To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke.

Autor:	Andressa de Souza J; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Ferrari Corrêa JC; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Marduy A; Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States., Dall'Agnol L; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Gomes de Sousa MH; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Nunes da Silva V; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Alves AB; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Silva SM; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil., Fregni F; Department of Physical Medicine and Rehabilitation, Neuromodulation Center, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States., Corrêa FI; Doctorate and Masters Program in Rehabilitation Science of University Nove de Julho, UNINOVE, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Frontiers in pain research (Lausanne, Switzerland) [Front Pain Res (Lausanne)] 2021 Jul 01; Vol. 2, pp. 696547. Date of Electronic Publication: 2021 Jul 01 (Print Publication: 2021).
DOI:	10.3389/fpain.2021.696547
Abstrakt:	Purpose: Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain. Methods: Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment. Results: A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups ( p = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes. Conclusions: We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy. Trial registry: Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017. Beginning of the recruitment of the volunteers: august, 2017. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Andressa de Souza, Ferrari Corrêa, Marduy, Dall'Agnol, Gomes de Sousa, Nunes da Silva, Alves, Silva, Fregni and Corrêa.)
Databáze:	MEDLINE
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