Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke

Background. Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective. To systematically evaluate the effect of NIBS on dysphagia after stroke and compa...

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Autores principales:	Lingling Li, Hailiang Huang, Yuqi Jia, Ying Yu, Zhiyao Liu, Xin Shi, Fangqi Wang
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/95dce12f523441e59aab036066dd15c8
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spelling	oai:doaj.org-article:95dce12f523441e59aab036066dd15c82021-11-15T01:20:13ZSystematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke1687-544310.1155/2021/3831472https://doaj.org/article/95dce12f523441e59aab036066dd15c82021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/3831472https://doaj.org/toc/1687-5443Background. Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective. To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS. Methods. Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Results. Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference SMD=1.44, 95% CI 0.80 to 2.08, P<0.05) and the water swallow test score (SMD=6.23, 95% CI 5.44 to 7.03, P<0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD=−1.04, 95% CI -1.50 to -0.58, P<0.05), the penetration-aspiration scale (PAS) score (SMD=−0.85, 95% CI -1.33 to -0.36, P<0.05), and the functional dysphagia scale score (SMD=−1.05, 95% CI -1.48 to -0.62, P<0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS P=0.52>tDCS P=0.48, the best probabilistic ranking of the SSA score is rTMS P=0.72>tDCS P=0.28, and the best probabilistic ranking of the PAS score is rTMS P=0.68>tDCS P=0.32. Conclusion. Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.Lingling LiHailiang HuangYuqi JiaYing YuZhiyao LiuXin ShiFangqi WangHindawi LimitedarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENNeural Plasticity, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Lingling Li Hailiang Huang Yuqi Jia Ying Yu Zhiyao Liu Xin Shi Fangqi Wang Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke
description	Background. Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective. To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS. Methods. Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Results. Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference SMD=1.44, 95% CI 0.80 to 2.08, P<0.05) and the water swallow test score (SMD=6.23, 95% CI 5.44 to 7.03, P<0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD=−1.04, 95% CI -1.50 to -0.58, P<0.05), the penetration-aspiration scale (PAS) score (SMD=−0.85, 95% CI -1.33 to -0.36, P<0.05), and the functional dysphagia scale score (SMD=−1.05, 95% CI -1.48 to -0.62, P<0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS P=0.52>tDCS P=0.48, the best probabilistic ranking of the SSA score is rTMS P=0.72>tDCS P=0.28, and the best probabilistic ranking of the PAS score is rTMS P=0.68>tDCS P=0.32. Conclusion. Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.
format	article
author	Lingling Li Hailiang Huang Yuqi Jia Ying Yu Zhiyao Liu Xin Shi Fangqi Wang
author_facet	Lingling Li Hailiang Huang Yuqi Jia Ying Yu Zhiyao Liu Xin Shi Fangqi Wang
author_sort	Lingling Li
title	Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke
title_short	Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke
title_full	Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke
title_fullStr	Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke
title_full_unstemmed	Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke
title_sort	systematic review and network meta-analysis of noninvasive brain stimulation on dysphagia after stroke
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/95dce12f523441e59aab036066dd15c8
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Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke

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