目的:卒中后吞咽困难是一种常见的卒中后吞咽障碍,导致吸入性肺炎和营养不良的风险增加。迫切需要有效和安全的干预措施来康复。这篇综述旨在回答两个关键的科学问题:(1)重复经颅磁刺激在卒中后吞咽困难康复中的功效如何?(2)重复经颅磁刺激是卒中后吞咽困难的安全干预措施吗?
方法:对四个电子数据库进行了全面搜索:PubMed,科克伦图书馆,WebofScience,和Embase。搜索旨在确定与我们感兴趣的主题有关的相关研究,并于2024年5月28日完成。
方法:根据PRISMA清单,对四个数据库进行了全面搜索,其中确定了13项相关的系统评价。纳入标准为系统评价重复经颅磁刺激治疗卒中后吞咽困难的疗效和安全性。排除标准是不关注卒中后吞咽困难或不评估重复经颅磁刺激作为治疗干预的综述。质量,偏见,reporting,使用经过验证的工具评估这些评论的总体证据质量,包括用于评估系统评价方法质量的AMSTAR2工具,用于评估偏差风险的ROBIS工具,和评估证据总体质量的等级方法。这种严格的方法确保我们的审查提供了有关使用重复经颅磁刺激治疗中风后吞咽困难的当前知识状态的全面和可靠的概述。
结果:纳入系统评价/荟萃分析的个别研究的样本量为66至555。纳入总体分析的所有研究的参与者总数为752。证据受到系统评价的方法论缺陷和异质性的限制。证据的质量从高到低不等,大多数结果质量适中。未来的研究应该采取更严格的,标准化,和全面的设计,以确认重复经颅磁刺激治疗卒中后吞咽困难的有效性和安全性。降低证据质量的主要原因是主要研究的样本量小和异质性高。
结论:本综述综合了重复经颅磁刺激治疗吞咽困难的研究,旨在为临床和政策决策提供信息。然而,目前的证据并不能最终确定重复经颅磁刺激用于卒中后吞咽困难康复的安全性和有效性.审查的研究质量各不相同,许多质量很差。因此,虽然一些研究表明重复经颅磁刺激的潜在益处,这些发现应谨慎解释.迫切需要更严格的,高质量的研究,以验证重复经颅磁刺激在卒中后吞咽困难康复中的应用。一旦我们拥有更强大的能力,这些发现对临床实践和政策的影响将更加清晰,基于证据的建议。
OBJECTIVE: Post-stroke dysphagia is a common swallowing disorder that occurs after a stroke, leading to an increased risk of aspiration pneumonia and malnutrition. There is a pressing need for effective and safe interventions for its rehabilitation. This review aims to answer two key scientific questions: (1) What is the efficacy of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke dysphagia? (2) Is repetitive transcranial magnetic stimulation a safe intervention for post-stroke dysphagia?
METHODS: A comprehensive search was conducted across four electronic databases: PubMed, Cochrane Library, Web of Science, and Embase. The search aimed to identify relevant studies concerning our topic of interest and was completed on 28 May 2024.
METHODS: In accordance with the PRISMA checklist, a comprehensive search of four databases was conducted, which identified 13 relevant systematic reviews. The inclusion criteria were systematic reviews that evaluated the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Exclusion criteria were reviews that did not focus on post-stroke dysphagia or did not evaluate repetitive transcranial magnetic stimulation as a therapeutic intervention. The quality, bias, reporting, and overall
evidence quality of these reviews were assessed using validated tools, including the AMSTAR 2 tool for assessing the methodological quality of systematic reviews, the ROBIS tool for assessing the risk of bias, and the GRADE approach for evaluating the overall quality of
evidence. This rigorous approach ensures that our review provides a comprehensive and reliable overview of the current state of knowledge on the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia.
RESULTS: The sample sizes for the individual studies included in the systematic reviews/meta-analyses ranged from 66 to 555. The total number of participants across all studies included in the overall analyses was 752. The
evidence was limited by the methodological flaws and heterogeneity of the systematic reviews. The quality of the
evidence varied from high to low, with most outcomes having moderate quality. Future research should adopt more rigorous, standardized, and comprehensive designs to confirm the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. The main reason for downgrading the
evidence quality was the small sample size and high heterogeneity of the primary studies.
CONCLUSIONS: This overview synthesized research on repetitive transcranial magnetic stimulation for dysphagia, aiming to inform clinical and policy decisions. However, the current evidence does not conclusively establish the safety and efficacy of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The studies reviewed varied in quality, and many were of poor quality. Therefore, while some studies suggest potential benefits of repetitive transcranial magnetic stimulation, these findings should be interpreted with caution. There is a pressing need for more rigorous, high-quality research to validate the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The implications of these findings for clinical practice and policy will be clearer once we have more robust, evidence-based recommendations.