Network meta-analysis of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke

doi:10.12307/2025.967

Abstract

Abstract: OBJECTIVE: Most of the existing studies are based on traditional Meta-analysis to study the efficacy of single stimulation protocols such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation on lower limb motor dysfunction in stroke patients, and it is not possible to clarify which stimulation protocol is the optimal choice. This study used network meta-analysis to systematically evaluate the clinical efficacy of different regimens of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke.
METHODS: CNKI, WanFang, VIP, CBM, PubMed, Medline and Web of Science databases were searched to collect randomized controlled trials on different regimens of non-invasive brain stimulation for lower limb motor dysfunction after stroke from inception to October 1, 2024. Data extraction was performed on the included studies. RevMan 5.4.1 software was used for traditional meta-analysis and the quality of the included studies was evaluated. Stata 17.0 software was used for network meta-analysis.
RESULTS: (1) A total of 39 studies involving 2 920 patients were included, involving 6 treatment methods: conventional rehabilitation training, high-frequency repetitive transcranial magnetic stimulation, low-frequency repetitive transcranial magnetic stimulation, intermittent theta burst stimulation, continuous theta burst stimulation, and transcranial direct current stimulation. (2) The results of network meta-analysis showed that high-frequency repetitive transcranial magnetic stimulation, low-frequency repetitive transcranial magnetic stimulation, intermittent theta burst stimulation, and transcranial direct current stimulation were superior to conventional rehabilitation training in the Fugl-Meyer assessment for lower extremity motor function. (3) In terms of improving Berg balance scale score, high-frequency repetitive transcranial magnetic stimulation, low-frequency repetitive transcranial magnetic stimulation, and intermittent theta burst stimulation were significantly different from conventional rehabilitation training (P < 0.05), and there was a significant difference between high-frequency repetitive transcranial magnetic stimulation and intermittent theta burst stimulation (P < 0.05). (4) In improving modified Barthel index and Barthel index, high-frequency repetitive transcranial magnetic stimulation, low-frequency repetitive transcranial magnetic stimulation, intermittent theta burst stimulation, and transcranial direct current stimulation were superior to conventional rehabilitation training. (5) Under the cumulative ranking chart, high-frequency repetitive transcranial magnetic stimulation showed the best efficacy in Fugl-Meyer assessment for lower extremity motor function, Berg balance scale score, modified Barthel index and Barthel index, followed by low-frequency repetitive transcranial magnetic stimulation.
CONCLUSION: Both high- and low-frequency repetitive transcranial magnetic stimulation can improve the lower limb motor function and balance function of patients with stroke, and can improve the activities of daily living of patients to varying degrees. Moreover, the effect of high-frequency repetitive transcranial magnetic stimulation is better than that of low-frequency repetitive transcranial magnetic stimulation.

Key words: stroke, non-invasive brain stimulation, lower limb function, network meta-analysis, systematical evaluation

CLC Number:

Yang Yuanyuan, Zhou Shanshan, Cheng Xiaofei, Feng Luye, Tang Jiqin. Network meta-analysis of non-invasive brain stimulation in the treatment of lower limb motor dysfunction after stroke[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(4): 1008-1018.

Figures/Tables 13

仍较高，遂采用随机效应模型进行分析，对结果仅做描述性分析。结果显示，高频重复经颅磁刺激、低频重复经颅磁刺激、间歇性θ爆发刺激、经颅直流电刺激与常规康复训练比较均能显著提高患者的Fugl-Meyer下肢运动功能评定量表评分、Berg平衡量表评分、改良Barthel/Barthel指数，改善脑卒中患者的下肢运动功能、平衡功能以及提高患者的日常生活活动能力，见图4-6。 2.5 网状Meta分析结果 2.5.1 网状关系图如网状关系图所示，此次研究所有结局指标网状关系图均没有形成闭环(图7)，图中以常规康复训练为中心，大致呈放射状结构；图中节点表示各干预措施总的样本量大小，此次研究以常规康复训练样本量以及低频重复经颅磁刺激总样本量居多；两节点之间的连线代表2个节点干预措施的直接比较，线段粗细表示研究数量的多少，此次研究以常规康复训练和低频重复经颅磁刺激以及常规康复训练和高频重复经颅磁刺激直接比较的研究量居多。 2.5.2 Fugl-Meyer下肢运动功能评定量表评分纳入研究中有38篇文献报了Fugl-Meyer下肢运动功能评定量表评分[13-50]，共6种干预措施，网状Meta结果显示，常规康复训练与高频重复经颅磁刺激[MD=3.83，95%CI(2.57，5.10)]、低频重复经颅磁刺激[MD=3.68，95%CI(2.67，4.68)]、间歇性θ爆发刺激[MD=2.97，95%CI(0.89，5.05)]、经颅直流电刺激[MD=3.24，95%CI(1.23，5.25)]比较差异有显著性意义(P < 0.05)；常规康复训练与连续性θ爆发刺激[MD=3.76，95%CI(-0.08，7.60)]比较无统计学差异(P > 0.05)，因此尚无明确证据表明，连续性θ爆发刺激在改善脑卒中患者下肢运动功能中优于常规康复训练；其余5种治疗措施间两两比较，结果显示差异均无显著性意义(P < 0.05)，见表3。累积排序图结果显示第一为高频重复经颅磁刺激(70.4%)，其次为低频重复经颅磁刺激(65.8%)，后面各干预措施从大到小依次为连续性θ爆发刺激(64.5%)、经颅直流电刺激(52.9%)、间歇性θ爆发刺激(45.8%)、常规康复训练(0.7%)，见图8A。"

2.5.3 Berg平衡量表评分纳入研究中有21篇文献报道了Berg平衡量表评分[23-42，51]，共6种干预措施，网状Meta结果显示，常规康复训练与高频重复经颅磁刺激[MD=11.17，95%CI(6.66，15.68)]、低频重复经颅磁刺激[MD=7.90，95%CI(5.00，10.79)]、间歇性θ爆发刺激[MD=4.98，95%CI(1.21，8.74)]比较差异有显著性意义(P < 0.05)；常规康复训练与连续性θ爆发刺激[MD=4.94，95%CI(-3.29，13.17)]、经颅直流电刺激[MD=4.71，95%CI(-1.50，10.91)]比较无统计学差异(P > 0.05)，说明目前无明确证据表明，连续性θ爆发刺激与经颅直流电刺激在改善脑卒中患者下肢平衡功能方面优于常规康复训练；高频重复经颅磁刺激与间歇性θ爆发刺激[MD=6.19，95%CI(0.32，12.07)]比较差异有显著性意义(P < 0.05)；其余治疗措施间两两比较无统计学差异(P > 0.05)，见表4。累积排序图结果显示第一为高频重复经颅磁刺激(94.4%)，其次为低频重复经颅磁刺激(71.3%)，后面各干预措施从大到小依次为连续性θ爆发刺激(45.3%)、间歇性θ爆发刺激(42.8%)、经颅直流电刺激(42.2%)、常规康复训练(3.9%)，见图8B。 2.5.4 改良Barthel/Barthel指数纳入研究中有22篇文献报道了改良Barthel/Barthel指数[13-34]，涉及5种干预措施，网状Meta结果显示，常规康复训练与高频重复经颅磁刺激[MD=9.46，95%CI(5.84，13.07)]、低频重复经颅磁刺激[MD=8.85，95%CI(5.19，12.50)]、间歇性θ爆发刺激[MD=6.36，95%CI(0.01，12.71)]、经颅直流电刺激[MD=8.75，95%CI (1.55，15.95)]比较差异有显著性意义(P < 0.05)；其余治疗措施间比较无统计学差异(P > 0.05)，见表5。累积排序图结果显示第一为高频重复经颅磁刺激(74.0%)，其次为低频重复经颅磁刺激(66.7%)，后面各干预措施从大到小依次为经颅直流电刺激(64.9%)、间歇性θ爆发刺激(43.4%)、常规康复训练(1.0%)，见图8C。 2.6 发表偏倚 Fugl-Meyer下肢运动功能评定量表评分漏斗图显示各研究大致分布在垂直线的周围及两侧，表明出现发表偏倚的可能性较少；Berg平衡量表评分、改良Barthel/Barthel指数漏斗图大致散在分布，有些研究落在了漏斗图以外，提示可能存在发表偏倚或小样本效应，具体原因可能是大部分文献未设置盲法和分配隐藏等，研究结果解释需谨慎(图9)。 2.7 GRADE证据质量评价通过分析各结局指标所纳入文献，可能由于多"

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