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A Systematic Review and Meta‐Analysis on the Use of Repetitive Transcranial Magnetic Stimulation for Spasticity Poststroke
Author(s) -
McIntyre Amanda,
Mirkowski Magdalena,
Thompson Spencer,
Burhan Amer M.,
Miller Tom,
Teasell Robert
Publication year - 2018
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2017.10.001
Subject(s) - medicine , spasticity , transcranial magnetic stimulation , meta analysis , stroke (engine) , randomized controlled trial , physical therapy , modified ashworth scale , physical medicine and rehabilitation , wrist , rehabilitation , population , sample size determination , inclusion and exclusion criteria , surgery , stimulation , mechanical engineering , statistics , alternative medicine , environmental health , mathematics , pathology , engineering
Abstract Background Spasticity is a common and potentially debilitating complication that develops after stroke, arising in approximately 30% of patients. Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in improving spasticity after stroke. Design Meta‐analysis and systematic review. Setting Not applicable. Patients A total of 273 poststroke (hemorrhagic = 123, ischemic = 150) participants were included with sample sizes ranging from 5 to 80. The majority of participants were male (66.0%) with a mean age ranging from 55.0 to 64.6 years. Mean stroke duration ranged from 6 months to 10 years. Methods A literature search of multiple databases was conducted for articles published in English from January 1980 to April 2015 using select keywords. Studies were included if (1) the population included was >50% stroke patients; (2) the sample size included ≥4 subjects; (3) the intervention applied was rTMS; and (4) upper extremity spasticity was assessed pre‐ and postintervention. Randomized controlled trials (RCTs) were assessed for methodologic quality with the Physiotherapy Evidence Database tool. All research designs were given a level of evidence according to a modified Sackett Scale. Main Outcome Measurements Modified Ashworth Scale (MAS). Results Ten studies met the inclusion criteria: 2 RCTs (Physiotherapy Evidence Database scores 8‐9) and 8 pre‐post studies. Meta‐analyses of primarily uncontrolled pre‐post studies found significant improvements in MAS for elbow ( P < .001), wrist ( P < .001), and finger flexors ( P < .001). However, a meta‐analysis of the 2 available RCTs failed to find a significant rTMS treatment effect on MAS for the wrist (standardized difference = .34, P = .30). Conclusions There is limited available evidence to support the use of rTMS in improving spasticity poststroke. Despite the positive findings reported, better powered and appropriately controlled trials are necessary. Level of Evidence II