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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2023, Vol. 13 ›› Issue (02) : 75 -83. doi: 10.3877/cma.j.issn.2095-123X.2023.02.002

临床研究

基于虚拟现实技术施经颅直流电刺激对脑卒中患者上肢功能影响的Meta分析
姜佳慧, 毕鸿雁†()   
  1. 250355　济南，山东中医药大学康复医学院
    250014　济南，山东中医药大学附属医院康复科
  • 收稿日期:2022-05-10 出版日期:2023-04-15
  • 通信作者: 毕鸿雁

Meta-analysis of the effect of transcranial direct current stimulation on upper limb function in stroke patients based on virtual reality technology

Jiahui Jiang, Hongyan Bi†()   

  1. Rehabilitation Medicine College, Shandong University of Traditional Chinese Medicine, Ji'nan 250355, China
    Department of Rehabilitation, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Ji'nan 250014, China
  • Received:2022-05-10 Published:2023-04-15
  • Corresponding author: Hongyan Bi
  • Supported by:
    Key Projects of Chinese Medicine Science and Technology in Shandong Province(2020Z04)
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引用本文：

姜佳慧, 毕鸿雁. 基于虚拟现实技术施经颅直流电刺激对脑卒中患者上肢功能影响的Meta分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(02): 75-83.

Jiahui Jiang, Hongyan Bi. Meta-analysis of the effect of transcranial direct current stimulation on upper limb function in stroke patients based on virtual reality technology[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(02): 75-83.

目的

系统评价基于虚拟现实（VR）技术施经颅直流电刺激（tDCS）对脑卒中患者上肢功能的有效性。

方法

计算机检索PubMed、EMBASE、Web of Science、Cochrane Library、中国知网和万方数据库，筛选在VR技术的基础上施tDCS治疗脑卒中患者上肢功能的随机对照研究。使用PEDro量表和Cochrane风险评估工具进行质量评价和偏倚风险评估。运用Review Manager5.3软件对纳入文献进行Meta分析、亚组分析、敏感性分析及发表偏倚分析。

结果

共纳入6篇文献、159例患者。试验组上肢Fugl-Meyer运动功能量表、黑盒测试、改良Ashworth痉挛量表和改良Barthel指数评分与对照组比较，差异有统计学意义（MD=3.38，95%CI：0.57~6.19，P<0.05；MD=6.20，95%CI：2.67~9.74，P<0.05；MD=-0.33，95%CI：-0.62~-0.05，P<0.05；MD=9.65，95%CI：4.28~15.01，P<0.05）；Wolf运动功能量表任务表现和完成时间比较，差异无统计学意义（MD=0.27，95%CI：-0.63~1.16，P>0.05；MD=-0.25，95%CI：-4.25~3.75，P>0.05）。

结论

在VR技术的基础上施tDCS有利于脑卒中患者上肢运动功能的恢复，对提高手的灵活性、降低肌张力和改善生活质量也表现出积极作用。

关键词: 经颅直流电刺激, 虚拟现实, 脑卒中, 上肢功能, Meta分析
Objective

To systematically evaluate the effectiveness of virtual reality (VR)-based administration of transcranial direct current stimulation on upper limb function in stroke patients.

Methods

A computer search of PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang Data was conducted to screen a randomised controlled study of upper limb function in stroke patients using transcranial direct current stimulation based on virtual reality technology. The PEDro scale and the Cochrane Risk Assessment Tool were used for quality assessment and risk of bias assessment. Meta-analysis, subgroup analysis, sensitivity analysis and publication bias analysis were performed on the included literature using Review Manager 5.3 software.

Results

A total of 6 papers and 159 patients were included. The scores of Fugl-Meyer motor function scale, Black box testing, modified Ashworth spasticity scale and modified Barthel index in the test group were significantly different from those in the control group (MD=3.38, 95%CI: 0.57-6.19, P<0.05; MD=6.20, 95%CI: 2.67-9.74, P<0.05; MD=0.33, 95%CI: 0.62-0.05, P<0.05; MD=9.65, 95%CI: 4.28-15.01, P<0.05); There was no statistically significant difference in Wolf motor function scale task performance and completion time (MD=0.27, 95%CI: -0.63-1.16, P>0.05; MD=-0.25, 95%CI: -4.25-3.75, P>0.05).

Conclusion

Transcranial direct current stimulation based on virtual reality techniques is beneficial for the recovery of upper limb motor function in stroke patients, and has shown positive effects on improving manual dexterity, reducing muscle tone and improving quality of life.

Key words: Transcranial direct current stimulation, Virtual reality, Stroke, Upper limb function, Meta-analysis
表1 检索策略
Tab.1 Search strategy
文献类型 检索策略
中文 （脑卒中OR中风OR脑血管意外OR脑栓塞OR脑梗OR偏瘫OR脑血栓OR蛛网膜下腔出血OR脑出血）AND（经颅直流电刺激）AND（虚拟现实OR视频游戏OR电脑游戏OR游戏干预）
英文（以PubMed为例） 1、"Stroke" [Mesh]
2、"Stroke" [Title/Abstract] OR "cerebrovascular accidents" [Title/Abstract] OR "cerebrovascular apoplexy" [Title/Abstract] OR "brain vascular accidents" [Title/Abstract] OR "cerebrovascular strokes" [Title/Abstract] OR "apoplexy" [Title/Abstract] OR "cerebral strokes" [Title/Abstract] OR "acute strokes" [Title/Abstract] OR "acute cerebrovascular accidents" [Title/Abstract]
3、"Transcranial Direct Current Stimulation" [Mesh]
4、"Transcranial Direct Current Stimulation" [Title/Abstract]
5、"Virtual Reality" [Mesh]
6、"Virtual Reality" [Title/Abstract] OR "Video Game" [Title/Abstract] OR "Computer Game" [Title/Abstract] OR "Game Intervention" [Title/Abstract]
7、"Upper Extremity" [Mesh]
8、"Upper Extremities" [Title/Abstract] OR "Upper Limb" [Title/Abstract] OR "Upper Limbs" [Title/Abstract]
9、1 AND 2
10、7 AND 8
11、6 AND 8 AND 9 AND 10
并查找相关研究的参考文献
图1 文献筛选流程图
Fig.1 Literature screening flow chart
表2 纳入文献的基本特征
Tab.2 Basic characteristics of the included literature
文献 分期 样本量（例） 年龄（岁，Mean±SD） 干预措施 干预参数 频率 疗程 结局指标
试验组 对照组 试验组 对照组 试验组 对照组
Lee和Chun[12]，2014 亚急性期 20 20 63.1±10.3 60.6±14.1 VR+tDCS VR tDCS：电极表面25 cm2
电流强度2 mA
VR:游戏情景互动		 30 min/次，5次/周 3周 ①③④⑤
Viana等[13]，2014 慢性期 10 10 56.0±10.2 55.0±12.2 VR+tDCS VR+假tDCS刺激 tDCS：电极表面35 cm2
电流最大输出2 mA
VR:交互式任务模拟：Wii游戏		 60 min/次，3次/周 5周 ①②④
Yao等[14]，2020 亚急性期+慢性期 10 10 63.0±7.5 66.2±6.2 VR+tDCS VR+假tDCS刺激 tDCS：电极表面35 cm2
电流刺激强度2 mA
VR：游戏情景互动：傅里叶智能系统		 20 min/次，5次/周 2周 ⑤
Lee和Cha[15]，2022 亚急性期 10 10 67.5±6.74 65.0±5.73 VR+tDCS VR+假tDCS刺激 tDCS：未提及
电流强度2 mA
VR：交互式任务模拟：佩戴Rapael智能手套		 20 min/次，5次/周 4周 ③
刘远文等[16]，2020 恢复期 15 15 62.86±9.05 64.53±9.59 VR+tDCS VR tDCS：电极表面25 cm2
电流刺激强度2 mA
电流密度0.057 mA/cm2
VR：游戏情景互动：ViRehab情景互动		 20 min/次，5次/周 4周 ①②⑤
Llorens等[17]，2021 慢性期 14 15 57.6±6.9 52.3±10.9 VR+tDCS VR+假tDCS刺激 tDCS：电极表面25 cm2
电流刺激强度2 mA
VR：交互式任务模拟：佩戴EyeX		 30 min/次，3~5 d/周 4周 ①②
图2 纳入研究的偏倚风险项目百分比
Fig.2 Percentage of risk of bias items included in the study
图3 偏倚风险评估结果
Fig.3 Results of bias risk assessment
图4 2组患者上肢Fugl-Meyer运动功能量表评分的比较
Fig.4 Comparison of upper extremity Fugl-Meyer assessment scores between 2 groups
图5 上肢Fugl-Meyer运动功能量表纳入研究的漏斗图
Fig.5 Funnel plot of upper extremity Fugl-Meyer assessment included studies
图6 2组患者的Wolf运动功能量表评分的比较
Fig.6 Comparison of Wolf motor function test scores between 2 groups
图7 2组患者黑盒测试评分的比较
Fig.7 Comparison of box and block test scores between 2 groups
图8 2组患者改良Ashworth痉挛量表评分的比较
Fig.8 Comparison of modified Ashworth scale scores between 2 groups
图9 2组患者改良Barthel指数评分的比较
Fig.9 Comparison of modified Barthel index scores between 2 groups
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