【論文摘要】The Effect of Transcranial Direct Current Stimulation on Activities of Daily Living in Stroke Patients: A Systematic Review

Abstract

Background and Purpose: Changes in interhemispheric activation balance after the occurrence of stroke have been postulated to impede the recovery of activities of daily living (ADL) among stroke patients. As a promising technique, transcranial direct current stimulation (tDCS) has gained much attention for its potential effects regarding restoration of motor function and ADL in cases of stroke. However, studies have reported inconsistent or conflicting results. The present systematic review investigates the effects of tDCS on ADL in stroke patients. Methods: Our literature search focused on tDCS studies that have investigated the effects on stroke patients' ADL. An initial search was carried out using the databases including MEDLINE, Embase, CINAHL, Amed, PubMed, Physiotherapy Evidence Database (PEDro), and airiti Library from May 2000 until June 2019. Keywords used including stroke, cerebrovascular accident, tDCS, and daily living. Studies were selected if met the following inclusion criteria: (1) studies on stroke patients, (2) multiple sessions of tDCS intervention, (3) assessment of the ADL before and after the intervention, (4) placebo-controlled study-design. The outcomes measures was ADL assessment by the Barthel index and functional independence measure. Two reviewers independently assessed the selected studies for bias and quality using the validated, reliable Cochrane Risk of Bias Tool and the PEDro scale respectively. Results: There were six articles were selected (N = 177, mean age = 57.2 ± 10.5). Additionally, studies included cases from onset to a range between 6.4 days and 18.5 months post-stroke. The PEDro scores ranged from 8 to 11 by the independent reviewers. These studies showed that subjects receiving tDCS (n = 89) had improvements in ADL ranging between 1.9% and 81.3% (average 34.3%) from baseline, while subjects receiving placebo-tDCS (n = 90) showed improvements in ADL ranging between 0% and 55.6% (average 18.0%) from baseline. Conclusion: This review shows the tDCS group had greater ADL recovery than the control group. Clinical Relevance: This study shows that the starting time of the intervention after stroke onset probably has a substantial impact on the efficacy of tDCS intervention, hence we suggest future studies could explore the efficacy in different timing of intervention.