Different electromagnetic stimulation programs improve post-stroke dysphagia:a network Meta-analysis
- VernacularTitle:不同电磁刺激方案改善脑卒中后吞咽障碍的网状Meta分析
- Author:
Tong HU
1
;
Xuan LI
;
Jing YUAN
;
Wei WANG
Author Information
- Publication Type:Journal Article
- Keywords: dysphagia; neuromuscular electrical stimulation; transcranial magnetic stimulation; transcranial direct current stimulation; electromyographic biofeedback therapy; peripheral magnetic stimulation; physical therapy; stroke; functional restoration; network meta
- From: Chinese Journal of Tissue Engineering Research 2025;29(24):5224-5236
- CountryChina
- Language:Chinese
- Abstract: OBJECTIVE:To conduct a network Meta-analysis to assess the efficacy of various electromagnetic stimulation programs in managing post-stroke dysphagia and identify the optimal stimulation program.METHODS:A comprehensive search was conducted across multiple databases,including CNKI,VIP,WanFang,the Chinese Biomedical Literature Database,PubMed,Web of Science,Embase,and The Cochrane Library.The search terms included"electric stimulation,""magnetic stimulation,""stroke,"and"deglutition disorders"in Chinese and English.The aim was to collect clinical randomized controlled trials evaluating various electromagnetic stimulation programs for the treatment of post-stroke dysphagia.The control group underwent conventional swallowing training,whereas the experimental group received electromagnetic stimulation in addition to the control treatment.The search was limited to publications from the inception of the databases until May 11,2024.EndNote X9 software was utilized for literature management,and the Cochrane risk of bias assessment tool along with the revised Jadad scale was used to assess the risk of bias and the quality of the included studies.Direct Meta-analysis and network Meta-analysis were performed on the functional oral intake scale score,leakage-aspiration grade score,and swallowing muscle group electromyographic activity score index using RevMan 5.4 software and Stata 17 software.The strength of evidence for the outcome indicators was evaluated in accordance with the GRADE evidence level and recommendation strength grading standards.RESULTS:A total of 59 studies were included in this analysis,comprising 50 high-quality documents and 9 low-quality documents,with a collective sample size of 3 801 patients and encompassing 15 different electromagnetic stimulation programs.(1)In the evaluation of feeding ability,the top five electromagnetic stimulation programs,ranked by the area under the cumulative ranking probability chart(SUCRA),were repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation and neuromuscular electrical stimulation(99.4％)＞repetitive peripheral magnetic stimulation and neuromuscular electrical stimulation(80.8％)＞repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation(74.2％)＞repetitive transcranial magnetic stimulation and myoelectric biofeedback electrical stimulation(68.4％)＞transcranial direct current stimulation combined with neuromuscular electrical stimulation(63.2％).(2)In the assessment of anti-aspiration ability,the top five electromagnetic stimulation programs,ranked by the area under the cumulative ranking probability chart(SUCRA),were repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation and neuromuscular electrical stimulation(99.25％)＞repetitive transcranial magnetic stimulation combined with myoelectric biofeedback electrical stimulation(87.5％)＞repetitive transcranial magnetic stimulation combined with neuromuscular electrical stimulation(80.6％)＞repetitive pheriphal magnetic stimulation combined with neuromuscular electrical stimulation(66.7％)＞transcranial direct current stimulation combined with neuromuscular electrical stimulation(57.8％).(3)In the assessment of surface electromyographic activity levels in the swallowing muscles,the top five electromagnetic stimulation programs ranked by the area under the cumulative ranking probability chart(SUCRA)were repetitive transcranial magnetic stimulation combined with neuromuscular electrical stimulation(87.1％)＞repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation(86.3％)＞transcranial direct current stimulation combined with neuromuscular electrical stimulation(83.9％)＞myoelectric biofeedback electrical stimulation combined with neuromuscular electrical stimulation(77.8％)＞transcranial direct current stimulation combined with myoelectric biofeedback electrical stimulation(74.4％).CONCLUSION:Electromagnetic stimulation significantly improves swallowing function in patients with post-stroke dysphagia.Combined central and peripheral magnetic stimulation has the best effect on improving oral intale ability and anti-aspiration ability in stroke patients(medium-level evidence),followed by central magnetic stimulation combined with peripheral electrical stimulation(medium-level evidence).
