tDCS联合MT对脑卒中患者上肢功能和日常生活活动能力康复效果的Meta分析

Meta-analysis of the rehabilitation effect of tDCS combined with MT on upper limb function and activities of daily living in stroke patients

目的系统评价经颅直流电刺激(tDCS)联合镜像疗法(MT)对脑卒中患者上肢功能和日常生活活动能力的康复效果。方法计算机检索PubMed、Web of Science、The Cochrane library、Embase、中国知网、万方、维普和中国生物医学文献数据库,收集所有经tDCS联合MT治疗脑卒中患者上肢障碍的随机对照试验,检索时限从建库至2023年1月,由两名研究者独立提取数据。使用RevMan5.4软件进行Meta分析。评价主要结局指标:Fugl-Meyer上肢功能评定量表(FMA-UL)评分和改良Barthel指数量表(MBI)评分。次要结局指标:盒子积木测试(BBT)评分。结果共纳入7篇随机对照试验,包含379例患者。Meta分析结果显示,与单独tDCS组相比,联合组FMA-UL评分[MD=5.17,95%CI(3.80,6.54)]和MBI评分[MD=6.71,95%CI(4.61,8.80)]均显著提高;与单独MT组相比,联合组FMA-UL评分[MD=6.72,95%CI(3.67,9.76)]、MBI评分[MD=17.91,95%CI(2.49,33.33)]及BBT评分[MD=9.52,95%CI(3.30,15.74)]均显著提高。结论相较于单独使用tDCS或MT,tDCS联合MT改善脑卒中患者上肢运动功能和日常生活活动能力的疗效更显著。

Objective To systematically evaluate the clinical efficacy of transcranial direct current stimulation(tDCS)combined with mirror therapy(MT)in the rehabilitation of upper limb function and activities of daily living in stroke patients.Methods A computer search of PubMed,Web of Science,The Cochrane library,Embase,CNKI,WanFang,VIP and the Chinese Biomedical Literature Database was conducted to collect all randomized controlled trials of tDCS combined with MT for the treatment of upper limb dysfunction in stroke patients.The search period was from the establishment of the database to January 2023.Two researchers independently extracted the data.Meta-analysis was performed using RevMan 5.4 software.The main outcome indicators were evaluated:Fugl-Meyer Upper Limb Function Scale(FMA-UL)score and modified Barthel Index scale(MBI)score.Secondary outcome indicators:Boxes Block Test(BBT)score.Results A total of 7 randomized controlled trials were included,involving 379 patients.Meta-analysis showed that compared with the tDCS alone group,the combined group had significantly higher FMA-UL scores[MD=5.17,95%CI(3.80,6.54)]and MBI scores[MD=6.71,95%CI(4.61,8.80)].Compared with the MT alone group,the combined group had significantly higher FMA-UL scores[MD=6.72,95%CI(3.67,9.76)],MBI scores[MD=17.91,95%CI(2.49,33.33)]and BBT scores[MD=9.52,95%CI(3.30,15.74)].Conclusion Compared with the use of tDCS or MT alone,tDCS combined with MT has a more significant effect in improving upper limb motor function and activities of daily living in stroke patients.