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物理治疗与经颅直流电刺激联合用于治疗中风后肩部疼痛:是联合还是不联合?一项针对中风后疼痛性肩部康复的联合随机临床试验分析

To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke.

作者信息

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

机构信息

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.

出版信息

Front Pain Res (Lausanne). 2021 Jul 1;2:696547. doi: 10.3389/fpain.2021.696547. eCollection 2021.


DOI:10.3389/fpain.2021.696547
PMID:35295490
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8915613/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3455/8915613/b6af69e8e31c/fpain-02-696547-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3455/8915613/b6af69e8e31c/fpain-02-696547-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3455/8915613/b6af69e8e31c/fpain-02-696547-g0001.jpg

相似文献

[1]
To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke.

Front Pain Res (Lausanne). 2021-7-1

[2]
Effects of transcranial direct current stimulation on the rehabilitation of painful shoulder following a stroke: protocol for a randomized, controlled, double-blind, clinical trial.

Trials. 2019-3-15

[3]
Brain activity and upper limb movement analysis in children with Down syndrome undergoing transcranial direct current stimulation combined with virtual reality training: study protocol for a randomized controlled trial.

Trials. 2022-1-28

[4]
Efficacy, safety, and tolerability of bilateral transcranial direct current stimulation combined to a resistance training program in chronic stroke survivors: A double-blind, randomized, placebo-controlled pilot study.

Restor Neurol Neurosci. 2019

[5]
Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial.

JMIR Res Protoc. 2024-4-30

[6]
Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke.

Cochrane Database Syst Rev. 2016-3-21

[7]
The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial.

Disabil Rehabil. 2016

[8]
Transcranial electrostimulation with special waveforms enhances upper-limb motor function in patients with chronic stroke: a pilot randomized controlled trial.

J Neuroeng Rehabil. 2021-6-30

[9]
Effects of cerebellar transcranial direct current stimulation on upper limb motor function after stroke: study protocol for the pilot of a randomized controlled trial.

Pilot Feasibility Stud. 2022-12-14

[10]
High-density transcranial direct current stimulation to improve upper limb motor function following stroke: study protocol for a double-blind randomized clinical trial targeting prefrontal and/or cerebellar cognitive contributions to voluntary motion.

Trials. 2023-12-4

引用本文的文献

[1]
Synergistic Effects of Joint-Biased Rehabilitation and Combined Transcranial Direct Current Stimulation (tDCS) in Chronic Ankle Instability: A Single-Blind, Three-Armed Randomized Controlled Trial.

Brain Sci. 2025-4-27

[2]
Efficacy of kinesthetic motor imagery based brain computer interface combined with tDCS on upper limb function in subacute stroke.

Sci Rep. 2025-4-7

[3]
Investigating combined acupuncture and transcranial direct current stimulation in patients with poststroke shoulder pain from China: protocol for a randomised controlled trial.

BMJ Open. 2024-9-10

[4]
Exploring the Potential of Transcranial Direct Current Stimulation for Relieving Central Post-Stroke Pain: A Randomized Controlled Pilot Study.

Life (Basel). 2023-5-12

[5]
Research Hotspots and Frontiers of Transcranial Direct Current Stimulation in Stroke: A Bibliometric Analysis.

Brain Sci. 2022-12-21

本文引用的文献

[1]
Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders.

Int J Neuropsychopharmacol. 2021-4-21

[2]
Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS.

Restor Neurol Neurosci. 2019

[3]
Effects of transcranial direct current stimulation on the rehabilitation of painful shoulder following a stroke: protocol for a randomized, controlled, double-blind, clinical trial.

Trials. 2019-3-15

[4]
Hemiplegic shoulder pain in people with stroke: present and the future.

Pain Manag. 2019-3-1

[5]
Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke.

Stroke. 2018-9

[6]
Expectations may influence the effects of transcranial direct current stimulation.

Neuropsychologia. 2018-9-15

[7]
The effects of transcranial direct current stimulation (tDCS) combined with group exercise treatment in subjects with chronic low back pain: a pilot randomized control trial.

Clin Rehabil. 2018-5-21

[8]
Anodal Transcranial Direct-Current Stimulation to Enhance Rehabilitation in Individuals With Rotator Cuff Tendinopathy: A Triple-Blind Randomized Controlled Trial.

J Orthop Sports Phys Ther. 2018-5-10

[9]
Delayed pain decrease following M1 tDCS in spinal cord injury: A randomized controlled clinical trial.

Neurosci Lett. 2017-9-29

[10]
Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns.

Front Psychol. 2017-5-10

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