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电刺激对脊髓损伤痉挛影响的神经生理学和临床结局指标:系统评价与荟萃分析。

Neurophysiological and clinical outcome measures of the impact of electrical stimulation on spasticity in spinal cord injury: Systematic review and meta-analysis.

作者信息

Massey Sarah, Vanhoestenberghe Anne, Duffell Lynsey

机构信息

Aspire Centre for Rehabilitation Engineering and Assistive Technologies, Division of Surgery and Interventional Sciences, University College London, London, United Kingdom.

Department of Medical Physics & Biomedical Engineering, University College London, London, United Kingdom.

出版信息

Front Rehabil Sci. 2022 Dec 16;3:1058663. doi: 10.3389/fresc.2022.1058663. eCollection 2022.

Abstract

This systematic review and meta-analysis aims to determine whether non-invasive electrical stimulation (ES) is effective at reducing spasticity in people living with spinal cord injury (SCI). PubMed, Web of Science, Scopus and Cochrane Central Register of Controlled Trials databases were searched in April 2022. Primary outcome measures were the Ashworth scale (AS), Modified Ashworth scale (MAS), Pendulum test and the Penn spasm frequency scale (PSFS). Secondary outcomes were the Hoffman (H)- reflex, motor-evoked potentials (MEPs) and posterior-root reflexes (PRRs). A random-effects model, using two correlation coefficients, ( , ) determined the difference between baseline and post-intervention measures for RCTs. A quantitative synthesis amalgamated data from studies with no control group (non-RCTs). Twenty-nine studies were included: five in the meta-analysis and 17 in the amalgamation of non-RCT studies. Twenty studies measured MAS or AS scores, 14 used the Pendulum test and one used the PSFS. Four measured the H-reflex and no studies used MEPs or PRRs. Types of ES used were: transcutaneous electrical nerve stimulation (TENS), transcutaneous spinal cord stimulation (TSCS), functional electrical stimulation (FES) cycling and FES gait. Meta-analyses of 3 studies using the MAS and 2 using the Pendulum test were carried out. For MAS scores, non-invasive ES was effective at reducing spasticity compared to a control group (, ; , ). For Pendulum test outcomes, there was no statistically significant difference between intervention and control groups. Quantitative synthesis of non-RCT studies revealed that 22 of the 29 studies reported improvement in at least one measure of spasticity following non-invasive ES, 13 of which were statistically significant (). Activation of the muscle was not necessary to reduce spasticity. Non-invasive ES can reduce spasticity in people with SCI, according to MAS scores, for both RCT and non-RCT studies, and Pendulum test values in non-RCT studies. This review could not correlate between clinical and neurophysiological outcomes; we recommend the additional use of neurophysiological outcomes for future studies. The use of TSCS and TENS, which did not induce a muscle contraction, indicate that activation of afferent fibres is at least required for non-invasive ES to reduce spasticity.

摘要

本系统评价和荟萃分析旨在确定非侵入性电刺激(ES)对降低脊髓损伤(SCI)患者的痉挛是否有效。于2022年4月检索了PubMed、Web of Science、Scopus和Cochrane对照试验中央注册库数据库。主要结局指标为Ashworth量表(AS)、改良Ashworth量表(MAS)、摆锤试验和宾夕法尼亚痉挛频率量表(PSFS)。次要结局为霍夫曼(H)反射、运动诱发电位(MEP)和后根反射(PRR)。采用随机效应模型,使用两个相关系数( , )确定随机对照试验(RCT)基线与干预后测量值之间的差异。定量综合分析合并了无对照组研究(非RCT)的数据。共纳入29项研究:5项纳入荟萃分析,17项纳入非RCT研究合并分析。20项研究测量了MAS或AS评分,14项使用摆锤试验,1项使用PSFS。4项测量了H反射,没有研究使用MEP或PRR。使用的ES类型包括:经皮神经电刺激(TENS)、经皮脊髓刺激(TSCS)、功能性电刺激(FES)骑行和FES步态。对3项使用MAS和2项使用摆锤试验的研究进行了荟萃分析。对于MAS评分,与对照组相比,非侵入性ES在降低痉挛方面有效( , ; , )。对于摆锤试验结果,干预组与对照组之间无统计学显著差异。非RCT研究的定量综合分析显示,29项研究中有22项报告非侵入性ES后至少一项痉挛测量指标有所改善,其中13项具有统计学显著性( )。减少痉挛不一定需要肌肉激活。根据MAS评分,对于RCT和非RCT研究,以及非RCT研究中的摆锤试验值,非侵入性ES可降低SCI患者的痉挛。本综述无法关联临床和神经生理学结局;我们建议未来研究额外使用神经生理学结局。未诱发肌肉收缩的TSCS和TENS的使用表明,非侵入性ES减少痉挛至少需要激活传入纤维。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ca8a/9801305/bbb28e81fae6/fresc-03-1058663-g001.jpg

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