Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
Disabil Rehabil. 2020 Mar;42(5):623-635. doi: 10.1080/09638288.2018.1503736. Epub 2018 Oct 16.
To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials. Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration's risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval. Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (-0.52 [-0.74 to -0.30] < 0.0001, 6 studies), especially in lower limbs (-0.58 [-0.82 to -0.34] < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias. Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.Implications for RehabilitationTranscutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.
为了评估经皮神经电刺激（TENS）在慢性脑卒中后痉挛中的作用，并通过系统评价和荟萃分析比较其单独使用或作为附加治疗的方案，我们检索了 MEDLINE、Cochrane 图书馆、EMBASE 和 Physiotherapy Evidence Database 中的随机临床试验，检索时间截至 2017 年 11 月（CRD42015020146）。两位独立的审查员使用 Cochrane 协作风险偏倚工具进行文章选择、数据提取和方法学质量评估。主要结局是采用改良 Ashworth 量表或其他有效量表评估痉挛。采用随机效应方法进行荟萃分析，汇总效应结果为均数差及其 95%置信区间。在 6506 篇文章中，10 项研究共 360 例患者纳入综述。TENS 单独或作为附加治疗优于安慰剂 TENS，可降低脑卒中后痉挛的严重程度（改良 Ashworth 量表：-0.52[-0.74 至-0.30]，P<0.0001，6 项研究），尤其是下肢痉挛（-0.58[-0.82 至-0.34]，P<0.0001，5 项研究），这与使用其他量表的研究结果一致。低频 TENS 比高频 TENS 稍能显著改善痉挛，但亚组间无显著差异。大多数研究存在低或不清楚的偏倚风险。TENS 可提供慢性脑卒中后痉挛的额外缓解，主要作为物理干预的附加治疗。需要更多设计良好、样本量大的研究来增加证据强度。
康复意义
TENS 作为物理干预的附加治疗，可进一步降低慢性脑卒中后痉挛的严重程度。
高、低频 TENS 结果相似，低频 TENS 具有稍小的数值优势。
需要更多的研究来证实 TENS 治疗痉挛的最佳方案。
