经颅直流电刺激联合机器人治疗脑卒中后上下肢功能：随机对照试验的系统评价和荟萃分析。

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method able to modulate neuronal activity after stroke. The aim of this systematic review was to determine if tDCS combined with robotic therapy (RT) improves limb function after stroke when compared to RT alone. METHODS: A search for randomized controlled trials (RCTs) published prior to July 15, 2021 was performed. The main outcome was function assessed with the Fugl-Meyer motor assessment for upper extremities (FM/ue) and 10-m walking test (10MWT) for the lower limbs. As secondary outcomes, strength was assessed with the Motricity Index (MI) or Medical Research Council scale (MRC), spasticity with the modified Ashworth scale (MAS), functional independence with the Barthel Index (BI), and kinematic parameters. RESULTS: Ten studies were included for analysis (n = 368 enrolled participants). The results showed a non-significant effect for tDCS combined with RT to improve upper limb function [standardized mean difference (SMD) = - 0.12; 95% confidence interval (CI): - 0.35-0.11)]. However, a positive effect of the combined therapy was observed in the lower limb function (SMD = 0.48; 95% CI: - 0.15-1.12). Significant results favouring tDCS combined with RT were not found in strength (SMD = - 0.15; 95% CI: - 0.4-0.1), spasticity [mean difference (MD) = - 0.15; 95% CI: - 0.8-0.5)], functional independence (MD = 2.5; 95% CI: - 1.9-6.9) or velocity of movement (SMD = 0.06; 95% CI: - 0.3-0.5) with a "moderate" or "low" recommendation level according to the GRADE guidelines. CONCLUSIONS: Current findings suggest that tDCS combined with RT does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.

背景：经颅直流电刺激（tDCS）是一种非侵入性的脑刺激方法，能够在中风后调节神经元活动。本系统评价的目的是确定与单独使用机器人疗法（RT）相比，tDCS 联合 RT 是否能改善中风后的肢体功能。

方法：我们对截至 2021 年 7 月 15 日之前发表的随机对照试验（RCT）进行了检索。主要结局是使用上肢 Fugl-Meyer 运动评估（FM/ue）和下肢 10 米步行测试（10MWT）评估功能。次要结局包括使用运动力量指数（MI）或医学研究委员会量表（MRC）评估力量，使用改良 Ashworth 量表（MAS）评估痉挛程度，使用巴氏指数（BI）评估功能独立性，以及运动学参数。

结果：纳入了 10 项研究进行分析（n=368 名入组参与者）。结果显示，tDCS 联合 RT 对上肢功能的改善没有显著效果[标准化均数差（SMD）=-0.12；95%置信区间（CI）：-0.35-0.11)]。然而，联合治疗对下肢功能有积极影响（SMD=0.48；95%CI：-0.15-1.12）。在力量（SMD=-0.15；95%CI：-0.4-0.1）、痉挛程度[平均差值（MD）=-0.15；95%CI：-0.8-0.5]、功能独立性（MD=2.5；95%CI：-1.9-6.9）或运动速度（SMD=0.06；95%CI：-0.3-0.5）方面，未发现有利于 tDCS 联合 RT 的显著结果，根据 GRADE 指南，这些结果被推荐为“中度”或“低度”。

结论：目前的研究结果表明，tDCS 联合 RT 并不能改善中风后的上肢功能、力量、痉挛程度、功能独立性或运动速度。然而，tDCS 可能增强单独使用 RT 对下肢功能的作用。tDCS 参数以及中风损伤的阶段或类型可能是决定该疗法有效性的关键因素。