The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials
BackgroundIntermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulat...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2023.1272003/full |
| _version_ | 1797660959415730176 |
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| author | Songbin Chen Songbin Chen Shunxi Zhang Wenqing Yang Yujie Chen Bingshui Wang Jixiang Chen Xiaotong Li Lanfang Xie Huangjie Huang Yangkang Zeng Lingling Tian Wenxue Ji Xijun Wei Yue Lan Hai Li |
| author_facet | Songbin Chen Songbin Chen Shunxi Zhang Wenqing Yang Yujie Chen Bingshui Wang Jixiang Chen Xiaotong Li Lanfang Xie Huangjie Huang Yangkang Zeng Lingling Tian Wenxue Ji Xijun Wei Yue Lan Hai Li |
| author_sort | Songbin Chen |
| collection | DOAJ |
| description | BackgroundIntermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke.ObjectiveThe purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life.MethodA literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD).ResultsTen studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: −0.56; 95% CI: −0.85 to −0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: −0.21 to 0.90; SMD: 0.35, 95% CI: −0.18 to 0.87; SMD: 0.03, 95% CI: −0.49 to 0.55; respectively).ConclusionOur results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739. |
| first_indexed | 2024-03-11T18:37:26Z |
| format | Article |
| id | doaj.art-fffca28cc5cb484e83f80831fdcc1967 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-03-11T18:37:26Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neuroscience |
| spelling | doaj.art-fffca28cc5cb484e83f80831fdcc19672023-10-12T17:00:20ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2023-10-011710.3389/fnins.2023.12720031272003The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trialsSongbin Chen0Songbin Chen1Shunxi Zhang2Wenqing Yang3Yujie Chen4Bingshui Wang5Jixiang Chen6Xiaotong Li7Lanfang Xie8Huangjie Huang9Yangkang Zeng10Lingling Tian11Wenxue Ji12Xijun Wei13Yue Lan14Hai Li15Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaDepartment of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Shenzhen University General Hospital, Shenzhen, ChinaDepartment of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaDepartment of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaDepartment of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaDepartment of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, ChinaBackgroundIntermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke.ObjectiveThe purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life.MethodA literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD).ResultsTen studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: −0.56; 95% CI: −0.85 to −0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: −0.21 to 0.90; SMD: 0.35, 95% CI: −0.18 to 0.87; SMD: 0.03, 95% CI: −0.49 to 0.55; respectively).ConclusionOur results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739.https://www.frontiersin.org/articles/10.3389/fnins.2023.1272003/fullstrokeintermittent theta burst stimulationupper limb functionmeta-analysisrehabilitation |
| spellingShingle | Songbin Chen Songbin Chen Shunxi Zhang Wenqing Yang Yujie Chen Bingshui Wang Jixiang Chen Xiaotong Li Lanfang Xie Huangjie Huang Yangkang Zeng Lingling Tian Wenxue Ji Xijun Wei Yue Lan Hai Li The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials Frontiers in Neuroscience stroke intermittent theta burst stimulation upper limb function meta-analysis rehabilitation |
| title | The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials |
| title_full | The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials |
| title_short | The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke a systematic review and meta analysis of randomized controlled trials |
| topic | stroke intermittent theta burst stimulation upper limb function meta-analysis rehabilitation |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2023.1272003/full |
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