重复经颅磁刺激对脑瘫患儿运动功能康复效果的Meta分析

Effect of repetitive transcranial magnetic stimulation on motor function in children with cerebral palsy:a Meta-analysis

目的系统评价重复经颅磁刺激(rTMS)对脑瘫患儿运动功能的康复疗效。方法计算机检索Cochrane Library、PubMed、Web of Science、Google Scholar、中国生物医学数据库、中国知网、维普期刊数据库、万方数据库,筛选关于rTMS改善脑瘫患儿运动功能的随机对照试验,检索时限从建库至2022年10月。按照Cochrane系统评价手册和物理治疗证据数据库量表对纳入文献进行质量评价,采用RevMan 5.4进行Meta分析、亚组分析、敏感性分析及发表偏倚分析。结果最终纳入17篇文献,共1283例患者。Meta分析显示,rTMS可显著改善脑瘫患儿粗大运动功能(MD=6.74,95%CI:5.26~8.21,P<0.05)、踝关节活动度(MD=3.38,95%CI:2.87~3.89,P<0.05)、发育商(DQ)(MD=5.62,95%CI:1.62~9.61,P<0.05),但对精细运动功能的改善效果不明显(MD=2.21,95%CI:-0.46~4.89,P>0.05)。以GMGM-88为指标的偏倚风险较低。结论rTMS在改善脑瘫患儿粗大运动功能方面和DQ方面具有疗效。

Objective To systematically evaluate the efficacy of repetitive transcranial magnetic stimulation(rTMS)on the rehabilitation of motor function in children with cerebral palsy.Methods Computer searches of Cochrane Library,PubMed,Web of Science,Google Scholar,China Biomedical Database,China Knowledge Network,Wipro Journal Database,Wanfang Database were conducted to screen randomised controlled trials on rTMS for improvement of motor function in children with cerebral palsy with a timeframe of the search from library construction to October 2022.The quality of the included literature was evaluated according to the Cochrane Handbook for Systematic Evaluation and The Physiotherapy Evidence Database scale,and Meta-analysis,subgroup analysis,sensitivity analysis,and publication bias analysis were performed using RevMan5.4.Results Seventeen papers with 1283 patients were finally included.rTMS significantly improved the Gross motor function measure-88 scores(MD=6.74,95%CI:5.26-8.21,P<0.05)and ankle mobility scores(MD=3.38,95%CI:2.87-3.89,P<0.05),developmental quotient(DQ)score(MD=5.62,95%CI:1.62-9.61,P<0.05),but fine motor function measure score(MD=2.21,95%CI:-0.46-4.89,P>0.05)was not significant.The risk of bias was low when GMGM-88 was used as an indicator.Conclusion rTMS is effective in improving gross motor function and DQ in children with cerebral palsy.