非侵入性脑刺激联合镜像疗法用于脑卒中后上肢康复：随机临床试验的系统评价和荟萃分析

Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials.

作者信息

Zhao Qingqing, Li Hong, Liu Yu, Mei Haonan, Guo Liying, Liu Xianying, Tao Xiaolin, Ma Jiang

机构信息

Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China.

College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, China.

出版信息

Front Neurol. 2022 Jul 19;13:918956. doi: 10.3389/fneur.2022.918956. eCollection 2022.

BACKGROUND

Non-invasive brain stimulation (NIBS) techniques and mirror therapy (MT) are promising rehabilitation measures for stroke. While the combination of MT and NIBS has been employed for post-stroke upper limb motor functional rehabilitation, its effectiveness has not been examined.

OBJECTIVE

This study aimed to evaluate the effectiveness of combined MT and NIBS in the recovery of upper limb motor function in stroke patients.

METHODS

The search was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG and VIP until December 2021. Randomized clinical trials (RCTs) comparing MT or NIBS alone with the combination of NIBS and MT in improving upper extremity motor recovery after stroke were selected. A meta-analysis was performed to calculate the mean differences (MD) or the standard mean differences (SMD) and 95% confidence intervals (CI) with random-effect models. Subgroup analyses were also conducted according to the types of control group, the types of NIBS, stimulation timing and phase poststroke.

RESULTS

A total of 12 articles, including 17 studies with 628 patients, were reviewed in the meta-analysis. In comparison with MT or NIBS alone, the combined group significantly improved body structure and function (MD = 5.97; 95% CI: 5.01-6.93; < 0.05), activity levels (SMD = 0.82; 95% CI 0.61-1.02; < 0.05). For cortical excitability, the motor evoked potential cortical latency (SMD = -1.05; 95% CI:-1.57--0.52; < 0.05) and the central motor conduction time (SMD=-1.31 95% CI:-2.02--0.61; < 0.05) of the combined group were significantly shortened. A non-significant homogeneous summary effect size was found for MEP amplitude (SMD = 0.47; 95%CI = -0.29 to 1.23; = 0.23). Subgroup analysis showed that there is an interaction between the stimulation sequence and the combined treatment effect.

CONCLUSION

In this meta-analysis of randomized clinical trials, in comparison to the control groups, MT combined with NIBS promoted the recovery of upper extremity motor function after stroke, which was reflected in the analysis of body structure and function, activity levels, and cortical excitability.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier CRD42022304455.

背景

非侵入性脑刺激（NIBS）技术和镜像疗法（MT）是很有前景的中风康复措施。虽然MT和NIBS的联合已被用于中风后上肢运动功能康复，但其有效性尚未得到检验。

目的

本研究旨在评估MT与NIBS联合应用对中风患者上肢运动功能恢复的有效性。

方法

检索截至2021年12月的PubMed、EMBASE、Cochrane图书馆、科学网、Science Direct、中国知网、万方和维普。选择比较单独使用MT或NIBS与NIBS和MT联合应用在改善中风后上肢运动恢复方面的随机临床试验（RCT）。采用随机效应模型进行荟萃分析，计算平均差（MD）或标准化平均差（SMD）及95%置信区间（CI）。还根据对照组类型、NIBS类型、刺激时机和中风后阶段进行亚组分析。

结果

荟萃分析共纳入12篇文章，包括17项研究、628例患者。与单独使用MT或NIBS相比，联合组在身体结构和功能（MD = 5.97；95%CI：5.01 - 6.93；P < 0.05）、活动水平（SMD = 0.82；95%CI 0.61 - 1.02；P < 0.05）方面有显著改善。对于皮质兴奋性，联合组的运动诱发电位皮质潜伏期（SMD = -1.05；95%CI：-1.57 - -0.52；P < 0.05）和中枢运动传导时间（SMD = -1.31；95%CI：-2.02 - -0.61；P < 0.05）显著缩短。运动诱发电位波幅的同质汇总效应量无统计学意义（SMD = 0.47；95%CI = -0.29至1.23；P = 0.23）。亚组分析表明刺激顺序与联合治疗效果之间存在交互作用。