Early Acupuncture Intervention Strongly Associates with Improved Swallowing Recovery in Post-Stroke Dysphagia: A Multicenter Real-World Cohort Study

Junlong Li^1,2Guiping Li^1,2,3*Shu Wang^4,5*Li Li^1,2Fei Wang^1,2Chen Yang^1,2Yan Shen^1,2Sha Yang^1,2Zhijie Xu^1,2Fan Xu^1,2Mengnan Lu^1,2Xiaomei Wang^1,2Yong Wang⁶Zhiliang Zhou⁷Hao Li⁸Yongjun Peng⁹Yue Cao¹⁰Xiangfang Chen¹¹Xiaoshan Zheng¹²Han Ke¹³

• ¹First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai District, China
• ²National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
• ³Tianjin Key Laboratory of Acupuncture and Moxibustion, Tianjin, China
• ⁴Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
• ⁵Key Laboratory of Cerebropathy Acupuncture Therapy of State Administration of Traditional Chinese Medicine, Tianjin, China
• ⁶Beijing University of Chinese Medicine Dongzhimen Hospital Medical in Xiamen, Xiamen, Fujian Province, China
• ⁷Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, Hebei, China
• ⁸Jiangsu Second Hospital of Traditional Chinese Medicine, Nanjing, Liaoning Province, China
• ⁹Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
• ¹⁰The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
• ¹¹Tianjin Wuqing Traditional Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin, China
• ¹²Chifeng Municipal Hospital, Chifeng, China
• ¹³Shandong Provincial Hospital Affiliated to Shandong First Medical University Jinan, Jinan, China

Background: Post-Stroke Dysphagia (PSD) is a common complication of stroke, significantly impairing recovery and quality of life. Acupuncture has shown potential in improving swallowing function, yet the optimal timing of intervention remains unclear. This study evaluated the effect of acupuncture timing on swallowing recovery in stroke patients.We conducted a multicenter real-world study across 27 hospitals in China, enrolling 382 stroke patients with PSD. Inclusion required symptom onset within 90 days and a Water Swallowing Test (WST) score >2. The primary outcome was swallowing function recovery at discharge, 90 ± 7 days, and 180 ± 7 days post-onset. Multivariate logistic regression was used to adjust for potential confounders.Results: Among 359 participants with complete data, early acupuncture (0-14 days post-stroke) was strongly associated with improved swallowing recovery. Delayed treatment beyond 28 days significantly reduced recovery odds at discharge (adjusted OR=2.17; 95% CI: 1.12-4.21) and 90 days (adjusted OR=2.57; 95% CI: 1.31-5.04). This effect diminished at 180 days (adjusted OR=1.55; 95% CI: 0.52-4.61). Medullary lesions and diabetes were also associated with poorer outcomes, while hyperlipidemia showed a potential protective effect.The study relied on WST as the sole functional assessment, which, while practical, lacks the sensitivity of instrumental measures like VFSS or FEES for detecting silent aspiration.Early acupuncture intervention within two weeks post-stroke is strongly associated with improved swallowing recovery in real-world clinical practice. Delayed treatment may limit clinical benefit. Future research should incorporate instrumental swallowing assessments and randomized trials to refine acupuncture timing and validate these findings.