Alashram Anas R, Padua Elvira, Aburub Aseel, Raju Manikandan, Annino Giuseppe
Department of Physiotherapy, Isra University, Amman, Jordan.
Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
PM R. 2023 Feb;15(2):222-234. doi: 10.1002/pmrj.12804. Epub 2022 May 21.
To examine the effects of transcranial direct current stimulation (tDCS) on upper extremity spasticity after stroke and to define the most effective tDCS parameters.
Systematic review in the following databases: PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, AMED, and Web of Science databases. Studies up to June 2020 were included.
Studies were included if the sample was composed of individuals with stroke, the intervention followed a tDCS intervention (alone or combined with another intervention), and the study was a randomized controlled trial including at least one measurement assessing upper extremity spasticity. Two authors independently screened the included studies. Conflicting decisions between authors were resolved by discussion with the third author. The methodological quality was assessed using the Cochrane Collaboration's tool. The authors determined that the meta-analysis was not feasible due to the heterogeneity in the protocols among the included studies.
After the screening of 1204 records, a total of seven studies met the specified inclusion criteria and involved 320 participants (mean age = 60.3), 31.1% of whom were females. Patients with ischemic stroke comprised 77.2% of the total patients, and 42.2% were with right hemispheric stroke. Six studies exhibited "high" quality and one exhibited "moderate" quality. Five of the selected studies that combined the tDCS intervention and other traditional interventions showed a significant reduction in upper extremity spasticity after stroke following tDCS intervention. The other two studies that delivered tDCs alone did not show a significant difference.
The evidence for the effect of tDCS on upper extremity spasticity after stroke was limited. The optimal tDCS treatment dosage remains unclear. Additional studies with large sample sizes and long-term follow-up are strongly warranted.
探讨经颅直流电刺激（tDCS）对脑卒中后上肢痉挛的影响，并确定最有效的tDCS参数。
在以下数据库进行系统评价：PubMed、SCOPUS、PEDro、CINAHL、MEDLINE、REHABDATA、AMED和Web of Science数据库。纳入截至2020年6月的研究。
如果样本由脑卒中患者组成，干预措施采用tDCS干预（单独或与其他干预措施联合），且该研究为随机对照试验，至少有一项评估上肢痉挛的测量指标，则纳入该研究。两位作者独立筛选纳入的研究。作者之间的分歧通过与第三位作者讨论解决。使用Cochrane协作网的工具评估方法学质量。作者认为，由于纳入研究的方案存在异质性，因此进行荟萃分析不可行。
在筛选了1204条记录后，共有7项研究符合指定的纳入标准，涉及320名参与者（平均年龄=60.3岁），其中31.1%为女性。缺血性脑卒中患者占总患者的77.2%，42.2%为右半球脑卒中患者。6项研究质量为“高”，1项研究质量为“中”。5项将tDCS干预与其他传统干预措施相结合选择的研究表明，tDCS干预后脑卒中后上肢痉挛明显减轻。另外两项单独进行tDCS治疗的研究未显示出显著差异。
tDCS对脑卒中后上肢痉挛影响的证据有限。最佳tDCS治疗剂量仍不清楚。强烈需要进行更多大样本量和长期随访的研究。
