{"title":"无创脑刺激治疗脑卒中后吞咽困难的系统评价和网络meta分析。","authors":"Lingling Li, Hailiang Huang, Yuqi Jia, Ying Yu, Zhiyao Liu, Xin Shi, Fangqi Wang","doi":"10.1155/2021/3831472","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia.</p><p><strong>Objective: </strong>To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS.</p><p><strong>Methods: </strong>Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the <i>Cochrane Handbook for Systematic Reviews of Interventions</i>. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI).</p><p><strong>Results: </strong>Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, <i>P</i> < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, <i>P</i> < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = -1.04, 95% CI -1.50 to -0.58, <i>P</i> < 0.05), the penetration-aspiration scale (PAS) score (SMD = -0.85, 95% CI -1.33 to -0.36, <i>P</i> < 0.05), and the functional dysphagia scale score (SMD = -1.05, 95% CI -1.48 to -0.62, <i>P</i> < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (<i>P</i> = 0.52) > tDCS (<i>P</i> = 0.48), the best probabilistic ranking of the SSA score is rTMS (<i>P</i> = 0.72) > tDCS (<i>P</i> = 0.28), and the best probabilistic ranking of the PAS score is rTMS (<i>P</i> = 0.68) > tDCS (<i>P</i> = 0.32).</p><p><strong>Conclusion: </strong>Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.</p>","PeriodicalId":51299,"journal":{"name":"Neural Plasticity","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2021-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580697/pdf/","citationCount":"17","resultStr":"{\"title\":\"Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke.\",\"authors\":\"Lingling Li, Hailiang Huang, Yuqi Jia, Ying Yu, Zhiyao Liu, Xin Shi, Fangqi Wang\",\"doi\":\"10.1155/2021/3831472\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia.</p><p><strong>Objective: </strong>To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS.</p><p><strong>Methods: </strong>Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the <i>Cochrane Handbook for Systematic Reviews of Interventions</i>. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI).</p><p><strong>Results: </strong>Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, <i>P</i> < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, <i>P</i> < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = -1.04, 95% CI -1.50 to -0.58, <i>P</i> < 0.05), the penetration-aspiration scale (PAS) score (SMD = -0.85, 95% CI -1.33 to -0.36, <i>P</i> < 0.05), and the functional dysphagia scale score (SMD = -1.05, 95% CI -1.48 to -0.62, <i>P</i> < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (<i>P</i> = 0.52) > tDCS (<i>P</i> = 0.48), the best probabilistic ranking of the SSA score is rTMS (<i>P</i> = 0.72) > tDCS (<i>P</i> = 0.28), and the best probabilistic ranking of the PAS score is rTMS (<i>P</i> = 0.68) > tDCS (<i>P</i> = 0.32).</p><p><strong>Conclusion: </strong>Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.</p>\",\"PeriodicalId\":51299,\"journal\":{\"name\":\"Neural Plasticity\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2021-11-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8580697/pdf/\",\"citationCount\":\"17\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neural Plasticity\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1155/2021/3831472\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2021/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"NEUROSCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neural Plasticity","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/2021/3831472","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 17
摘要
背景:吞咽困难是卒中后常见的后遗症。无创脑刺激(NIBS)是一种在康复过程中用于改变皮质兴奋性和改善吞咽困难的工具。目的:系统评价NIBS治疗脑卒中后吞咽困难的疗效，并比较两种不同NIBS治疗脑卒中后吞咽困难的效果。方法:从PubMed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方数据、VIP和CBM数据库检索自成立至2021年6月的NIBS对脑卒中后吞咽困难影响的随机对照试验。对试验的质量进行评估，并根据Cochrane干预措施系统评价手册提取数据。采用RevMan 5.3和ADDIS 1.16.8进行统计分析。效应量采用标准化平均差(SMD)和95%置信区间(CI)进行评估。结果:最终纳入18项研究，涉及738例患者。meta分析显示，NIBS可改善吞咽困难结局和严重程度量表(DOSS)评分(标准均差(SMD) = 1.44, 95% CI 0.80 ~ 2.08, P < 0.05)和吞咽水测试评分(SMD = 6.23, 95% CI 5.44 ~ 7.03, P < 0.05)。NIBS可降低标准化吞咽评估(SSA)评分(SMD = -1.04, 95% CI -1.50 ~ -0.58, P < 0.05)、穿透-吸入量表(PAS)评分(SMD = -0.85, 95% CI -1.33 ~ -0.36, P < 0.05)和功能性吞咽困难量表评分(SMD = -1.05, 95% CI -1.48 ~ -0.62, P < 0.05)。网络meta分析显示，两种不同NIBS对DOSS评分影响的最佳概率排序为rTMS (P = 0.52) > tDCS (P = 0.48)， SSA评分的最佳概率排序为rTMS (P = 0.72) > tDCS (P = 0.28)， PAS评分的最佳概率排序为rTMS (P = 0.68) > tDCS (P = 0.32)。结论:已有证据表明NIBS可改善脑卒中后吞咽功能障碍，减少误吸的发生，且rTMS优于tDCS。受纳入研究数量的限制，未来还需要更多的大样本、多中心、双盲、高质量的临床随机对照试验来进一步证实本研究的结果。
Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke.
Background: Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia.
Objective: To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS.
Methods: Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI).
Results: Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, P < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, P < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = -1.04, 95% CI -1.50 to -0.58, P < 0.05), the penetration-aspiration scale (PAS) score (SMD = -0.85, 95% CI -1.33 to -0.36, P < 0.05), and the functional dysphagia scale score (SMD = -1.05, 95% CI -1.48 to -0.62, P < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (P = 0.52) > tDCS (P = 0.48), the best probabilistic ranking of the SSA score is rTMS (P = 0.72) > tDCS (P = 0.28), and the best probabilistic ranking of the PAS score is rTMS (P = 0.68) > tDCS (P = 0.32).
Conclusion: Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.
期刊介绍：
Neural Plasticity is an international, interdisciplinary journal dedicated to the publication of articles related to all aspects of neural plasticity, with special emphasis on its functional significance as reflected in behavior and in psychopathology. Neural Plasticity publishes research and review articles from the entire range of relevant disciplines, including basic neuroscience, behavioral neuroscience, cognitive neuroscience, biological psychology, and biological psychiatry.
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