Sun Ying-Ying, Wang Lei, Peng Jin-Lin, Huang Yi-Jie, Qiao Fu-Qiang, Wang Pu
School of Education and Psychology, University of Jinan, Jinan, China.
Jinan Tongkang Children's Hospital, Jinan, China.
Front Pediatr. 2023 Feb 16;11:835472. doi: 10.3389/fped.2023.835472. eCollection 2023.
This review was conducted to assess the quality of the evidence of effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating motor and language ability of cerebral palsy (CP).
Medline, Cochrane library, Web of Science, Embase, PubMed, and CNKI databases were searched up to July 2021 by two independent reviewers. Randomized controlled trials (RCTs) that were published in English and Chinese and met the following criteria were included. The population comprised patients who met the diagnostic criteria for CP. Intervention included the following: comparison about rTMS and sham rTMS or comparison about rTMS combine with other physical therapy and other physical therapy. Outcomes included motor function, as follows: gross motor function measure (GMFM), Gesell Development Diagnosis Scale, fine motor function measure (FMFM), Peabody developmental motor scale, and Modified Ashworth scale. For language ability, sign-significant relation (S-S) was included. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.
Finally, 29 studies were included in the meta-analysis. Results of evaluation using the Cochrane Collaborative Network Bias Risk Assessment Scale showed that 19 studies specifically explained randomization, among which two studies described allocation concealment, four studies blinded participants and persons and had low risk of bias, and six studies explained that the assessment of outcome measures was blinded. Significant improvements in motor function were observed. The GMFM of total score was determined by using the random-effect model [2= 88%; MD = -1.03; 95% CI (-1.35, -0.71); < 0.0001] and FMFM was determined by using the fixed-effect model [ = 0.40 and 2 = 3%; SMDs = -0.48, 95% CI (-0.65, -0.30); < 0.01]. For language ability, the language improvement rate was determined using a fixed-effect model [ = 0.88 and 2 = 0%; MD = 0.37, 95% CI (0.23, 0.57); < 0.01]. According to the PEDro scale, 10 studies had low-quality, four studies had excellent quality, and the other studies had good quality. Using the GRADEpro GDT online tool, we included a total of 31 outcome indicators, as follows: 22 for low quality, seven for moderate quality, and two for very low quality.
The rTMS could improve the motor function and language ability of patients with CP. However, rTMS prescriptions varied, and the studies had low sample sizes. Studies using rigorous and standard research designs about prescriptions and large samples are needed to collect sufficient evidence about the effectiveness of using rTMS to treat patients with CP.
本综述旨在评估重复经颅磁刺激（rTMS）治疗脑瘫（CP）运动和语言能力有效性的证据质量。
两名独立评审人员对截至2021年7月的Medline、Cochrane图书馆、科学网、Embase、PubMed和中国知网数据库进行检索。纳入发表的中英文随机对照试验（RCT），且符合以下标准。研究对象为符合CP诊断标准的患者。干预措施包括：rTMS与假rTMS的比较，或rTMS联合其他物理治疗与其他物理治疗的比较。结局指标包括运动功能，如下：粗大运动功能测量量表（GMFM）、格塞尔发育诊断量表、精细运动功能测量量表（FMFM）、皮博迪发育运动量表和改良Ashworth量表。对于语言能力，纳入符号-显著性关系（S-S）。采用物理治疗证据数据库（PEDro）量表评估方法学质量。
最终，29项研究纳入荟萃分析。使用Cochrane协作网偏倚风险评估量表的评估结果显示，19项研究具体说明了随机化情况，其中两项研究描述了分配隐藏，四项研究对参与者和人员实施了盲法且偏倚风险较低，六项研究说明结局指标评估实施了盲法。观察到运动功能有显著改善。总分GMFM采用随机效应模型确定[I² = 88%；MD = -1.03；95%CI（-1.35，-0.71）；P < 0.0001]，FMFM采用固定效应模型确定[I² = 0.40且I² = 3%；SMD = -0.48，95%CI（-0.65，-0.30）；P < 0.01]。对于语言能力，语言改善率采用固定效应模型确定[I² = 0.88且I² = 0%；MD = 0.37，95%CI（0.23，0.57）；P < 0.01]。根据PEDro量表，10项研究质量低，4项研究质量优，其他研究质量良好。使用GRADEpro GDT在线工具，我们共纳入31项结局指标，如下：22项低质量，7项中等质量，2项极低质量。
rTMS可改善CP患者的运动功能和语言能力。然而，rTMS处方各异，且研究样本量较小。需要采用关于处方和大样本的严谨且标准的研究设计来收集足够的证据，以证明使用rTMS治疗CP患者的有效性。
