Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Movement Analysis and Neurological Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil; Centro Universitário Ritter dos Reis (UniRitter), Laureate International Universities, Porto Alegre, Brazil.
Arch Phys Med Rehabil. 2018 Feb;99(2):355-366.e1. doi: 10.1016/j.apmr.2017.07.009. Epub 2017 Aug 9.
To evaluate the effectiveness of noninvasive brain stimulation (NIBS)-repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)-on hemispatial neglect and performance in activities of daily living (ADL) after stroke.
MEDLINE (PubMed), EMBASE, Cochrane CENTRAL, Scopus, SciELO, and Physiotherapy Evidence Database were searched from database inception to December 2016.
Randomized controlled trials or crossover trials focused on determining the effects of tDCS or rTMS combined or not combined with other therapies for hemispatial neglect after stroke.
Methodological characteristics of the studies, number of participants, comparison groups, interventions, and outcomes were extracted.
Ten trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with other therapies significantly improves hemispatial neglect (standardized mean difference [SMD]=-1.91; 95% confidence interval [CI], -2.57 to -1.25; I=71%). A sensitivity analysis showed that rTMS (SMD=-2.16; 95% CI, -3.00 to -1.33; I=76%) and tDCS (SMD=-1.07; 95% CI, -1.76 to -0.37; I=0%) had positive effects on hemispatial neglect. Furthermore, both excitatory (SMD=-2.34; 95% CI, -3.56 to -1.12; I=65%) and inhibitory (SMD=-1.69; 95% CI, -2.49 to -0.88; I=75%) stimulations were effective.
This meta-analysis reveals moderate-quality evidence for the effectiveness of NIBS protocols combined with other therapies on hemispatial neglect and performance in ADL after stroke.
评估非侵入性脑刺激（NIBS）-重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）对脑卒中后偏侧空间忽略和日常生活活动（ADL）表现的疗效。
从数据库建立到 2016 年 12 月，检索了 MEDLINE（PubMed）、EMBASE、Cochrane 中心、Scopus、SciELO 和物理治疗证据数据库。
专注于确定 rTMS 或 tDCS 与其他治疗方法联合或不联合治疗脑卒中后偏侧空间忽略的随机对照试验或交叉试验。
提取研究的方法学特征、参与者人数、比较组、干预措施和结果。
有 10 项试验共 226 名参与者的数据适合进行荟萃分析。荟萃分析显示，NIBS 联合其他疗法可显著改善偏侧空间忽略（标准化均数差[SMD]=-1.91；95%置信区间[CI]，-2.57 至-1.25；I=71%）。敏感性分析显示 rTMS（SMD=-2.16；95% CI，-3.00 至-1.33；I=76%）和 tDCS（SMD=-1.07；95% CI，-1.76 至-0.37；I=0%）对偏侧空间忽略有积极影响。此外，兴奋性刺激（SMD=-2.34；95% CI，-3.56 至-1.12；I=65%）和抑制性刺激（SMD=-1.69；95% CI，-2.49 至-0.88；I=75%）均有效。
这项荟萃分析揭示了中等质量证据，证明 NIBS 方案联合其他疗法治疗脑卒中后偏侧空间忽略和 ADL 表现有效。
