机构：[1]Department of Rehabilitation Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.[2]Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.[3]Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China.神经科系统神经内科首都医科大学宣武医院[4]Hebei Key Laboratory of Brain Science and Psychiatric-Psychologic Disease, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.[5]Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China.
To evaluate the efficacy and safety of transcranial direct current stimulation in poststroke patients with upper extremity motor dysfunction using a systematic review and meta-analysis.We searched the Web of Science, Cochrane Library, EMBASE, and PubMed for randomized controlled trials investigating the effects of both active and sham stimulation up until January 27, 2024.Efficacy, including the upper extremity Fugl-Meyer Assessment, Action Research Arm Test, Barthel Index, and safety, were assessed. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Physiotherapy Evidence Database Scale. Meta-analysis was performed using the RevMan 5.4 software.Forty-four studies with 1555 participants were included. Transcranial direct current stimulation proved effective in improving upper extremity motor function (standardized mean difference = 0.22, 95% confidence interval: 0.12-0.32, P < 0.001) and Barthel Index (mean difference = 4.65, 95% confidence interval: 2.82-6.49, P < 0.001). Subgroup analysis revealed the highest transcranial direct current stimulation efficacy in patients with subacute stroke. Both anodal and cathodal stimulation were effective against upper extremity motor dysfunction. C3/C4 was the most effective stimulus target. Optimal stimulation parameters included stimulus current densities <0.057 mA/cm2 for 20-30 min and <30 sessions. Adverse effects and dropouts during follow-up showed that transcranial direct current stimulation is safe and feasible.Our findings suggest that both anodal and cathodal stimulation were significantly effective in subacute stroke patients, particularly when preceding other treatments and when C3/C4 is targeted.
基金：
This work was supported by the National
Key R&D Program of China (grant number 2022
YFC3600503); Natural Science Foundation of Hebei
Province (grant number H2020206632, H2020206643);
Medical Science Research Project of Hebei Province
(grant number 20210916, 20211628); Scientific Research
Program of Hebei Administration of Traditional Chinese
Medicine (grant number 2023065).
第一作者机构：[1]Department of Rehabilitation Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
通讯作者：
通讯机构：[2]Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.[3]Department of Neurology, Hebei Hospital, Xuanwu Hospital, Capital Medical University, Shijiazhuang, Hebei, China.[5]Neuromedical Technology Innovation Center of Hebei Province, Shijiazhuang, Hebei, China.[*1]Department of Neurology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei 050030, China
推荐引用方式(GB/T 7714)：
Tang Xian,Zhang Nan,Shen Zhiyuan,et al.Transcranial direct current stimulation for upper extremity motor dysfunction in poststroke patients: A systematic review and meta-analysis[J].CLINICAL REHABILITATION.2024,38(6):749-769.doi:10.1177/02692155241235336.
APA：
Tang Xian,Zhang Nan,Shen Zhiyuan,Guo Xin,Xing Jun...&Xing Yuan.(2024).Transcranial direct current stimulation for upper extremity motor dysfunction in poststroke patients: A systematic review and meta-analysis.CLINICAL REHABILITATION,38,(6)
MLA：
Tang Xian,et al."Transcranial direct current stimulation for upper extremity motor dysfunction in poststroke patients: A systematic review and meta-analysis".CLINICAL REHABILITATION 38..6(2024):749-769
