Doan Thanh-Nhan, Ho Wen-Chao, Wang Liang-Hui, Chang Fei-Chun, Tran Trang Thi Quynh, Chou Li-Wei
Department of Public Health, China Medical University, Taichung 406040, Taiwan.
Department of Rehabilitation, Quang Nam Northern Mountainous Region General Hospital, Quang Nam 560000, Vietnam.
Life (Basel). 2022 Jun 10;12(6):875. doi: 10.3390/life12060875.
Background: To date, there is no conclusive evidence that transcutaneous neuromuscular electrical stimulation (TNMES) benefits patients with post-stroke dysphagia (PSD). In addition, the optimal TNMES electrode placement has not been well-established. This systematic review and meta-analysis were conducted to investigate these two research gaps. Methods: Five major databases were systematically searched for randomized controlled trials (RCTs) through January 2022. Effect sizes were computed using Hedges’ g statistic, which were then entered into the random-effects model to obtain pooled effect estimates. Results: Twenty-four RCTs met the eligibility criteria. On the improvement of swallowing function, TNMES alone was not superior to conventional swallowing therapies (CSTs); combined therapy of TNMES and CSTs significantly surpassed CSTs alone (standardized mean difference (SMD) = 0.91, 95% confidence interval (95% CI): 0.68 to 1.14, p < 0.0001; I2 = 63%). Moreover, significant pooled effect sizes were observed in subgroups with horizontal electrode placement above the hyoid bone (SMD = 0.94, 95% CI: 0.72 to 1.16; I2 = 0%) and horizontal electrode placement just above and below the hyoid bone (SMD = 0.87, 95% CI: 0.59 to 1.14; I2 = 0%). The largest pooled effect size was observed in the subgroup that individualized electrode placement according to dysphagia evaluation (SMD = 1.65, 95% CI: 0.38 to 2.91; I2 = 90%). Conclusion: TNMES should be used in combination with CSTs for PSD. Horizontal electrode placement should target suprahyoid muscles or both suprahyoid and thyrohyoid muscles.
迄今为止，尚无确凿证据表明经皮神经肌肉电刺激（TNMES）对中风后吞咽困难（PSD）患者有益。此外，TNMES电极的最佳放置位置尚未明确。本系统评价和荟萃分析旨在探讨这两个研究空白。方法：通过系统检索五个主要数据库，查找截至2022年1月的随机对照试验（RCT）。使用Hedges’ g统计量计算效应量，然后将其纳入随机效应模型以获得合并效应估计值。结果：24项RCT符合纳入标准。在吞咽功能改善方面，单纯TNMES并不优于传统吞咽疗法（CST）；TNMES与CST联合治疗显著优于单纯CST（标准化均数差（SMD）=0.91，95%置信区间（95%CI）：0.68至1.14，p<0.0001；I2=63%）。此外，在舌骨上方水平电极放置的亚组（SMD=0.94，95%CI：0.72至1.16；I2=0%）和舌骨上下方水平电极放置的亚组（SMD=0.87，95%CI：0.59至1.14；I2=0%）中观察到显著的合并效应量。在根据吞咽困难评估进行个体化电极放置的亚组中观察到最大的合并效应量（SMD=1.65，95%CI：0.38至2.91；I2=90%）。结论：PSD患者应将TNMES与CST联合使用。水平电极放置应针对舌骨上肌群或舌骨上肌群和甲状舌骨肌。
