School of Arts, Sciences and Humanities, Physical activity sciences, University of São Paulo, São Paulo, Brazil.
Harvard Center for Noninvasive Brain Stimulation, Harvard Medical School, Boston, MA, USA.
Spinal Cord. 2020 Jun;58(6):635-646. doi: 10.1038/s41393-020-0438-2. Epub 2020 Feb 17.
Systematic review and meta-analysis.
We aimed to investigate the effects of anodal transcranial direct current stimulation (tDCS) against sham on muscle strength and motor functionality after incomplete spinal cord injury (iSCI).
University of São Paulo, Brazil.
A preplanned protocol was registered (PROSPERO, CRD42016050444). Pubmed, Embase, Web of Science, Cochrane Central Library and BVS databases were searched independently by two authors up to March 2018. Cochrane Collaboration's Tool was used for the risk of bias assessments. Generic inverse variance and random-effects model were used to calculate pooled effect sizes (ES), 95% confidence intervals (CIs) and p-values in meta-analyses.
Six randomized clinical trials met inclusion criteria (n = 78 iSCI individuals) and were included in the meta-analysis. Results showed a marginal significant pooled effect of active tDCS in improving motor functionality with a small ES (SMD = 0.26, 95% CI = -0.00 to 0.53, p = 0.05, I = 0%). On the other hand, the pooled effect of active tDCS on muscle strength did not reach statistical significance, in parallel with a small ES (SMD = 0.35, 95% CI = -0.21 to 0.92, p = 0.22, I = 0%) when compared with sham tDCS. No significant adverse events were reported.
Overall, there was a significant effect of tDCS in improving motor functionality following iSCI. However, a small ES and the marginal p-value suggest that these results should be interpreted with caution. Further high-quality clinical trials are needed to support or refute the use of tDCS in daily clinical practice.
系统评价和荟萃分析。
我们旨在研究经颅直流电刺激（tDCS）对不完全性脊髓损伤（iSCI）后肌肉力量和运动功能的影响。
巴西圣保罗大学。
按照预先制定的方案（PROSPERO，CRD42016050444）进行注册。两位作者分别独立检索 Pubmed、Embase、Web of Science、Cochrane 中央图书馆和 BVS 数据库，检索截止日期为 2018 年 3 月。采用 Cochrane 协作工具评估偏倚风险。荟萃分析中采用通用倒数方差和随机效应模型计算汇总效应大小（ES）、95%置信区间（CI）和 p 值。
符合纳入标准的 6 项随机临床试验（n=78 例 iSCI 患者）纳入荟萃分析。结果显示，与假刺激相比，tDCS 治疗的运动功能有显著的边际改善，ES 值较小（SMD=0.26，95%CI=-0.00 至 0.53，p=0.05，I=0%）。另一方面，与假刺激相比，tDCS 对肌肉力量的汇总效应无统计学意义，ES 值也较小（SMD=0.35，95%CI=-0.21 至 0.92，p=0.22，I=0%）。未报告有明显的不良反应。
总的来说，tDCS 对 iSCI 后运动功能的改善有显著作用。然而，ES 值较小，p 值仅为边缘显著，提示这些结果应谨慎解释。需要进一步开展高质量的临床试验来支持或反驳 tDCS 在日常临床实践中的应用。
