School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
Alfred Health, Melbourne, Australia.
Int J Stroke. 2022 Apr;17(4):378-388. doi: 10.1177/17474930211006301. Epub 2021 Apr 12.
Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation.
The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence.
Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria ( = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence ( = -3.40, 95% -4.46 to -2.34) and a medium effect when commenced >3 months after stroke ( = -0.67, 95% -1.09 to -0.26). Electroacupuncture has a large effect when administered >5 times a week ( = -2.32, 95% -2.96 to -1.68) and a small effect when administered five times a week ( = -0.44, 95% -0.69 to -0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence.
Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.
尿失禁和大便失禁是中风后的致残性障碍，可以通过电刺激进行临床治疗。
本系统评价的目的是确定非植入式电刺激治疗中风后尿失禁严重程度的有效性。
在 MEDLINE、EMBASE、CINAHL、PEDro 和 CENTRAL 中搜索了用于治疗中风后尿失禁的非植入式电刺激的临床试验。在总共 5043 篇文献中，有 10 项试验符合入选标准（=894 例）。9 项试验报告了尿失禁严重程度的结果，使经皮神经电刺激（TENS；5 项试验）和电针（4 项试验）的meta 分析成为可能。研究提供了高质量到中等质量的证据，表明在中风后<3 个月开始的 TENS 对尿失禁有较大的影响（=−3.40，95%置信区间为−4.46 至−2.34），而在中风后>3 个月开始的 TENS 则有中等的影响（=−0.67，95%置信区间为−1.09 至−0.26）。每周进行>5 次电针治疗的效果较大（=−2.32，95%置信区间为−2.96 至−1.68），每周进行 5 次电针治疗的效果较小（=−0.44，95%置信区间为−0.69 至−0.18）。只有一项试验报告了非植入式电刺激对中风后大便失禁的影响。
评估非植入式电刺激对中风后尿失禁影响的已发表试验较少且存在异质性。综合试验表明，早期和频繁地使用电刺激治疗可能比假治疗或不治疗更有效。需要进一步的试验以客观方式测量尿失禁。
