Department of Rehabilitation Medicine, Jiangxi Provincial People's Hospital, Nanchang; First Affiliated Hospital of Nanchang Medical College, Nanchang.
Department of Rehabilitation Medicine, First Affiliated Hospital of Nanchang University, Nanchang.
Arch Phys Med Rehabil. 2022 Jul;103(7):1436-1447. doi: 10.1016/j.apmr.2022.03.004. Epub 2022 Mar 22.
This review aimed to systematically evaluate the effect of transcranial direct current stimulation (tDCS) on poststroke dysphagia.
PubMed, Cochrane Library (CENTRAL), Web of Science, VIP, CNKI, and Wanfang databases were systematically searched up to June 2021.
Randomized controlled trials (RCTs) on the effects of tDCS on poststroke dysphagia.
The extracted data included the author, country of publication, time of publication, key elements of bias risk assessment (such as RCTs and blind methods), sample size and basic information (age, course of disease, stroke location), intervention measures, treatment methods of tDCS (stimulation location, intensity, duration), relevant outcome indicators, and relevant data (SDs).The Cochrane Risk of Bias Assessment Tool and Physiotherapy Evidence Database Scale were used to assess the risk of bias.
Sixteen RCTs were included in this meta-analysis. Overall, the results revealed a large and statistically significant pooled effect size (0.80; confidence interval [CI], 0.45-1.14; P<.001). The subgroup that explored the course of the disease yielded a large and significant effect size for the chronic phase group (0.80; CI, 0.43-1.16; P<.001). For the stimulation intensity, 1 mA and 1.6 mA showed a moderate and significant effect sizes (0.47; CI, 0.13-0.81; P=.006 vs 1.39; CI, 0.69-2.08; P<.001). In the subgroup analyses, the affected (0.87; CI, 0.26-1.48; P=.005) vs unaffected (0.61; CI, 0.23-0.99; P=.002) hemisphere showed a significant result, and stimulation of the affected hemisphere had a more obvious effect. Subgroup analysis of stroke location showed that tDCS was effective for dysphagia after unilateral hemispheric stroke, bulbar paralysis, and brainstem stroke but not for dysphagia after ataxic and basal ganglia stroke. However, the subgroup analysis of stroke location revealed a significant result (0.81; CI, 0.44-1.18; P<.001).
This meta-analysis demonstrated the height and significant beneficial effect of tDCS on improving poststroke dysphagia.
本综述旨在系统评估经颅直流电刺激（tDCS）对脑卒中后吞咽障碍的影响。
系统检索了 PubMed、Cochrane 图书馆（CENTRAL）、Web of Science、VIP、CNKI 和万方数据库，检索时间截至 2021 年 6 月。
tDCS 对脑卒中后吞咽障碍影响的随机对照试验（RCT）。
提取的数据包括作者、出版国家、出版时间、偏倚风险评估的关键要素（如 RCT 和盲法）、样本量和基本信息（年龄、病程、卒中部位）、干预措施、tDCS 的治疗方法（刺激部位、强度、持续时间）、相关结局指标和相关数据（SD）。采用 Cochrane 偏倚风险评估工具和物理治疗证据数据库量表评估偏倚风险。
本荟萃分析纳入了 16 项 RCT。总体而言，结果显示合并效应量较大且具有统计学意义（0.80；置信区间 [CI]，0.45-1.14；P<.001）。对于病程亚组，慢性期组的效应量较大且具有统计学意义（0.80；CI，0.43-1.16；P<.001）。对于刺激强度，1 mA 和 1.6 mA 显示出中度且显著的效应大小（0.47；CI，0.13-0.81；P=.006 与 1.39；CI，0.69-2.08；P<.001）。在亚组分析中，患侧（0.87；CI，0.26-1.48；P=.005）与非患侧（0.61；CI，0.23-0.99；P=.002）半球均显示出显著结果，且刺激患侧半球的效果更为明显。卒中部位亚组分析显示，tDCS 对单侧半球卒中、延髓性麻痹和脑干卒中后吞咽障碍有效，但对共济失调和基底节卒中后吞咽障碍无效。然而，卒中部位的亚组分析显示出显著结果（0.81；CI，0.44-1.18；P<.001）。
本荟萃分析表明 tDCS 对改善脑卒中后吞咽障碍有高度显著的有益效果。
