China Athletics College, Beijing Sport University, Beijing, China.
Sports Coaching College, Beijing Sport University, Beijing, China.
J Gerontol A Biol Sci Med Sci. 2023 May 11;78(5):842-852. doi: 10.1093/gerona/glac158.
Considerable evidence showed that repetitive transcranial magnetic stimulation (rTMS) can improve standing balance and walking performance in older adults with age-related neurological disorders. We here thus completed a systematic review and meta-analysis to quantitatively examine such benefits of rTMS.
A search strategy based on the PICOS principle was used to obtain the literature in 4 databases. The screening and assessments of quality and risk of bias in the included studies were independently completed by 2 researchers. Outcomes included scales related to standing balance, Timed Up and Go (TUG) time, and walking speed/time/distance.
Twenty-three studies consisting of 532 participants were included, and the meta-analysis was completed on 21 of these studies. The study quality was good. Compared to control, rTMS induced both short-term (≤3 days after last intervention session) and long-term (≥1 month following last intervention session) significant improvements in balance scales (eg, Berg Balance Scale), TUG time, and walking speed/time/distance (short-term: standardized mean difference [SMD] = 0.26-0.34, 95% confidence interval [CI] = 0.05-0.62; long-term: SMD = 0.40-0.47, 95% CI = 0.04-0.79) for both PD and stroke cohorts. Subgroup analyses suggested that greater than 9 sessions of high-frequency rTMS targeting primary motor cortex with greater than 3 000 pulses/wk can maximize such benefits. Only a few mild-to-moderate adverse events/side effects were reported, which were similar between rTMS and control group.
The results suggest that rTMS holds promise to improve balance and walking performance in older adults with age-related neurological disorders. Future studies with more rigorous design are needed to confirm the observations in this work.
大量证据表明，重复经颅磁刺激（rTMS）可改善与年龄相关的神经退行性疾病老年人的站立平衡和步行能力。因此，我们进行了系统评价和荟萃分析，以定量评估 rTMS 的这些益处。
基于 PICOS 原则制定搜索策略，在 4 个数据库中获取文献。由 2 名研究人员独立完成纳入研究的筛选和质量评估及偏倚风险评估。结局指标包括与站立平衡、计时起立行走（TUG）时间和步行速度/时间/距离相关的量表。
共纳入 23 项研究（532 例参与者），其中 21 项研究进行了荟萃分析。研究质量较高。与对照组相比，rTMS 可在短期（末次干预疗程后≤3 天）和长期（末次干预疗程后≥1 个月）均显著改善平衡量表（如 Berg 平衡量表）、TUG 时间和步行速度/时间/距离（短期：标准化均数差 [SMD]为 0.260.34，95%置信区间 [CI]为 0.050.62；长期：SMD 为 0.400.47，95%CI 为 0.040.79），无论是在 PD 还是脑卒中队列中。亚组分析表明，针对初级运动皮层的高频 rTMS（>9 个疗程，每周>3000 脉冲），超过 9 个疗程和每周超过 3000 脉冲可最大程度发挥这种益处。仅报告了少数轻度至中度不良事件/副作用，rTMS 组与对照组相似。
结果表明，rTMS 有望改善与年龄相关的神经退行性疾病老年人的平衡和步行能力。需要进一步开展更严格设计的研究来证实本研究的结果。
