Comparative Effectiveness of Combined and Single Neurostimulation and Traditional Dysphagia Therapies for Post-Stroke Dysphagia: A Network Meta-Analysis.

IF 3.7 2区医学 Q1 CLINICAL NEUROLOGY

Neurorehabilitation and Neural Repair Pub Date : 2023-04-01 DOI:10.1177/15459683231166940

Kondwani Joseph Banda, Ko-Chiu Wu, Hsiu-Ju Jen, Hsin Chu, Li-Chung Pien, Ruey Chen, Tso-Ying Lee, Sheng-Kai Lin, Shih-Han Hung, Kuei-Ru Chou

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引用次数: 1

Abstract

Background: Comparative therapeutic benefits of combined and single neurostimulation therapies including neuromuscular electrical stimulation (NMES), pharyngeal electrical stimulation (PES), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and traditional dysphagia therapy (TDT) remain unknown in post-stroke dysphagia (PSD) rehabilitation. Therefore, we performed the first network meta-analysis (NMA) to determine comparative effectiveness of combined and single neurostimulation and traditional dysphagia therapies for PSD.

Methods: A frequentist NMA model was performed with therapy effect sizes presented as standardized mean differences (SMD) and corresponding 95% confidence interval (95% CI) for therapy comparisons while netrank function ranked the therapies in R-Software. Meta-regression models for study characteristics were analyzed using Bayesian NMA Model.

Results: Overall, 50 randomized controlled studies with 2250 participants were included. NMES + TDT 3.82 (95% CI, 1.62-6.01), tDCS + TDT 3.34 (95% CI, 1.09-5.59), rTMS + TDT 3.32 (95% CI, 1.18-5.47), NMES 2.69 (95% CI, 0.44-4.93), and TDT 2.27 (95% CI, 0.12-4.41) demonstrated very large effect in improving swallowing function. NMES + TDT -0.50 (95% CI, -0.68 to -0.32, rTMS + TDT -0.44 (95% CI, -0.67 to -0.21), TDT -0.28 (95% CI, -0.46 to -0.10), and NMES -0.19 (95% CI, -0.34 to -0.04) demonstrated medium to small effect in reducing pharyngeal transit time (PTT). rTMS -0.51 (95% CI, -0.93 to -0.08) demonstrated medium effect in reducing oral transit time (OTT). No significant therapy comparison differences were found for reducing aspiration/penetration. The highest ranked therapy was NMES + TDT for better swallowing function and reduction of PTT, rTMS for reduction of OTT, and tDCS + TDT for reduction of aspiration/penetration. Therapeutic effects of the therapies were moderated by frequency, sessions, and duration.

Conclusion: Combined therapies including NMES + TDT, tDCS + TDT, and rTMS + TDT demonstrate better therapeutic effect for improved swallowing function and reduction of PTT, OTT, and aspiration/penetration for PSD.

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联合和单一神经刺激与传统吞咽困难治疗卒中后吞咽困难的疗效比较:网络荟萃分析。

背景:联合和单一神经刺激疗法，包括神经肌肉电刺激(NMES)、咽电刺激(PES)、重复经颅磁刺激(rTMS)、经颅直流刺激(tDCS)和传统的吞咽困难治疗(TDT)，在脑卒中后吞咽困难(PSD)康复中的比较治疗效果尚不清楚。因此，我们进行了首次网络荟萃分析(NMA)，以确定联合和单一神经刺激与传统吞咽困难疗法对PSD的比较有效性。方法:采用频率NMA模型，采用标准化平均差异(SMD)和相应的95%置信区间(95% CI)表示治疗效果大小，用于治疗比较，而网络函数在R-Software中对治疗进行排名。采用贝叶斯NMA模型对研究特征的元回归模型进行分析。结果:总共纳入了50项随机对照研究，2250名参与者。NMES + TDT 3.82 (95% CI, 1.62-6.01)、tDCS + TDT 3.34 (95% CI, 1.09-5.59)、rTMS + TDT 3.32 (95% CI, 1.18-5.47)、NMES 2.69 (95% CI, 0.44-4.93)和TDT 2.27 (95% CI, 0.12-4.41)对改善吞咽功能有非常大的效果。NMES + TDT -0.50 (95% CI， -0.68至-0.32)、rTMS + TDT -0.44 (95% CI， -0.67至-0.21)、TDT -0.28 (95% CI， -0.46至-0.10)和NMES -0.19 (95% CI， -0.34至-0.04)在减少咽部过境时间(PTT)方面表现出中到小的效果。rTMS -0.51 (95% CI， -0.93至-0.08)表明在减少口腔运输时间(OTT)方面有中等效果。在减少误吸/穿透方面没有发现显著的治疗比较差异。排名最高的是NMES + TDT治疗，可改善吞咽功能和减少PTT, rTMS治疗可减少OTT, tDCS + TDT治疗可减少吸入/穿透。治疗效果随频率、疗程和持续时间而减慢。结论:NMES + TDT、tDCS + TDT、rTMS + TDT联合治疗对改善PSD患者的吞咽功能、降低PTT、OTT、吸入/渗透均有较好的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurorehabilitation and Neural Repair 医学-康复医学

CiteScore

8.30

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Neurorehabilitation & Neural Repair (NNR) offers innovative and reliable reports relevant to functional recovery from neural injury and long term neurologic care. The journal''s unique focus is evidence-based basic and clinical practice and research. NNR deals with the management and fundamental mechanisms of functional recovery from conditions such as stroke, multiple sclerosis, Alzheimer''s disease, brain and spinal cord injuries, and peripheral nerve injuries.