不同电磁刺激方案对脑卒中患者手功能及日常生活活动能力效果的网状Meta分析OA
Effects of different electromagnetic stimulation protocols on hand function and activities of daily living for stroke patients:a network meta-analysis
目的 采用网状Meta分析(NMA)系统对比各类电磁刺激方案对脑卒中患者手功能和日常生活活动能力的疗效,筛选最优康复刺激方案. 方法 严格遵循PRISMA-NMA规范,系统检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science和Embase数据库,检索时限为各数据库建库至2026年4月,纳入对比不同电磁刺激方案改善脑卒中后手功能和日常生活活动能力的随机对照试验(RCT).采用Cochrane偏倚风险工具和PEDro量表进行文献质量评价,采用GRADE系统对Fugl-Meyer评定量表上肢部分(FMA-UE)和改良Barthel指数(MBI)进行证据分级;进行文献筛选、数据提取和偏倚风险评价;采用RevMan 5.4和Stata 17.0进行Meta分析和NMA. 结果 最终纳入22项RCT,涵盖17种单一/联合电磁刺激方案.纳入研究PEDro评分6～10分.改善FMA-UE评分最好的前5位方案为重复外周磁刺激(rPMS)+重复经颅磁刺激(rTMS)、间歇性θ爆发刺激(iTBS)+rPMS、iTBS+经颅直流电刺激(tDCS)、经皮穴位电刺激(TEAS)、对侧控制功能性电刺激(CCFES);改善MBI评分的方案最好的是tDCS,以下依次为TEAS、iTBS+rPMS.FMA-UE、MBI结局指标证据等级均为中等,漏斗图提示发表偏倚风险较低,网状模型一致性检验结果良好. 结论 电磁刺激可有效促进脑卒中后偏瘫患者上肢运动功能重建、提升日常生活活动能力;中枢-外周联合磁刺激方案对改善上肢运动功能效果最优,tDCS对提升患者日常生活活动能力更具优势.
Objective To systematically compare the effects of diverse electromagnetic stimulation protocols on hand function and activities of daily living(ADL)in stroke patients using network meta-analysis(NMA),and screen the optimal stimulation strategy for post-stroke hand dysfunction rehabilitation. Methods NMA was performed in accordance with the PRISMA-NMA statement.Databases of CNKI,Wanfang data,VIP,CBM,PubMed,Web of Science and Embase were searched from database inception to April,2026 for eligi-ble randomized controlled trials(RCTs)comparing different electromagnetic stimulation protocols for post-stroke hand impairment.The Cochrane Risk of Bias tool and PEDro scale were used to assess methodological quality of included studies,while the GRADE system was adopted to grade evidence quality of primary out-comes of Fugl-Meyer Assessment-Upper Extremities(FMA-UE)and modified Barthel Index(MBI).After litera-ture screening,data extraction and bias evaluation,RevMan 5.4 and Stata 17.0 were used for meta-analysis and NMA. Results A total of 22 RCT involving 17 electromagnetic stimulation protocols were finally included.The PEDro scores ranged from six to ten.The top five protocols for improving FMA-UE score were repetitive peripheral magnetic stimulation(rPMS)+repetitive transcranial magnetic stimulation(rTMS),intermittent theta-burst stimulation(iT-BS)+rPMS,iTBS+transcranial direct current stimulation(tDCS),transcutaneous electrical acupoint stimula-tion(TEAS)and contralaterally controlled functional electrical stimulation(CCFES).tDCS was the most effec-tive on MBI,followed by TEAS and iTBS+rPMS.Evidence quality for FMA-UE and MBI was moderate.Funnel plots suggested low risk of publication bias,and consistency tests verified good coherence between direct and in-direct comparisons in network models. Conclusion Electromagnetic stimulation significantly facilitates upper limb and hand functional recovery,and improves ADL in stroke patients.The combined central-peripheral magnetic stimulation protocol may be the most effective on motor rehabilitation,whereas tDCS on ADL.
刘姗;杨家海;李蕊;许坤尧;周芷萌;周凌云;曾茂;何莎;代洛阳;覃婷;胡庆林
贵州中医药大学第二临床医学院,贵州 贵阳市 550002贵州中医药大学第二临床医学院,贵州 贵阳市 550002北京积水潭医院贵州医院康复科,贵州 贵阳市 550014贵州中医药大学第二临床医学院,贵州 贵阳市 550002贵州中医药大学第二临床医学院,贵州 贵阳市 550002贵州中医药大学第二附属医院老年医学科,贵州 贵阳市 550002贵州中医药大学骨伤学院,贵州 贵阳市 550002北京积水潭医院贵州医院康复科,贵州 贵阳市 550014北京积水潭医院贵州医院康复科,贵州 贵阳市 550014北京积水潭医院贵州医院康复科,贵州 贵阳市 550014北京积水潭医院贵州医院康复科,贵州 贵阳市 550014
医药卫生
脑卒中电磁刺激手功能日常生活活动能力网状Meta分析
strokeelectromagnetic stimulationhand functionactivities of daily livingnetwork meta-analysis
《中国康复理论与实践》 2026 (8)
916-926,11
贵州省高层次创新型人才"千层次"人才培养项目(No.gzwjrs 2023-009) Supported by Guizhou High-level Innovative Talents Training Project(Thousand-level Talents)(No.gzwjrs 2023-009)
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