Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
J Med Eng Technol. 2021 Aug;45(6):494-501. doi: 10.1080/03091902.2021.1922527. Epub 2021 May 26.
Transcranial direct current stimulation (TDCS) and robot-assisted therapy (RAT) proved to be promising interventions in post-stroke rehabilitation. However, the effects of combining the two treatments are not significantly clear. To determine the effects of combined therapy using transcranial direct current stimulation (tDCS) with robot-assisted therapy (RAT) in the impairment of the upper limb in stroke rehabilitation. The Cochrane Library, MEDLINE, Embase, Google Scholar, and Trial Registries were systematically searched for randomised controlled trials in May 2020. As the outcome, the Fugl-Meyer Assessment score (FMS) was used. A pairwise and a network meta-analysis were performed. 5 RCTs with RAT versus RAT + tDCS groups and 21 RCTs with RAT versus the control group with 892 people were analysed. Of these studies, 10 RCTs evaluated acute-subacute (<8 weeks) people, while 16 chronic people. By analysing the FMS with a pair-wise meta-analysis, we demonstrate significant improvements only in the RAT alone compared to the control (acute-subacute, SMD:4.09 (1.31, 6.87) and chronic, SMD:2.22 (0.99, 3.45)). Instead, performing a network meta-analysis, through an analysis of the surface under the cumulative ranking curve (SUCRA) we report a ranking of the effectiveness of the interventions. We assess SUCRA in acute-subacute stroke: Control:0.23, RAT + tDCS:0.31, RAT:0.96 and in chronic stroke: Control:0.06, RAT + tDCS:0.62, RAT:0.82. RAT is, respectively, 96% and 82% likely to be the best-ranked treatment. Despite the limitations, this network meta-analysis appears to demonstrate through the rank of interventions that adding tDCS to RAT is not useful in upper-limb stroke rehabilitation.
经颅直流电刺激（TDCS）和机器人辅助治疗（RAT）已被证明是脑卒中康复有前途的干预措施。然而，联合两种治疗方法的效果尚不清楚。目的：确定经颅直流电刺激（tDCS）联合机器人辅助治疗（RAT）对脑卒中康复上肢功能障碍的影响。方法：系统检索了 Cochrane 图书馆、MEDLINE、Embase、Google Scholar 和试验注册处 2020 年 5 月的随机对照试验。主要结果为 Fugl-Meyer 评估评分（FMS）。进行了成对和网络荟萃分析。共分析了 5 项 RAT 与 RAT+tDCS 组和 21 项 RAT 与对照组的 RCT，共 892 人。其中 10 项 RCT 评估了急性-亚急性（<8 周）人群，16 项评估了慢性人群。通过对 FMS 进行成对荟萃分析，我们仅显示 RAT 组与对照组相比有显著改善（急性-亚急性：SMD：4.09（1.31，6.87）；慢性：SMD：2.22（0.99，3.45））。相反，通过分析表面累积排序曲线下面积（SUCRA）进行网络荟萃分析，我们报告了干预措施有效性的排序。我们评估了急性-亚急性脑卒中的 SUCRA：对照组：0.23，RAT+tDCS：0.31，RAT：0.96；慢性脑卒中的 SUCRA：对照组：0.06，RAT+tDCS：0.62，RAT：0.82。RAT 分别有 96%和 82%的可能性是最佳治疗方法。尽管存在局限性，但这项网络荟萃分析似乎通过干预措施的排名表明，在上肢卒中康复中，将 tDCS 与 RAT 联合使用并不可用。
