| Purpose:By using the method of literature metrology,extracted clinical studies of repetitive transcranial magnetic stimulation(rTMS)on treatment of dysphagia after stroke.Using the methods of systematic review and Meta analysis in evidence-based medicine,to explore the clinical efficacy and safety of repetitive transcranial magnetic stimulation(rTMS)on treatment of dysphagia after stroke,in order to provide reference for further clinical research and practice.Method:According to the source database and the appropriate search terms,to develop effective retrieval strategies,comprehensive retrieval at home and abroad in large biomedical database,select the China biomedical literature database Chinese database(CBM),China Journal Full-text Database(CNKI),general information resource system(VIP)and Wanfang database(WanFang Med Online);English database including Pubmed,Springer,Cochrane Library and Embase.A comprehensive collection of published literature on repetitive transcranial magnetic stimulation in the treatment of dysphagia after stroke was published before December 2016,formulate strict inclusion and exclusion criteria,the process control of the collected literature by literature manager implementation of original documents,and to develop a data extraction form,the extracted data in each study.A total of two researchers were selected to screen the literature independently,to evaluate the quality of the literature,to extract data,and to determine the literature to be included.Meta analysis was carried out using Revman5.3 software provided by Cocharne Library website,and finally using the GRADE evidence classification system to classificate the combined results.Result:Bibliometric data shows,through the literature database screening of 255 articles(150 Chinese,English 105),after repeated screening and exclusion:do not meet the research theme and review included a total of 13 papers,including 13 English papers,0 Chinese papers.The publication time all concentrated after 2009;which 2 articles in 2009,2010、2011、2013 years each one,2014 pubished 3 articles,2015 pubished 2 articles each years,2016 pubished 3 articles.There are 8 articles for clinical RCT studies,4 for self-control study,1 paired design study.For the 4 self-control test,the sample size range from 4 to 7 cases,the remaining 9 group study included the number of subjects among 18 to 47,there were 5 studies with 2 groups or 2 groups of control group,the other 5 only including 1 test group and 1 control group.A total of 273 subjects were enrolled,which 162 in the treatment group and 111 in the control group.A total of 8 articles were included for Meta analysis,which the quality grade is "A" including 3 articles,the quality grade is "B" including 5 articles,the remaining 4 self-control study,1 paired design study did not merging data,the quality rating of them are "B".The outcome for Meta analysis including the penetration aspiration scale(PAS),functional dysphagia score(FDS),videofluoroscopic dysphagia scale(VDS),dysphagia outcome and severity score(DOSS),degree of dysphagia(DD),Barthel Index(BI),American speech language hearing association outcome evaluation system of swallowing function score(ASHA NOMS).Among them,7 articles measured in PAS,3 articles measured in FDS,2 articles measured in VDS,2 articles measured in DOSS,3 articles measured in DD,4 articles measured in BI,2 articles measured in ASHA NOMS.The result of the merger of PAS was statistically significant [SMD=-0.71,95%CI(-0.98,-0.44),P < 0.00001],FDS after the merger results were statistically significant [SMD=-0.57,95%CI(-0.91,-0.24),P =0.0008],VDS after the merger results were statistically significant [SMD=-0.50,95%CI(-0.87,-0.13),P =0.008],DOSS after the merger results the statistical significance of [SMD= 0.56,95%CI(0.21,0.91),P =0.002],DD after the merger have statistical significance [SMD=-4.09,95%CI(-4.74,-3.44),P < 0.00001],BI after the merger results were statistically significant [SMD= 0.64,95%CI(0.40,0.87),P < 0.00001],ASHA NOMS was not statistically significant after the merger [SMD= 0.37,95%CI(-0.03,0.78),P = 0.07].Conclusion:1.rTMS is effective in the treatment of dysphagia after stroke,and the difference can be maintained for a long time after the end of the treatment.2.The therapeutic effect of rTMS on PAS,FDS,VDS,DOSS,DD and BI in patients with dysphagia after stroke is consistent.3.There is no standard parameters of rTMS on the treatment of dysphagia after stroke,such as the choice of stimulus frequency,the choice of stimulation site and the stimulation time.At present,the main point of view is to stimulate the contralateral hemisphere in low frequency and stimulate the affected hemisphere with high frequency.The aim is to reduce the excitability of the healthy hemisphere and improve the excitability of the affected hemisphere.The main cortical area of stimulation was pharyngeal cortex.4.rTMS has no clinical adverse effects in the treatment of dysphagia after stroke. |
PDF Full Text Request