Xiaomin Wu, Baixiang Zhang, Gareth Ambler, Qingfa Chen, Huayao Huang, Huiying Lin, Shuangfang Fang, Nan Liu, Houwei Du
{"title":"重复经颅磁刺激治疗脑卒中后吞咽困难：系统回顾和网络荟萃分析。","authors":"Xiaomin Wu, Baixiang Zhang, Gareth Ambler, Qingfa Chen, Huayao Huang, Huiying Lin, Shuangfang Fang, Nan Liu, Houwei Du","doi":"10.1016/j.apmr.2024.12.018","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear.</p><p><strong>Data sources: </strong>PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024.</p><p><strong>Study selection: </strong>RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD.</p><p><strong>Data extraction: </strong>Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI).</p><p><strong>Data synthesis: </strong>Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, -0.94; 95% CrI, -1.51 to -0.44), HF/bilateral hemisphere (bi-hemi) (SMD, -2.59; 95% CrI, -3.50 to -1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, -0.79; 95% CrI, -1.55 to -0.10), HF/bilateral cerebellar (bi-CRB) (SMD, -1.02; 95% CrI, -1.83 to -0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, -2.72; 95% CrI, -4.12 to -1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, -1.36; 95% CrI, -2.86 to -0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, -2.68; 95% CrI, -4.26 to -1.26). However, rTMS failed to improve swallowing function in chronic stage.</p><p><strong>Conclusions: </strong>This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Repetitive Transcranial Magnetic Stimulation Strategies for Poststroke Dysphagia: A Systematic Review and Network Meta-analysis.\",\"authors\":\"Xiaomin Wu, Baixiang Zhang, Gareth Ambler, Qingfa Chen, Huayao Huang, Huiying Lin, Shuangfang Fang, Nan Liu, Houwei Du\",\"doi\":\"10.1016/j.apmr.2024.12.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear.</p><p><strong>Data sources: </strong>PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024.</p><p><strong>Study selection: </strong>RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD.</p><p><strong>Data extraction: </strong>Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI).</p><p><strong>Data synthesis: </strong>Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, -0.94; 95% CrI, -1.51 to -0.44), HF/bilateral hemisphere (bi-hemi) (SMD, -2.59; 95% CrI, -3.50 to -1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, -0.79; 95% CrI, -1.55 to -0.10), HF/bilateral cerebellar (bi-CRB) (SMD, -1.02; 95% CrI, -1.83 to -0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, -2.72; 95% CrI, -4.12 to -1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, -1.36; 95% CrI, -2.86 to -0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, -2.68; 95% CrI, -4.26 to -1.26). However, rTMS failed to improve swallowing function in chronic stage.</p><p><strong>Conclusions: </strong>This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.</p>\",\"PeriodicalId\":8313,\"journal\":{\"name\":\"Archives of physical medicine and rehabilitation\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-12-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of physical medicine and rehabilitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.apmr.2024.12.018\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of physical medicine and rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.apmr.2024.12.018","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
Repetitive Transcranial Magnetic Stimulation Strategies for Poststroke Dysphagia: A Systematic Review and Network Meta-analysis.
Objective: Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear.
Data sources: PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024.
Study selection: RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD.
Data extraction: Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI).
Data synthesis: Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, -0.94; 95% CrI, -1.51 to -0.44), HF/bilateral hemisphere (bi-hemi) (SMD, -2.59; 95% CrI, -3.50 to -1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, -0.79; 95% CrI, -1.55 to -0.10), HF/bilateral cerebellar (bi-CRB) (SMD, -1.02; 95% CrI, -1.83 to -0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, -2.72; 95% CrI, -4.12 to -1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, -1.36; 95% CrI, -2.86 to -0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, -2.68; 95% CrI, -4.26 to -1.26). However, rTMS failed to improve swallowing function in chronic stage.
Conclusions: This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.
期刊介绍：
The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities.
Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
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