroke brain. Perry, L. Screening swallowing function of patients with acute stroke. A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity. Booth, A, Clarke, M, Ghersi, D, Moher, D, Petticrew, M, and Stewart, L. An international registry of systematic-review protocols. Lesion location and other predictive factors of dysphagia and its complications in acute stroke. • The comparative effectiveness data provided may drive future research toward innovative screening tools and methodologies, particularly those incorporating patient-specific variables and stroke recovery stages. During the full-text review phase, articles were excluded based on various criteria.This meta-analysis showed that early rehabilitation can improve neurological function and quality of life in ischemic stroke patients compared with late rehabilitation, which is mainly manifested by significant improvements in NIHSS score, CSS score, BI/MBI score and FMA score.Supplemental manual searches of references final inclusion in the study and gray literature were conducted to ensure that the searches were comprehensive.The extracted information encompassed detailed study characteristics, participant demographics, intervention protocols including stimulation parameters, outcome measures, and quantitative results.We included 16,268 patients with clinical diagnosis of ischemic stroke and with available MRI-DWI findings.Despite methodological variations between studies, stimulation parameters maintained relative consistency within each NIBS modality category (Table 1).The assessment of heterogeneity utilized both the chi-square test and I2 statistic, with I2 values above 75% indicating high heterogeneity and values below 40% suggesting low heterogeneity58.Management of a stroke often involves a care team with several specialties.A stroke can sometimes cause temporary or permanent disabilities.The NIHSS scale consists of 11 tests, with lower scores indicating that the patient is doing better. 3 Data extraction and risk of bias Review Manager 5.4.1 was used for analysis. After the independent assessment by two independent researchers, cross-checks were carried out, and any disagreement was resolved through consultation and reference to relevant data. However, at present, timing of the most effective rehabilitation (i.e. early vs. late) are still controversial . Ischemic stroke is often accompanied by different degrees of nerve damage and dysfunction, among which limb motor dysfunction is the most common . Review Manager 5.4.1 was used for relevant analysis. A systematic and a scoping review on the psychometrics and clinical utility of the volume-viscosity swallow test (V-VST) in the clinical screening and assessment of oropharyngeal dysphagia. This network meta-analysis highlights the importance of accurate dysphagia screening tools for stroke patients. The meta-analysis indicates that BSST, with its high NPV and specificity, could have a unique role in assessing dysphagia in acute stroke patients, such as in assessing swallowing function during rehabilitation. In cases where the two primary reviewers had disagreements about data extraction, a third reviewer (YL) arbitrated and made the final decision. If unresolved differences persisted, a third reviewer (HJ) was consulted for resolution. Any differences between the two primary reviewers were resolved through discussion. The remaining records underwent preliminary screening based on titles and abstracts, followed by a comprehensive evaluation through full-text reading. The search strategies used in this review are outlined in Supplementary Table S1, summarizing the retrieval information for each database. In this paper, a meta-analysis was performed only in regard to the number of deaths from serious events. However, a small number of studies regarding NIHSS and MBI are distributed outside of the 95% CI in the funnel plots, suggesting there is a small sample effect (Fig. 6). The results show that the funnel plots are roughly symmetrical, indicating that there is a low likelihood of publication bias in the articles. In this article, the four outcomes metrics of NIHSS, mRS, MBI, and FMA were tested for publication bias. Intelligent, mobile stroke imaging The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding authors. • Our findings quantify the sensitivity and specificity of each tool, offering concrete data to guide clinicians in selecting the most effective screening method for stroke-induced dysphagia. There is a critical need for personalized screening approaches in dysphagia management post-stroke, highlighting the gap in comprehensive comparative analyses. Existing dysphagia screening tools exhibit varied efficacy across different patient populations; however, this study identifies MASA, GUSS, and V-VST as reliable and relatively accurate tools for dysphagia screening. The original contributions presented in the study are included in the article/Supplementary materials, further inquiries can be directed to the corresponding author. This raises concerns about the potential inclusion of patients with stroke mimics in the analysis. Third, we included studies published in varying periods, and technical evolutions of MRI machines may enable more detection of ischemic lesions. These findings are in line with previous reports demonstrating that DWI-negative can be used as an imaging indicator of favorable prognosis. However, no systematic synthesis has been obtained in this regard so far. In addition, brainstem lesions tend to be smaller and might be overlooked due to the presence of magnetic susceptibility artifacts (16, 20). However, mild stroke represents a substantial proportion of routine stroke patients presenting to the emergency room, which adds to the value of our study (34). Fourth, median baseline NIHSS scores of most included studies were consistent with minor and moderate stroke subtypes, which have more proclivity of DWI-negative findings and could affect our results. The prognostic implications of DWI-negative ischemic stroke have not been fully explored.