Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China; Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
Arch Phys Med Rehabil. 2020 Jan;101(1):130-140. doi: 10.1016/j.apmr.2019.07.013. Epub 2019 Aug 26.
The purpose of this review was to systematically assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) intervention on gait in individuals with Parkinson disease (PD).
We searched online electronic databases up to March 28, 2019, including MEDLINE, Embase, the Cochrane Library, and so on.
The inclusion criteria for this review were randomized controlled trials (RCTs), exploring the effect of rTMS in patients diagnosed with idiopathic PD.
Data extraction was performed independently by 2 reviewers based on predefined criteria and the methodologic quality of included studies was quantified by the Physiotherapy Evidence Database scale. The outcome measure was walking performance, including walking time (short term and long term), Timed Up and Go (TUG) test, and so on.
Among 14 eligible studies, including 298 participants (mean age ± SD [y], 63.24±9.71; 191 [64%] men) were analyzed in this meta-analysis. Walking time was improved with rTMS compared with sham rTMS (standardized mean difference [SMD] -0.30; 95% confidence interval [CI], -0.57 to -0.03; P=.03). The score for the freezing of gait questionnaire did not differ significantly between rTMS and no intervention. Four studies compared TUG between the 2 treatment groups and no significant differences were found between the rTMS and control group (SMD -0.45; 95% CI, -1.32 to 0.41; P=.30). During the off-state, there were no significant differences in estimated effect sizes (SMD=-0.29; 95% CI, -0.79 to 0.21; P=.25), which is significantly different in on-state (SMD -0.98; 95% CI, -1.78 to -0.18; P=.02) evaluation.
The results of the meta-analysis propose the favorable effect of rTMS on walking performance in the short term but not over the long term in individuals with PD.
本综述旨在系统评估重复经颅磁刺激（rTMS）干预对帕金森病（PD）患者步态的有效性。
我们检索了在线电子数据库，截至 2019 年 3 月 28 日，包括 MEDLINE、Embase、Cochrane 图书馆等。
本综述的纳入标准为随机对照试验（RCT），探讨 rTMS 对特发性 PD 患者的影响。
数据提取由 2 位审阅者独立进行，基于预设标准，并使用物理治疗证据数据库量表量化纳入研究的方法学质量。主要结局指标为步行表现，包括行走时间（短期和长期）、计时起立行走测试（TUG）等。
在 14 项符合条件的研究中，包括 298 名参与者（平均年龄±标准差[y]，63.24±9.71；191[64%]名男性）进行了荟萃分析。与假刺激 rTMS 相比，rTMS 可改善行走时间（标准化均数差[SMD]-0.30；95%置信区间[CI]，-0.57 至-0.03；P=.03）。rTMS 与无干预组之间的冻结步态问卷评分无显著差异。四项研究比较了两组的 TUG，rTMS 组与对照组之间无显著差异（SMD-0.45；95%CI，-1.32 至 0.41；P=.30）。在关闭状态下，估计的效应大小无显著差异（SMD=-0.29；95%CI，-0.79 至 0.21；P=.25），但在开启状态下评估时差异显著（SMD-0.98；95%CI，-1.78 至-0.18；P=.02）。
荟萃分析结果表明，rTMS 对 PD 患者的短期行走表现有有利影响，但对长期行走表现没有影响。
