经颅直流电刺激结合特定任务训练对脑卒中患者时空步态参数和功能活动能力的影响：系统综述与荟萃分析》（The effect of transcranial direct current stimulation combined with task-specific training on spatio-temporal gait parameters and functional mobility in individuals with stroke: a systematic review and meta-analysis）。
Jéssica Miranda de Aquino Miranda, Pedro Henrique Sousa de Andrade, Maria Eduarda Salum Aveiro Henrique, Bruno Henrique de Souza Fonseca, Rodrigo Bazan, Luciane Aparecida Pascucci Sande de Souza, Gustavo José Luvizutto
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引用次数: 0
摘要
简介经颅直流电刺激（transcranial direct current stimulation，tDCS）对脑卒中后运动康复有启动作用：我们验证了经颅直流电刺激结合特定任务训练在改善脑卒中患者时空步态参数和功能活动能力方面是否优于不干预、特定任务训练或模拟干预：我们检索了 MEDLINE、EMBASE、CINAHL、Scopus、Cochrane Central、Web of Science 和 LILACS，使用与中风、tDCS 和任务特异性训练相关的术语检索了 2024 年 5 月之前发表的文章。采用 PEDro 量表评估偏倚风险。采用 "推荐、评估、发展和评价分级 "方法对每项结果的证据确定性进行分类。采用随机效应模型进行 Meta 分析：共确定了 1,685 项研究，其中 18 项纳入了定性分析。7项研究被纳入荟萃分析；所有结果均被归类为 "质量很低"。只有步行速度的改善与 tDCS 结合特定任务训练有关（平均差 [MD]，0.06；95% 置信区间 [CI]：0.04，0.07；P 结论：本系统综述提供了低质量的证据，证明 tDCS 与特定任务训练相结合可提高中风后患者的速度。tDCS 和特定任务训练这两项干预措施成本低廉且易于实施；因此，平均估计值可被视为具有临床价值，尽管 CIs 跨度既包括临床上微不足道的效果，也包括有价值的效果：注册：系统综述国际前瞻性注册（PROSPERO；编号 CRD42023396021）。
The effect of transcranial direct current stimulation combined with task-specific training on spatio-temporal gait parameters and functional mobility in individuals with stroke: a systematic review and meta-analysis.
Introduction: Transcranial direct current stimulation (tDCS) has a priming effect on post- stroke motor rehabilitation.
Objective: We verified whether tDCS combined with task-specific training was superior to nonintervention, task-specific training, or simulated intervention in improving spatio-temporal gait parameters and functional mobility in stroke patients.
Methods: We searched MEDLINE, EMBASE, CINAHL, Scopus, Cochrane Central, Web of Science, and LILACS for articles published until May 2024, using terms related to stroke, tDCS, and task-specific training. The risk of bias was assessed using the PEDro scale. The Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to classify the certainty of the evidence for each outcome. Meta-analysis was performed using a random-effects model.
Results: A total of 1,685 studies were identified, of which 18 were included in the qualitative analysis. Seven studies were included in the meta-analysis; all outcomes were classified as "very low quality." Improvements in walking speed only were associated with tDCS combined with task-specific training (mean difference [MD], 0.06; 95% confidence interval [CI]: 0.04, 0.07; p < 0.001; I = 0%). There were no differences in other spatio-temporal gait parameters or functional mobility.
Conclusion: This systematic review provides low-quality evidence that tDCS, in combination with task-specific training, increases speed in individuals after stroke. Both interventions, tDCS and task-specific training, are inexpensive and easy to implement; therefore, the mean estimate may be considered clinically worthwhile, although the CIs spans both clinically trivial and worthwhile effects.
Registration: International Prospective Register of Systematic Reviews (PROSPERO; number CRD42023396021).
期刊介绍：
Topics in Stroke Rehabilitation is the leading journal devoted to the study and dissemination of interdisciplinary, evidence-based, clinical information related to stroke rehabilitation. The journal’s scope covers physical medicine and rehabilitation, neurology, neurorehabilitation, neural engineering and therapeutics, neuropsychology and cognition, optimization of the rehabilitation system, robotics and biomechanics, pain management, nursing, physical therapy, cardiopulmonary fitness, mobility, occupational therapy, speech pathology and communication. There is a particular focus on stroke recovery, improving rehabilitation outcomes, quality of life, activities of daily living, motor control, family and care givers, and community issues.
The journal reviews and reports clinical practices, clinical trials, state-of-the-art concepts, and new developments in stroke research and patient care. Both primary research papers, reviews of existing literature, and invited editorials, are included. Sharply-focused, single-issue topics, and the latest in clinical research, provide in-depth knowledge.
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