Vaz Patricia Graef, Salazar Ana Paula da Silva, Stein Cinara, Marchese Ritchele Redivo, Lukrafka Janice Luisa, Plentz Rodrigo Della Méa, Pagnussat Aline Souza
a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.
b Department of Physiotherapy , Centro Universitário Ritter dos Reis (UniRitter) - Laureate International Universities , Porto Alegre , Brazil.
Top Stroke Rehabil. 2019 Apr;26(3):201-213. doi: 10.1080/10749357.2019.1565696. Epub 2019 Feb 8.
Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation (NIBS) techniques able to modulate cortical excitability.
To determine the effects of NIBS combined with other therapies on gait speed after stroke.
Electronic databases searched were PUBMED, EMBASE, COCHRANE, SCOPUS, SCIELO and PEDro. Eligibility criteria were randomized controlled trials that reported the effects of tDCS and rTMS combined with other therapies for improving gait speed, walking cadence, functional ambulation category (FAC) and motricity index (MI-LE) after stroke. Risk of bias was assessed by Cochrane risk of bias assessment tool. Mean differences (MD) and 95% confidence intervals were calculated. Quality of evidence was assessed by Grades of Researches, Assessment, Development and Evaluation approach.
Ten studies (226 subjects) were included in the meta-analysis. NIBS combined with other therapies was effective for improving gait speed (MD 0.09 m/s [95% CI, 0.05 to 0.13; I 0%, p < 0.0001]). Gait speed improved in both acute/subacute (MD 0.08 m/s [95% CI, 0.02 to 0.14]) and chronic phases (MD 0.08 m/s [95% CI, 0.03 to 0.13]). Furthermore, inhibitory (MD 0.09 m/s [95% CI, 0.04 to 0.14]) and excitatory (MD 0.07 m/s [95% CI, 0.02 to 0.12]) protocols were effective to improve gait speed. NIBS was also effective to improve walking cadence but was unable to modify other outcomes (FAC and MI-LE).
This systematic review with meta-analysis synthesizes moderate-quality evidence that NIBS combined with other therapies are effective to improve gait speed after stroke. Systematic Review registration number: PROSPERO registration number CDR42015024237.
重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS）是非侵入性脑刺激（NIBS）技术，能够调节皮层兴奋性。
确定非侵入性脑刺激联合其他疗法对中风后步态速度的影响。
检索的电子数据库有PUBMED、EMBASE、COCHRANE、SCOPUS、SCIELO和PEDro。纳入标准为随机对照试验，这些试验报告了tDCS和rTMS联合其他疗法对改善中风后步态速度、步行节奏、功能性步行分类（FAC）和运动指数（MI-LE）的效果。采用Cochrane偏倚风险评估工具评估偏倚风险。计算平均差（MD）和95%置信区间。采用研究、评估、发展与评价等级方法评估证据质量。
10项研究（226名受试者）纳入荟萃分析。非侵入性脑刺激联合其他疗法对提高步态速度有效（MD 0.09 m/s [95% CI，0.05至0.13；I² 0%，p < 0.0001]）。急性/亚急性期（MD 0.08 m/s [95% CI，0.02至0.14]）和慢性期（MD 0.08 m/s [95% CI，0.03至0.13]）步态速度均有所提高。此外，抑制性（MD 0.09 m/s [95% CI，0.04至0.14]）和兴奋性（MD 0.07 m/s [95% CI，0.02至0.12]）方案对提高步态速度有效。非侵入性脑刺激对改善步行节奏也有效，但无法改变其他结果（FAC和MI-LE）。
这项荟萃分析的系统评价综合了中等质量的证据，表明非侵入性脑刺激联合其他疗法对改善中风后步态速度有效。系统评价注册号：PROSPERO注册号CDR42015024237。
