Department of Rehabilitation, Hebei General Hospital, Shijiazhuang, 050051, China.
Department of Gastrointestinal Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
J Neuroeng Rehabil. 2024 Nov 30;21(1):209. doi: 10.1186/s12984-024-01491-x.
Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are common non-invasive brain stimulation (NIBS) methods for functional recovery after stroke. Motor imagery (MI) can be used in the rehabilitation of limb motor function after stroke, but its effectiveness remains to be rigorously established. Furthermore, there is a growing interest in the combined application of NIBS with MI, yet the evidence regarding its impact on the recovery of upper limb function after stroke is inconclusive. This meta-analysis aimed to demonstrate whether combining the two is superior to NIBS alone or MI alone to provide a reference for clinical decision-making.
PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG, and VIP databases were searched for randomized controlled trials on the effects of MI combined NIBS in motor function recovery after stroke until February 2024. The outcomes of interest were associated with body functions or structure (impairment) and activity (functional). The primary outcome was assessed with the Fugl-Meyer assessment of the upper extremity (FMA-UE) for motor function of the upper limbs and the modified Barthel Index (MBI) for the ability to perform daily living activities. For secondary outcomes, functional activity level was measured using wolf motor function test (WMFT) and action research arm test (ARAT), and cortical excitability was assessed using cortical latency of motor evoked potential (MEP-CL) and central motor conduction time (CMCT). The methodological quality of the selected studies was evaluated using the evidence‑based Cochrane Collaboration's tool. 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.
A total of 14 articles, including 886 patients, were reviewed in the meta-analysis. In comparison with MI or NIBS alone, the combined therapy significantly improved the motor function of the upper limbs (MD = 5.43; 95% CI 4.34-6.53; P < 0.00001) and the ability to perform activities of daily living (MD = 11.07; 95% CI 6.33-15.80; P < 0.00001). Subgroup analyses showed an interaction between the stage of stroke, the type of MI, and the type of NIBS with the effect of the combination therapy.
The combination of MI and NIBS may be a promising therapeutic approach to enhance upper limb motor function, functional activity, and activities of daily living after stroke.
PROSPERO registration CRD42023493073.
经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS）是常见的用于中风后功能恢复的非侵入性脑刺激（NIBS）方法。运动想象（MI）可用于中风后肢体运动功能的康复，但它的有效性仍有待严格确立。此外，人们对 NIBS 与 MI 的联合应用越来越感兴趣，但关于其对上肢功能恢复的影响的证据尚无定论。本荟萃分析旨在证明联合应用这两种方法是否优于单独应用 NIBS 或 MI，为临床决策提供参考。
检索了 2024 年 2 月之前在 PubMed、EMBASE、Cochrane 图书馆、Web of Science、Science Direct、CNKI、WANFANG 和 VIP 数据库中关于 MI 联合 NIBS 对中风后运动功能恢复影响的随机对照试验。感兴趣的结局与身体功能或结构（损伤）和活动（功能）有关。主要结局采用上肢 Fugl-Meyer 评估（FMA-UE）评估上肢运动功能，改良巴氏指数（MBI）评估日常生活活动能力。次要结局采用沃尔夫运动功能测试（WMFT）和动作研究臂测试（ARAT）评估功能活动水平，采用运动诱发电位皮质潜伏期（MEP-CL）和皮质运动传导时间（CMCT）评估皮质兴奋性。采用循证 Cochrane 协作工具评估入选研究的方法学质量。采用随机效应模型计算均数差（MD）或标准均数差（SMD）和 95%置信区间（CI）进行荟萃分析。
荟萃分析共纳入 14 篇文章，共 886 例患者。与 MI 或 NIBS 单独治疗相比，联合治疗显著改善了上肢运动功能（MD=5.43；95%CI 4.34-6.53；P<0.00001）和日常生活活动能力（MD=11.07；95%CI 6.33-15.80；P<0.00001）。亚组分析显示，中风阶段、MI 类型和 NIBS 类型与联合治疗效果之间存在交互作用。
MI 和 NIBS 的联合应用可能是一种有前途的治疗方法，可增强中风后上肢运动功能、功能活动和日常生活活动能力。
PROSPERO 注册 CRD42023493073。
