Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Rehabilitation, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
Clin Rehabil. 2024 Oct;38(10):1289-1305. doi: 10.1177/02692155241264757. Epub 2024 Jul 25.
Post-stroke dysphagia is a common swallowing disorder that occurs after a stroke, leading to an increased risk of aspiration pneumonia and malnutrition. There is a pressing need for effective and safe interventions for its rehabilitation. This review aims to answer two key scientific questions: (1) What is the efficacy of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke dysphagia? (2) Is repetitive transcranial magnetic stimulation a safe intervention for post-stroke dysphagia?
A comprehensive search was conducted across four electronic databases: PubMed, Cochrane Library, Web of Science, and Embase. The search aimed to identify relevant studies concerning our topic of interest and was completed on 28 May 2024.
In accordance with the PRISMA checklist, a comprehensive search of four databases was conducted, which identified 13 relevant systematic reviews. The inclusion criteria were systematic reviews that evaluated the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Exclusion criteria were reviews that did not focus on post-stroke dysphagia or did not evaluate repetitive transcranial magnetic stimulation as a therapeutic intervention. The quality, bias, reporting, and overall evidence quality of these reviews were assessed using validated tools, including the AMSTAR 2 tool for assessing the methodological quality of systematic reviews, the ROBIS tool for assessing the risk of bias, and the GRADE approach for evaluating the overall quality of evidence. This rigorous approach ensures that our review provides a comprehensive and reliable overview of the current state of knowledge on the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia.
The sample sizes for the individual studies included in the systematic reviews/meta-analyses ranged from 66 to 555. The total number of participants across all studies included in the overall analyses was 752. The evidence was limited by the methodological flaws and heterogeneity of the systematic reviews. The quality of the evidence varied from high to low, with most outcomes having moderate quality. Future research should adopt more rigorous, standardized, and comprehensive designs to confirm the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. The main reason for downgrading the evidence quality was the small sample size and high heterogeneity of the primary studies.
This overview synthesized research on repetitive transcranial magnetic stimulation for dysphagia, aiming to inform clinical and policy decisions. However, the current evidence does not conclusively establish the safety and efficacy of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The studies reviewed varied in quality, and many were of poor quality. Therefore, while some studies suggest potential benefits of repetitive transcranial magnetic stimulation, these findings should be interpreted with caution. There is a pressing need for more rigorous, high-quality research to validate the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The implications of these findings for clinical practice and policy will be clearer once we have more robust, evidence-based recommendations.
卒中后吞咽困难是一种常见的吞咽障碍，发生在卒中后，会增加吸入性肺炎和营养不良的风险。对于其康复，迫切需要有效的、安全的干预措施。本综述旨在回答两个关键的科学问题：（1）重复经颅磁刺激在卒中后吞咽困难的康复中的疗效如何？（2）重复经颅磁刺激对卒中后吞咽困难是一种安全的干预措施吗？
全面检索了四个电子数据库：PubMed、Cochrane 图书馆、Web of Science 和 Embase。检索旨在确定与我们关注的主题相关的研究，并于 2024 年 5 月 28 日完成。
根据 PRISMA 清单，全面检索了四个数据库，确定了 13 篇相关的系统评价。纳入标准为评估重复经颅磁刺激治疗卒中后吞咽困难疗效和安全性的系统评价。排除标准为不关注卒中后吞咽困难或不评估重复经颅磁刺激作为治疗干预的综述。使用经过验证的工具评估这些综述的质量、偏倚、报告和整体证据质量，包括用于评估系统评价方法学质量的 AMSTAR 2 工具、用于评估偏倚风险的 ROBIS 工具以及用于评估整体证据质量的 GRADE 方法。这种严格的方法确保了我们的综述提供了一个关于重复经颅磁刺激治疗卒中后吞咽困难的全面而可靠的知识现状概述。
系统评价/荟萃分析中纳入的研究的样本量范围为 66 至 555。所有研究的总参与者人数为 752 人。证据受到系统评价的方法缺陷和异质性的限制。证据质量从高到低不等，大多数结局的质量为中等。未来的研究应采用更严格、标准化和全面的设计，以确认重复经颅磁刺激治疗卒中后吞咽困难的疗效和安全性。降低证据质量的主要原因是初级研究的样本量小和高度异质性。
本综述综合了关于重复经颅磁刺激治疗吞咽困难的研究，旨在为临床和政策决策提供信息。然而，目前的证据并没有确凿地确定重复经颅磁刺激治疗卒中后吞咽困难康复的安全性和有效性。综述中纳入的研究质量参差不齐，许多研究的质量较差。因此，尽管一些研究表明重复经颅磁刺激可能有一定的益处，但这些发现应谨慎解释。需要更多严格的高质量研究来验证重复经颅磁刺激治疗卒中后吞咽困难康复的应用。一旦我们有了更可靠的、基于证据的建议，这些发现对临床实践和政策的影响将更加清晰。
