Andressa de Souza Janaina, Ferrari Corrêa João Carlos, Marduy Anna, Dall'Agnol Letizzia, Gomes de Sousa Maria Helena, Nunes da Silva Victor, Alves André Barreto, Silva Soraia Micaela, Fregni Felipe, Corrêa Fernanda Ishida
Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil.
Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States.
Front Pain Res (Lausanne). 2021 Jul 1;2:696547. doi: 10.3389/fpain.2021.696547. eCollection 2021.
Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain. Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment. A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups ( = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes. We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy. Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017. Beginning of the recruitment of the volunteers: august, 2017.
经颅直流电刺激（tDCS）是一种干预措施，鉴于其有助于在受刺激的脑区产生可塑性，似乎是增强康复治疗效果的理想工具。在中风治疗中，这种策略已被大量使用；然而，结果却参差不齐。在本试验中，我们评估了经颅直流电刺激（tDCS）联合物理治疗对有肩部疼痛的中风幸存者的镇痛和功能效果。26名有肩部疼痛的中风成年幸存者接受了10次被动活动，并使用自行车测力计进行上肢锻炼，同时结合主动或假tDCS。使用视觉模拟量表（VAS）测量偏瘫肩部的疼痛强度；次要结果是在10次治疗前后以及治疗结束后1个月评估的运动障碍水平、握力、活动范围、上肢运动功能和生活质量（QOL）。两组均发现有临床意义的疼痛减轻（3分），且在随访中得以维持；两组之间无显著差异（ = 0.3）。同样，肩部活动范围得到改善，运动功能和生活质量改善，两组之间无显著差异。一个需要强调的结果是，两组在所有这些结果的改善方面都有显著的效应量。我们在本研究中讨论，当物理治疗本身效果显著时，tDCS并非有用的联合策略，并且我们还在主要物理治疗的天花板效应这一框架下回顾了联合治疗的其他阴性试验。试验注册：巴西临床试验注册中心，RBR - 8F5MNY（http://www.ensaiosclinicos.gov.br/rg/RBR - 8f5mny/）。于2017年6月2日注册。志愿者招募开始时间：2017年8月。
