Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials
BackgroundNon-invasive brain stimulation (NIBS) techniques and mirror therapy (MT) are promising rehabilitation measures for stroke. While the combination of MT and NIBS has been employed for post-stroke upper limb motor functional rehabilitation, its effectiveness has not been examined.ObjectiveThi...
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| Format: | Article |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.918956/full |
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| author | Qingqing Zhao Qingqing Zhao Hong Li Yu Liu Yu Liu Haonan Mei Liying Guo Liying Guo Xianying Liu Xianying Liu Xiaolin Tao Jiang Ma |
| author_facet | Qingqing Zhao Qingqing Zhao Hong Li Yu Liu Yu Liu Haonan Mei Liying Guo Liying Guo Xianying Liu Xianying Liu Xiaolin Tao Jiang Ma |
| author_sort | Qingqing Zhao |
| collection | DOAJ |
| description | BackgroundNon-invasive brain stimulation (NIBS) techniques and mirror therapy (MT) are promising rehabilitation measures for stroke. While the combination of MT and NIBS has been employed for post-stroke upper limb motor functional rehabilitation, its effectiveness has not been examined.ObjectiveThis study aimed to evaluate the effectiveness of combined MT and NIBS in the recovery of upper limb motor function in stroke patients.MethodsThe search was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG and VIP until December 2021. Randomized clinical trials (RCTs) comparing MT or NIBS alone with the combination of NIBS and MT in improving upper extremity motor recovery after stroke were selected. A meta-analysis was performed to calculate the mean differences (MD) or the standard mean differences (SMD) and 95% confidence intervals (CI) with random-effect models. Subgroup analyses were also conducted according to the types of control group, the types of NIBS, stimulation timing and phase poststroke.ResultsA total of 12 articles, including 17 studies with 628 patients, were reviewed in the meta-analysis. In comparison with MT or NIBS alone, the combined group significantly improved body structure and function (MD = 5.97; 95% CI: 5.01–6.93; P < 0.05), activity levels (SMD = 0.82; 95% CI 0.61–1.02; P < 0.05). For cortical excitability, the motor evoked potential cortical latency (SMD = −1.05; 95% CI:−1.57–−0.52; P < 0.05) and the central motor conduction time (SMD=-1.31 95% CI:−2.02-−0.61; P < 0.05) of the combined group were significantly shortened. A non-significant homogeneous summary effect size was found for MEP amplitude (SMD = 0.47; 95%CI = −0.29 to 1.23; P = 0.23). Subgroup analysis showed that there is an interaction between the stimulation sequence and the combined treatment effect.ConclusionIn this meta-analysis of randomized clinical trials, in comparison to the control groups, MT combined with NIBS promoted the recovery of upper extremity motor function after stroke, which was reflected in the analysis of body structure and function, activity levels, and cortical excitability.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022304455. |
| first_indexed | 2024-04-12T07:09:49Z |
| format | Article |
| id | doaj.art-b41dfe08fcb24b1187165e23f5ab8436 |
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| language | English |
| last_indexed | 2024-04-12T07:09:49Z |
| publishDate | 2022-07-01 |
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| spelling | doaj.art-b41dfe08fcb24b1187165e23f5ab84362022-12-22T03:42:41ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-07-011310.3389/fneur.2022.918956918956Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trialsQingqing Zhao0Qingqing Zhao1Hong Li2Yu Liu3Yu Liu4Haonan Mei5Liying Guo6Liying Guo7Xianying Liu8Xianying Liu9Xiaolin Tao10Jiang Ma11Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaCollege of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, ChinaDepartment of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaDepartment of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaFaculty of Graduate Studies, Hebei Medical University, Shijiazhuang, ChinaCollege of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, ChinaDepartment of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaCollege of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, ChinaDepartment of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaFaculty of Graduate Studies, Hebei Medical University, Shijiazhuang, ChinaDepartment of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaDepartment of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, ChinaBackgroundNon-invasive brain stimulation (NIBS) techniques and mirror therapy (MT) are promising rehabilitation measures for stroke. While the combination of MT and NIBS has been employed for post-stroke upper limb motor functional rehabilitation, its effectiveness has not been examined.ObjectiveThis study aimed to evaluate the effectiveness of combined MT and NIBS in the recovery of upper limb motor function in stroke patients.MethodsThe search was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG and VIP until December 2021. Randomized clinical trials (RCTs) comparing MT or NIBS alone with the combination of NIBS and MT in improving upper extremity motor recovery after stroke were selected. A meta-analysis was performed to calculate the mean differences (MD) or the standard mean differences (SMD) and 95% confidence intervals (CI) with random-effect models. Subgroup analyses were also conducted according to the types of control group, the types of NIBS, stimulation timing and phase poststroke.ResultsA total of 12 articles, including 17 studies with 628 patients, were reviewed in the meta-analysis. In comparison with MT or NIBS alone, the combined group significantly improved body structure and function (MD = 5.97; 95% CI: 5.01–6.93; P < 0.05), activity levels (SMD = 0.82; 95% CI 0.61–1.02; P < 0.05). For cortical excitability, the motor evoked potential cortical latency (SMD = −1.05; 95% CI:−1.57–−0.52; P < 0.05) and the central motor conduction time (SMD=-1.31 95% CI:−2.02-−0.61; P < 0.05) of the combined group were significantly shortened. A non-significant homogeneous summary effect size was found for MEP amplitude (SMD = 0.47; 95%CI = −0.29 to 1.23; P = 0.23). Subgroup analysis showed that there is an interaction between the stimulation sequence and the combined treatment effect.ConclusionIn this meta-analysis of randomized clinical trials, in comparison to the control groups, MT combined with NIBS promoted the recovery of upper extremity motor function after stroke, which was reflected in the analysis of body structure and function, activity levels, and cortical excitability.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022304455.https://www.frontiersin.org/articles/10.3389/fneur.2022.918956/fullstrokemirror therapy (MT)non-invasive brain stimulation (NIBS)upper motor functionrepetitive transcranial magnetic stimulation (rTMS)transcranial direct current stimulation (tDCS) |
| spellingShingle | Qingqing Zhao Qingqing Zhao Hong Li Yu Liu Yu Liu Haonan Mei Liying Guo Liying Guo Xianying Liu Xianying Liu Xiaolin Tao Jiang Ma Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials Frontiers in Neurology stroke mirror therapy (MT) non-invasive brain stimulation (NIBS) upper motor function repetitive transcranial magnetic stimulation (rTMS) transcranial direct current stimulation (tDCS) |
| title | Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials |
| title_full | Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials |
| title_fullStr | Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials |
| title_full_unstemmed | Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials |
| title_short | Non-invasive brain stimulation associated mirror therapy for upper-limb rehabilitation after stroke: Systematic review and meta-analysis of randomized clinical trials |
| title_sort | non invasive brain stimulation associated mirror therapy for upper limb rehabilitation after stroke systematic review and meta analysis of randomized clinical trials |
| topic | stroke mirror therapy (MT) non-invasive brain stimulation (NIBS) upper motor function repetitive transcranial magnetic stimulation (rTMS) transcranial direct current stimulation (tDCS) |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.918956/full |
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