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Meta-Analysis
. 2025 Jun;83(6):1-8.
doi: 10.1055/s-0045-1809417. Epub 2025 Jun 17.

Application value of the FOCUS-PDCA cycle in nursing care for dysphagia in patients with cerebral infarction: a meta-analysis

Xiaojing Lu  1 , Jiandong Zhang  2 , Ranran Wang  3 , Xiujuan Liu  1
Affiliations
Meta-Analysis

Application value of the FOCUS-PDCA cycle in nursing care for dysphagia in patients with cerebral infarction: a meta-analysis

Xiaojing Lu et al. Arq Neuropsiquiatr. 2025 Jun.

Abstract

In recent years, there has been growing interest in applying quality improvement methodologies to healthcare processes. One such approach is the Find, Organize, Clarify, Understand, Select-Plan, Do, Check, and Act (FOCUS-PDCA) cycle.To evaluate the effectiveness of the FOCUS-PDCA cycle in the management of dysphagia in patients with cerebral infarction.We conducted a comprehensive literature search on the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, and Wanfang databases for articles published up to October 31st, 2024, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Randomized controlled trials and high-quality retrospective studies comparing the FOCUS-PDCA cycle with conventional care were included. The primary outcomes were swallowing function, quality of life, neurological and limb functions, and complication rates. Data were pooled using random-effects models, and heterogeneity was assessed using the I2 statistic.We included 6 studies involving 638 patients. The FOCUS-PDCA group showed significant improvements in swallowing function (standardized mean difference [SMD] = 1.65; 95%CI: 0.08-3.21), quality of life (SMD = 2.16; 95%CI: 0.54-3.79), and neurological and limb functions (SMD = 1.03; 95%CI: 0.07-2.00) compared with the conventional care group. The FOCUS-PDCA approach significantly reduced complication rates (risk ratio = 0.48; 95%CI: 0.32-0.68).The FOCUS-PDCA cycle appears to be an effective strategy to improve outcomes in patients with cerebral infarction and dysphagia. However, more high-quality studies are needed to confirm these findings and guide clinical practice.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of the study selection process.
Figure 2
Figure 2
( A ) Forest plots for swallowing function (videofluoroscopic swallowing study, VFSS); ( B ) Forest plots for the quality of life; ( C ) Forest plots for neurological and limb functions; and ( D ) Forest plots for complication rate.
Figure 3
Figure 3
( A ): Egger's test plot for swallowing function (VFSS); ( B ) Egger's test plot for the quality of life; and ( C ) Egger's test plot for complication rate.
See this image and copyright information in PMC

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