Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UFPB |
Texto Completo: | https://repositorio.ufpb.br/jspui/handle/123456789/30492 |
Resumo: | Background: In the literature, the analgesic effects of Transcranial Direct Current Stimulation (tDCS) in populations with chronic pain have been well reported. In Neuropathic Pain the results are still contrasting, with previous reviews showing small effect sizes and a considerable level of heterogeneity. The objective of the present study is to evaluate the effectiveness of treatment with tDCS in patients with chronic neuropathic pain on pain intensity, disability and psychosocial factors and to determine the predictors of this effectiveness when considering the influence exerted by sample characteristics, study design and parameters of the intervention. Methodology: A systematic search of the electronic databases of MEDLINE, CINAHL, EMBASE and CENTRAL conducted from June to July 2021 was carried out. Controlled clinical trials involving patients with chronic neuropathic pain who applied tDCS were included. The effect was measured using the standardized mean difference (SMD) with a 95% confidence interval, calculated with the values obtained after the intervention between the active and control groups. The level of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development and Evolution) to explore potential moderating factors, we performed meta-regression analyses. Results: Based on 16 controlled clinical trials, mostly with low risk of bias, in a total of 432 individuals, tDCS was superior to simulation in improving pain (SMD = -0.41; 95% CI (-0.72 , -0.11); p=0.007). The meta-analysis did not show statistical significance in favor of active intervention to improve disability, as well as psychosocial outcomes. These results were based on a low level of evidence. Meta-regression analyzes showed that the duration of pain is negatively correlated with the effect size [diff SMD=0.003 (0.001; 0.012), p=0.02], R²= 1.00. The stimulation target was responsible for 86% of the variability, while the randomization description was responsible for 15% of the heterogeneity [diff SMD=0.385 (-1.749; -0.239), p=0.009], as was the study design [ diff SMD=0.380 (-0.033; 1.457), p=0.03]. Conclusion: tDCS may have beneficial effects on the outcome of pain intensity. The duration of symptoms, place of application of tDCS and methodological quality are moderators of the effects of tDCS. Future studies are needed to improve the quality of evidence. |
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Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizadosFisioterapia - ReabilitaçãoDor neuropáticaEstimulação transcraniana por corrente contínuaDor crônicaPhysiotherapy - RehabilitationNeuropathic painTranscranial direct current stimulationChronic painCNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONALBackground: In the literature, the analgesic effects of Transcranial Direct Current Stimulation (tDCS) in populations with chronic pain have been well reported. In Neuropathic Pain the results are still contrasting, with previous reviews showing small effect sizes and a considerable level of heterogeneity. The objective of the present study is to evaluate the effectiveness of treatment with tDCS in patients with chronic neuropathic pain on pain intensity, disability and psychosocial factors and to determine the predictors of this effectiveness when considering the influence exerted by sample characteristics, study design and parameters of the intervention. Methodology: A systematic search of the electronic databases of MEDLINE, CINAHL, EMBASE and CENTRAL conducted from June to July 2021 was carried out. Controlled clinical trials involving patients with chronic neuropathic pain who applied tDCS were included. The effect was measured using the standardized mean difference (SMD) with a 95% confidence interval, calculated with the values obtained after the intervention between the active and control groups. The level of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development and Evolution) to explore potential moderating factors, we performed meta-regression analyses. Results: Based on 16 controlled clinical trials, mostly with low risk of bias, in a total of 432 individuals, tDCS was superior to simulation in improving pain (SMD = -0.41; 95% CI (-0.72 , -0.11); p=0.007). The meta-analysis did not show statistical significance in favor of active intervention to improve disability, as well as psychosocial outcomes. These results were based on a low level of evidence. Meta-regression analyzes showed that the duration of pain is negatively correlated with the effect size [diff SMD=0.003 (0.001; 0.012), p=0.02], R²= 1.00. The stimulation target was responsible for 86% of the variability, while the randomization description was responsible for 15% of the heterogeneity [diff SMD=0.385 (-1.749; -0.239), p=0.009], as was the study design [ diff SMD=0.380 (-0.033; 1.457), p=0.03]. Conclusion: tDCS may have beneficial effects on the outcome of pain intensity. The duration of symptoms, place of application of tDCS and methodological quality are moderators of the effects of tDCS. Future studies are needed to improve the quality of evidence.NenhumaContextualização: Na literatura tem sido bem relatado os efeitos analgésicos da Estimulação Transcraniana por Corrente Contínua (ETCC) em populações com dor crônica. Na Dor Neuropática os resultados ainda são contrastantes, com revisões anteriores mostrando tamanhos de efeito pequenos e com nível considerável de heterogeneidade. O objetivo do presente estudo é avaliar a eficácia do tratamento com a ETCC em pacientes com dor neuropática crônica na intensidade da dor, incapacidade e fatores psicossociais e determinar os preditores dessa eficácia ao considerar a influência exercida pelas características da amostra, desenho do estudo e parâmetros da intervenção. Metodologia: Uma busca sistemática nos bancos de dados eletrônicos da MEDLINE, CINAHL, EMBASE e CENTRAL conduzida no período de junho a julho de 2021 foi realizada. Ensaios clínicos controlados envolvendo pacientes com dor neuropática crônica que aplicassem a ETCC, foram incluídos. A mensuração do efeito foi por meio da diferença média padronizada (SMD) com intervalo de confiança de 95%, calculados com os valores obtidos pós intervenção entre os grupos ativo e controle. O nível de evidência foi avaliado com o GRADE (Grading of Recommendations Assessment, Development and Evoluation) para explorar os potenciais fatores moderadores realizamos análises de meta-regressão. Resultados: Com base em 16 ensaios clínicos controlados em sua maioria de baixo risco de viés, num total de 432 indivíduos, a ETCC foi superior a simulação para melhora da dor (SMD = -0,41; 95% IC (-0,72, -0,11); p=0,007). A meta-análise não apresentou significância estatística favorável à intervenção ativa para melhorar a incapacidade, assim quanto aos desfechos psicossociais. Esses resultados foram baseados em baixo nível de evidência. As análises de meta-regressão mostraram que o tempo de duração da dor está correlacionado negativamente com o tamanho de efeito [diff SMD=0,003 (0,001; 0,012), p=0,02], R²= 1,00. O alvo da estimulação foi responsável por 86% da variabilidade, enquanto que a descrição da randomização foi responsável por 15% da heterogeneidade [diff SMD=0,385 (-1,749; -0,239), p=0,009], assim como o desenho do estudo [diff SMD=0,380 (-0,033; 1,457), p=0,03]. Conclusão: A ETCC pode ter efeitos benéficos sobre o desfecho da intensidade da dor. A duração dos sintomas, local de aplicação da ETCC e qualidade metodológica apresentam são moderadores dos efeitos da ETCC. Estudos futuros são necessários para melhorar a qualidade de evidência.Universidade Federal da ParaíbaBrasilFisioterapiaPrograma de Pós-Graduação em FisioterapiaUFPBKamonseki, Danilo Harudyhttp://lattes.cnpq.br/3862220756233320Carvalho, Carolina Dias de2024-06-26T11:43:08Z2023-11-012024-06-26T11:43:08Z2023-08-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesishttps://repositorio.ufpb.br/jspui/handle/123456789/30492porAttribution-NoDerivs 3.0 Brazilhttp://creativecommons.org/licenses/by-nd/3.0/br/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFPBinstname:Universidade Federal da Paraíba (UFPB)instacron:UFPB2024-06-27T06:08:39Zoai:repositorio.ufpb.br:123456789/30492Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufpb.br/PUBhttp://tede.biblioteca.ufpb.br:8080/oai/requestdiretoria@ufpb.br|| diretoria@ufpb.bropendoar:2024-06-27T06:08:39Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB)false |
dc.title.none.fl_str_mv |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
title |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
spellingShingle |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados Carvalho, Carolina Dias de Fisioterapia - Reabilitação Dor neuropática Estimulação transcraniana por corrente contínua Dor crônica Physiotherapy - Rehabilitation Neuropathic pain Transcranial direct current stimulation Chronic pain CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
title_short |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
title_full |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
title_fullStr |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
title_full_unstemmed |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
title_sort |
Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados |
author |
Carvalho, Carolina Dias de |
author_facet |
Carvalho, Carolina Dias de |
author_role |
author |
dc.contributor.none.fl_str_mv |
Kamonseki, Danilo Harudy http://lattes.cnpq.br/3862220756233320 |
dc.contributor.author.fl_str_mv |
Carvalho, Carolina Dias de |
dc.subject.por.fl_str_mv |
Fisioterapia - Reabilitação Dor neuropática Estimulação transcraniana por corrente contínua Dor crônica Physiotherapy - Rehabilitation Neuropathic pain Transcranial direct current stimulation Chronic pain CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
topic |
Fisioterapia - Reabilitação Dor neuropática Estimulação transcraniana por corrente contínua Dor crônica Physiotherapy - Rehabilitation Neuropathic pain Transcranial direct current stimulation Chronic pain CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
description |
Background: In the literature, the analgesic effects of Transcranial Direct Current Stimulation (tDCS) in populations with chronic pain have been well reported. In Neuropathic Pain the results are still contrasting, with previous reviews showing small effect sizes and a considerable level of heterogeneity. The objective of the present study is to evaluate the effectiveness of treatment with tDCS in patients with chronic neuropathic pain on pain intensity, disability and psychosocial factors and to determine the predictors of this effectiveness when considering the influence exerted by sample characteristics, study design and parameters of the intervention. Methodology: A systematic search of the electronic databases of MEDLINE, CINAHL, EMBASE and CENTRAL conducted from June to July 2021 was carried out. Controlled clinical trials involving patients with chronic neuropathic pain who applied tDCS were included. The effect was measured using the standardized mean difference (SMD) with a 95% confidence interval, calculated with the values obtained after the intervention between the active and control groups. The level of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development and Evolution) to explore potential moderating factors, we performed meta-regression analyses. Results: Based on 16 controlled clinical trials, mostly with low risk of bias, in a total of 432 individuals, tDCS was superior to simulation in improving pain (SMD = -0.41; 95% CI (-0.72 , -0.11); p=0.007). The meta-analysis did not show statistical significance in favor of active intervention to improve disability, as well as psychosocial outcomes. These results were based on a low level of evidence. Meta-regression analyzes showed that the duration of pain is negatively correlated with the effect size [diff SMD=0.003 (0.001; 0.012), p=0.02], R²= 1.00. The stimulation target was responsible for 86% of the variability, while the randomization description was responsible for 15% of the heterogeneity [diff SMD=0.385 (-1.749; -0.239), p=0.009], as was the study design [ diff SMD=0.380 (-0.033; 1.457), p=0.03]. Conclusion: tDCS may have beneficial effects on the outcome of pain intensity. The duration of symptoms, place of application of tDCS and methodological quality are moderators of the effects of tDCS. Future studies are needed to improve the quality of evidence. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-11-01 2023-08-30 2024-06-26T11:43:08Z 2024-06-26T11:43:08Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://repositorio.ufpb.br/jspui/handle/123456789/30492 |
url |
https://repositorio.ufpb.br/jspui/handle/123456789/30492 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
Attribution-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nd/3.0/br/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NoDerivs 3.0 Brazil http://creativecommons.org/licenses/by-nd/3.0/br/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal da Paraíba Brasil Fisioterapia Programa de Pós-Graduação em Fisioterapia UFPB |
publisher.none.fl_str_mv |
Universidade Federal da Paraíba Brasil Fisioterapia Programa de Pós-Graduação em Fisioterapia UFPB |
dc.source.none.fl_str_mv |
reponame:Biblioteca Digital de Teses e Dissertações da UFPB instname:Universidade Federal da Paraíba (UFPB) instacron:UFPB |
instname_str |
Universidade Federal da Paraíba (UFPB) |
instacron_str |
UFPB |
institution |
UFPB |
reponame_str |
Biblioteca Digital de Teses e Dissertações da UFPB |
collection |
Biblioteca Digital de Teses e Dissertações da UFPB |
repository.name.fl_str_mv |
Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB) |
repository.mail.fl_str_mv |
diretoria@ufpb.br|| diretoria@ufpb.br |
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1809927048158773248 |