一项关于重复经颅磁刺激治疗脑卒中后痉挛的系统评价和荟萃分析。
A Systematic Review and Meta-Analysis on the Use of Repetitive Transcranial Magnetic Stimulation for Spasticity Poststroke.
机构信息
Lawson Health Research Institute, Parkwood Institute, London, ON, Canada.
St Joseph's Health Care, Parkwood Institute, London, ON; and Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
出版信息
PM R. 2018 Mar;10(3):293-302. doi: 10.1016/j.pmrj.2017.10.001. Epub 2017 Oct 16.
BACKGROUND
Spasticity is a common and potentially debilitating complication that develops after stroke, arising in approximately 30% of patients.
OBJECTIVE
To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in improving spasticity after stroke.
DESIGN
Meta-analysis and systematic review.
SETTING
Not applicable.
PATIENTS
A total of 273 poststroke (hemorrhagic = 123, ischemic = 150) participants were included with sample sizes ranging from 5 to 80. The majority of participants were male (66.0%) with a mean age ranging from 55.0 to 64.6 years. Mean stroke duration ranged from 6 months to 10 years.
METHODS
A literature search of multiple databases was conducted for articles published in English from January 1980 to April 2015 using select keywords. Studies were included if (1) the population included was >50% stroke patients; (2) the sample size included ≥4 subjects; (3) the intervention applied was rTMS; and (4) upper extremity spasticity was assessed pre- and postintervention. Randomized controlled trials (RCTs) were assessed for methodologic quality with the Physiotherapy Evidence Database tool. All research designs were given a level of evidence according to a modified Sackett Scale.
MAIN OUTCOME MEASUREMENTS
Modified Ashworth Scale (MAS).
RESULTS
Ten studies met the inclusion criteria: 2 RCTs (Physiotherapy Evidence Database scores 8-9) and 8 pre-post studies. Meta-analyses of primarily uncontrolled pre-post studies found significant improvements in MAS for elbow (P < .001), wrist (P < .001), and finger flexors (P < .001). However, a meta-analysis of the 2 available RCTs failed to find a significant rTMS treatment effect on MAS for the wrist (standardized difference = .34, P = .30).
CONCLUSIONS
There is limited available evidence to support the use of rTMS in improving spasticity poststroke. Despite the positive findings reported, better powered and appropriately controlled trials are necessary.
LEVEL OF EVIDENCE
II.
背景
痉挛是一种常见且可能使人衰弱的并发症，发生于大约 30%的脑卒中患者。
目的
评估重复经颅磁刺激（rTMS）对脑卒中后痉挛的治疗效果。
设计
荟萃分析和系统综述。
环境
不适用。
患者
共纳入 273 例脑卒中患者（出血性 123 例，缺血性 150 例），样本量从 5 例到 80 例不等。多数患者为男性（66.0%），平均年龄为 55.0 岁到 64.6 岁。平均脑卒中病程为 6 个月到 10 年。
方法
使用特定关键词，对 1980 年 1 月至 2015 年 4 月发表的英文文献进行了多个数据库的文献检索。纳入的研究需满足以下标准：（1）人群中 >50%为脑卒中患者；（2）样本量≥4 例；（3）应用的干预措施为 rTMS；（4）治疗前后均评估了上肢痉挛。对随机对照试验（RCT）采用物理治疗证据数据库工具进行方法学质量评估。所有研究设计均根据改良 Sackett 量表进行证据水平分级。
主要观察指标
改良 Ashworth 量表（MAS）。
结果
共有 10 项研究符合纳入标准：2 项 RCT（物理治疗证据数据库评分 8-9 分）和 8 项前后对照研究。主要为未设对照组的前后对照研究的荟萃分析显示，肘、腕和指屈肌 MAS 评分均显著改善（肘：P <.001，腕：P <.001，指屈肌：P <.001）。然而，2 项 RCT 的荟萃分析显示 rTMS 对腕 MAS 评分的治疗效果无统计学意义（标准化差值=0.34，P =.30）。
结论
现有证据有限，无法支持 rTMS 用于改善脑卒中后痉挛。尽管报告了阳性结果，但仍需要进行更大样本量和适当对照的试验。
证据等级
II。
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