无创脑刺激联合其他疗法能否改善中风后上肢运动功能障碍、功能表现及日常生活活动参与度？一项随机对照试验的系统评价与荟萃分析

Does noninvasive brain stimulation combined with other therapies improve upper extremity motor impairment, functional performance, and participation in activities of daily living after stroke? A systematic review and meta-analysis of randomized controlled trial.

作者信息

Ahmed Ishtiaq, Mustafaoglu Rustem, Benkhalifa Nesrine, Yakhoub Yakhoub Hassan

机构信息

Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey.

出版信息

Top Stroke Rehabil. 2023 Apr;30(3):213-234. doi: 10.1080/10749357.2022.2026278. Epub 2022 Feb 3.

DOI:10.1080/10749357.2022.2026278

PMID:35112659

Abstract

BACKGROUND

Several studies have investigated the effect of noninvasive brain stimulation (NIBS) on upper limb motor function in stroke, but the evidence so far is conflicting.

OBJECTIVE

We aimed to determine the effect of NIBS on upper limb motor impairment, functional performance, and participation in activities of daily living after stroke.

METHOD

Literature search was conducted for randomized controlled trials (RCTs) assessing the effect of "tDCS" or "rTMS" combined with other therapies on upper extremity motor recovery after stroke. The outcome measures were Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI). The mean difference (MD) and 95%CI were estimated for motor outcomes. Cochrane risk of bias tool was used to assess the quality of evidence.

RESULT

Twenty-five RCTs involving 1102 participants were included in the review. Compared to sham stimulation, NIBS combined with other therapies has effectively improved FMA-UE (MD0.97 [95%CI, 0.09 to 1.86; p = .03]) and BI score (MD9.11 [95%CI, 2.27 to 15.95; p = .009]) in acute/sub-acute stroke (MD1.73 [95%CI, 0.61 to 2.85; p = .003]) but unable to modify FMA-UE score in chronic stroke (MD-0.31 [95%CI, -1.77 to 1.15; p = .68]). Only inhibitory (MD3.04 [95%CI, 1.76 to 4.31; I = 82%, p < .001] protocol is associated with improved FMA-UE score. Twenty minutes of stimulation/session for ≥20 sessions was found to be effective in improving FMA-UE score (Stimulation time: ES0.45; p ≤ .001; Sessions: ES0.33; p ≤ .001). The NIBS did not produce any significant improvement in WMFT as compared to sham NIBS (MD0.91 [95% CI, -0.89 to 2.70; p = .32]).

CONCLUSION

Moderate to high-quality evidence suggested that NIBS combined with other therapies is effective in improving upper extremity motor impairment and participation in activities of daily living after acute/sub-acute stroke.

摘要

背景

多项研究探讨了无创脑刺激（NIBS）对中风后上肢运动功能的影响，但目前证据相互矛盾。

目的

我们旨在确定NIBS对中风后上肢运动障碍、功能表现及日常生活活动参与度的影响。

方法

检索评估“经颅直流电刺激（tDCS）”或“重复经颅磁刺激（rTMS）”联合其他疗法对中风后上肢运动恢复影响的随机对照试验（RCT）。结局指标为上肢Fugl-Meyer评估量表（FMA-UE）、Wolf运动功能测试（WMFT）及Barthel指数（BI）。对运动结局评估平均差（MD）及95%置信区间（CI）。采用Cochrane偏倚风险工具评估证据质量。

结果

本综述纳入25项RCT，共1102名参与者。与假刺激相比，NIBS联合其他疗法能有效改善急性/亚急性中风患者的FMA-UE（MD0.97 [95%CI，0.09至1.86；p = 0.03]）及BI评分（MD9.11 [95%CI，2.27至15.95；p = 0.009]），但在慢性中风患者中无法改善FMA-UE评分（MD-0.31 [95%CI，-1.77至1.15；p = 0.68]）。仅抑制性（MD3.04 [95%CI，1.76至4.31；I² = 82%，p < 0.001]）方案与FMA-UE评分改善相关。发现每次刺激20分钟且≥20次对改善FMA-UE评分有效（刺激时间：效应量0.45；p ≤ 0.001；疗程：效应量0.33；p ≤ 0.001）。与假NIBS相比，NIBS对WMFT无显著改善（MD0.91 [95%CI，-0.89至2.70；p = 0.32]）。