Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Physiotherapy, Ramaiah Medical College, Bangalore, Karnataka, India.
Arch Phys Med Rehabil. 2019 Apr;100(4):751-768. doi: 10.1016/j.apmr.2018.10.016. Epub 2018 Nov 16.
(1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity.
PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017.
Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments.
Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.
Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD -0.64; 95% confidence interval [95% CI], -0.98 to -0.31; P=.0001; I=17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD -0.83; 95% CI, -1.51 to -0.15; P=.02; I=27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.
There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).
（1）确定经皮神经电刺激（TENS）对脑卒中后痉挛的影响。（2）确定 TENS 的不同参数（强度、频率、持续时间）对脑卒中成人痉挛减轻的影响。（3）确定脑卒中后时间对 TENS 对痉挛影响的有效性的影响。
从创建到 2017 年 3 月，在 PubMed、PEDro、CINAHL、Web of Science、CENTRAL 和 EMBASE 数据库中进行了搜索。
如果（1）它们使用临床和神经生理学工具评估 TENS 对急性或亚急性或慢性脑卒中患者痉挛管理的效果；（2）TENS 单独或作为其他治疗的辅助手段使用，则包括随机对照试验（RCT）、准 RCT 和非 RCT。
两位作者使用经过试验验证的表格，独立筛选并从 15 项研究中提取数据，这些研究是通过搜索获得的。通过与其他作者讨论解决分歧。使用 Cochrane 偏倚风险标准评估研究质量。
使用随机效应模型进行荟萃分析，结果表明（1）与安慰剂 TENS 相比，TENS 与其他物理治疗联合治疗更能有效降低下肢痉挛（SMD-0.64；95%置信区间[95%CI]，-0.98 至-0.31；P=.0001；I=17%）；（2）与单独的其他物理治疗干预相比，TENS 与其他物理治疗联合应用时可有效降低痉挛（SMD-0.83；95%CI，-1.51 至-0.15；P=.02；I=27%）。有限的研究评估了 TENS 对上肢痉挛的有效性。
有强有力的证据表明，TENS 作为一种辅助手段，在慢性脑卒中幸存者中应用超过 30 分钟，刺激神经或肌肉腹部时，对降低下肢痉挛非常有效（在 PROSPERO 中注册的综述方案：CRD42015020151）。
