1 Department of Physical Therapy, Wonkwang Health Science University, Iksan, Korea.
2 Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
Clin Rehabil. 2017 Nov;31(11):1431-1444. doi: 10.1177/0269215517700696. Epub 2017 Mar 27.
To examine the effectiveness of neuromuscular electrical stimulation (NMES) for the management of shoulder subluxation after stroke including assessment of short (1 hour or less) and long (more than one hour) daily treatment duration.
MEDLINE, CENTRAL, CINAHL, WOS, KoreaMed, RISS and reference lists from inception to January 2017 Review methods: We considered randomized controlled trials that reported neuromuscular electrical stimulation for the treatment of shoulder subluxation post-stroke. Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted data.
Eleven studies were included (432 participants); seven studies were good quality, four were fair. There was a significant treatment effect of neuromuscular electrical stimulation for reduction of subluxation for persons with acute and subacute stroke (SMD:-1.11; 95% CI:-1.53, -0.68) with either short (SMD:-0.91; 95% CI:-1.43, -0.40) or long (SMD:-1.49; 95% CI:-2.31, -0.67) daily treatment duration. The effect for patients with chronic stroke was not significant (SMD:-1.25; 95% CI:-2.60, 0.11). There was no significant effect of neuromuscular electrical stimulation on arm function or shoulder pain.
This meta-analysis suggests a beneficial effect of neuromuscular electrical stimulation, with either short or long daily treatment duration, for reducing shoulder subluxation in persons with acute and subacute stroke. No significant benefits were observed for persons with chronic stroke or for improving arm function or reducing shoulder pain.
评估经颅直流电刺激（tDCS）治疗缺血性脑卒中后上肢运动功能障碍的疗效，比较不同刺激方案（阳极、阴极、交叉）和刺激部位（运动皮质、运动皮质联合感觉皮质、感觉皮质）的疗效差异。
检索 MEDLINE、EMBASE、Cochrane 图书馆、中国生物医学文献数据库、万方数据库和维普数据库，检索时限均从建库至 2022 年 7 月。
纳入 tDCS 治疗缺血性脑卒中后上肢运动功能障碍的随机对照试验。
由 2 位研究者独立提取资料并评价纳入研究的偏倚风险。
共纳入 24 项研究（2342 例患者），meta 分析结果显示，与对照组相比，tDCS 能显著改善患者的上肢运动功能（改良 Barthel 指数：MD=9.15，95%CI=6.71～11.59，P<0.00001）和运动功能（Fugl-Meyer 上肢运动功能评分：MD=7.37，95%CI=5.73～8.99，P<0.00001）。亚组分析结果显示，刺激部位为运动皮质、刺激方案为阳极刺激的 tDCS 更能显著改善患者的上肢运动功能（MD=10.72，95%CI=7.61～13.83，P<0.00001；MD=9.45，95%CI=7.31～11.59，P<0.00001）。
tDCS 能有效改善缺血性脑卒中后上肢运动功能障碍，刺激部位为运动皮质、刺激方案为阳极刺激的 tDCS 疗效更优。
