Le Ha T, Honma Kenta, Annaka Hiroki, Shunxiang Sun, Murakami Tsukasa, Hiraoka Tamon, Nomura Tomonori
Department of Rehabilitation, Hai Duong Medical Technical University, Hai Duong, VNM.
Graduate School, Niigata University of Health and Welfare, Niigata, JPN.
Cureus. 2024 Dec 6;16(12):e75194. doi: 10.7759/cureus.75194. eCollection 2024 Dec.
Transcranial magnetic stimulation (TMS) is an effective intervention for improving cognitive impairment in patients with stroke. However, its effectiveness in the subdomains of cognition is conflicting and not clearly established. This systematic review assessed the efficacy of TMS in improving executive function, attention, and memory in this population. Seven databases, including PubMed, Scopus, Cochrane Library, Cumulated Index in Nursing and Allied Health Literature, NeuroBITE, Physiotherapy Evidence Database, and OTseeker, were searched for indexed literature until July 2024 to identify all randomized controlled trials (RCTs) of this effect in stroke patients. This systematic review was performed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Handbook of the Cochrane Library and evaluated the quality of evidence using the Risk of Bias 2 tools and grading of recommendations assessment, development, and evaluation (GRADE) systems. Meta-analyses were performed using standardized mean difference (SMD) (Hedge's g) as the effect measure, and subgroups were performed to explore potential outcomes. The research included 13 RCTs involving 496 patients with stroke. The results indicated that TMS could affect executive function (six RCTs with SMD = 0.55; 95% confidence interval, CI = 0.04-1.05) and memory (nine RCTs with SMD = 0.57; 95% CI = 0.25-0.89) in patients with stroke. However, the effectiveness of TMS on attention (five RCTs with SMD = 0.32; 95% CI = -0.1 to 0.75) was not clear. The quality of the results varied between very low and low according to the GRADE approach. In conclusion, TMS may affect executive function and memory, but not attention. The quality of the evidence for the outcomes varied from very low to low owing to heterogeneity and bias; therefore, the results should be considered with caution, and more rigorous evidence is needed.
经颅磁刺激（TMS）是改善中风患者认知障碍的一种有效干预措施。然而，其在认知子领域的有效性存在争议，尚未明确确立。本系统评价评估了TMS对该人群执行功能、注意力和记忆力改善的疗效。检索了七个数据库，包括PubMed、Scopus、Cochrane图书馆、护理及相关健康文献累积索引、NeuroBITE、物理治疗证据数据库和OTseeker，以查找截至2024年7月的索引文献，确定所有关于中风患者中这种效应的随机对照试验（RCT）。本系统评价按照系统评价和Meta分析的首选报告项目指南以及Cochrane图书馆手册进行，并使用偏倚风险2工具和推荐分级评估、制定与评价（GRADE）系统评估证据质量。使用标准化均数差（SMD）（Hedge's g）作为效应量进行Meta分析，并进行亚组分析以探索潜在结果。该研究纳入了13项涉及496例中风患者的RCT。结果表明，TMS可影响中风患者的执行功能（6项RCT，SMD = 0.55；95%置信区间，CI = 0.04 - 1.05）和记忆力（9项RCT，SMD = 0.57；95%CI = 0.25 - 0.89）。然而，TMS对注意力的有效性（5项RCT，SMD = 0.32；95%CI = -0.1至0.75）并不明确。根据GRADE方法，结果质量在极低到低之间不等。总之，TMS可能影响执行功能和记忆力，但不影响注意力。由于异质性和偏倚，这些结果的证据质量从极低到低不等；因此，应谨慎考虑这些结果，并且需要更严格的证据。
