Archives of physical medicine and rehabilitation · 2025
Cathodal High-Definition Transcranial Direct Current Stimulation Primed Intermittent Theta-Burst Stimulation for Upper Limb Motor Recovery in Stroke: A Secondary Analysis.
СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Zhang Li, Huang Guilan, Bian Li, Song Da, Zheng Kai, Xu Xinlei, Dai Wenjun, Ren Caili, Shen Ying
Аннотация
OBJECTIVE: To identify baseline factors linked to a positive response to intermittent theta-burst stimulation (iTBS) in individuals with stroke.
DESIGN: Secondary analysis of a randomized controlled trial.
SETTING: A single rehabilitation hospital.
PARTICIPANTS: Sixty stroke patients (N=60) (mean age, 61.48±8.91y; 48 men), including both ischemic and hemorrhagic stroke types.
INTERVENTIONS: iTBS combined with routine rehabilitation.
MAIN OUTCOME MEASURES: Responders were defined as patients with a ≥7-point improvement in the Fugl-Meyer Assessment of the Upper Extremity. Baseline variables included demographics, stroke-related factors, and initial motor assessments. Uni- and multivariate logistic regression analyses were conducted to identify predictors of treatment response. A receiver operating characteristic curve was used to determine the optimal time window poststroke for intervention.
RESULTS: Among the 60 patients, 34 (56.7%) were classified as responders. Univariate analyses identified several baseline predictors of treatment response, including time since stroke onset, intervention type, Fugl-Meyer Assessment of the Upper Extremity, Motricity Index-Upper Extremity, and Shoulder Abduction and Finger Extension score. In the whole sample, multivariate logistic regression identified time since stroke onset as an independent predictor (odds ratio [OR], 0.963; P=.042). Notably, time since onset remained significant in the iTBS group (OR, 0.920; P=.016). Patients treated within the first month poststroke were more likely to respond (χ2=4.884; P=.027). Receiver operating characteristic analysis identified an optimal cutoff of 37.5 days poststroke (area under the curve=0.734).
CONCLUSIONS: Earlier poststroke administration of the iTBS intervention yielded greater improvements in upper limb motor function. Incorporating a preconditioning iTBS protocol may enhance treatment outcomes, guiding clinicians in optimizing stroke rehabilitation strategies.
DESIGN: Secondary analysis of a randomized controlled trial.
SETTING: A single rehabilitation hospital.
PARTICIPANTS: Sixty stroke patients (N=60) (mean age, 61.48±8.91y; 48 men), including both ischemic and hemorrhagic stroke types.
INTERVENTIONS: iTBS combined with routine rehabilitation.
MAIN OUTCOME MEASURES: Responders were defined as patients with a ≥7-point improvement in the Fugl-Meyer Assessment of the Upper Extremity. Baseline variables included demographics, stroke-related factors, and initial motor assessments. Uni- and multivariate logistic regression analyses were conducted to identify predictors of treatment response. A receiver operating characteristic curve was used to determine the optimal time window poststroke for intervention.
RESULTS: Among the 60 patients, 34 (56.7%) were classified as responders. Univariate analyses identified several baseline predictors of treatment response, including time since stroke onset, intervention type, Fugl-Meyer Assessment of the Upper Extremity, Motricity Index-Upper Extremity, and Shoulder Abduction and Finger Extension score. In the whole sample, multivariate logistic regression identified time since stroke onset as an independent predictor (odds ratio [OR], 0.963; P=.042). Notably, time since onset remained significant in the iTBS group (OR, 0.920; P=.016). Patients treated within the first month poststroke were more likely to respond (χ2=4.884; P=.027). Receiver operating characteristic analysis identified an optimal cutoff of 37.5 days poststroke (area under the curve=0.734).
CONCLUSIONS: Earlier poststroke administration of the iTBS intervention yielded greater improvements in upper limb motor function. Incorporating a preconditioning iTBS protocol may enhance treatment outcomes, guiding clinicians in optimizing stroke rehabilitation strategies.