Research Report Abstracts - Gesundheit

eS714
inapplicable because they included items involving the use
of long leg braces for walking or standing, and some patients
did not use long leg braces. In the Barthel Index, a ceiling
effect was prominent for slowly progressive MD (58.9%),
while a floor effect existed for DMD (17.9%). Among the
slowly progressive MDs, FSHD patients had the best level
of functioning; they had better leg function and their ADL
were less affected than patients with other forms of slowly
progressive MD.
Conclusions: Brooke and Vignos scale were insufficient for
accessing the upper and lower limbs functional status for
slowly progressive MD. Some of the limitations of these
measures as applied to MD should be carefully considered.
Implications: We suggest these applications be used in
combination with other measures, or that a complicated
instrument capable of evaluating the various levels of functional
status be used. For example, to assess the basic mobility
abilities (sitting from lying, rolling and changing body position)
for DMD, and to assess the arm functions (managing
objects overhead and carrying objects) for BMD, LGMD and
FSHD is needed.
Keywords: Muscular dystrophy; Functional status; Barthel
Index
Funding acknowledgements: This study was supported by
grants for the National Science Council (NSC89-2614-B-
037-005-M47, 90-2614-B-037-004-M47, 91-2614-B-037-
009-M47).
Ethics approval: The study was approved by the hospital’s
institutional review board.
Research Report Platform Presentation
Number: RR-PL-3210 Wednesday 22 June 16:00
RAI: Elicium 2
TRANSCRANIAL DIRECT CURRENT
STIMULATION FOR THE REDUCTION OF
CLINICAL AND EXPERIMENTALLY INDUCED
PAIN: A SYSTEMATIC REVIEW AND
META-ANALYSIS
Luedtke K. 1,2,3 , Rushton A. 1 , Wright C. 1 , Geiss B. 2 ,
Juergens T.P. 2 , May A. 2
1University of Birmingham, School of Health and Population
Sciences, College of Medical and Dental Sciences,
Birmingham, United Kingdom, 2Institute of Systems Neurosciences,
University Hospital Eppendorf, Hamburg,
Germany, 3Backpain Clinic ‘Am Michel’, Hamburg,
Germany
Purpose: To evaluate the effectiveness of transcranial direct
current stimulation (tDCS) on clinical and experimental pain,
and to identify the most beneficial stimulation parameters.
Relevance: Central processing presents a promising treatment
target in chronic pain syndromes. Surgically implanted
brain stimulation has demonstrated pain-reducing effects.
tDCS is non-invasive, pain-free, easy to administer and does
not have serious side effects. Hence, it can be employed in
physiotherapy management. Recent evidence suggests that
tDCS is a potentially effective intervention.
Participants: Participants were adult healthy volunteers or
chronic pain patients. A total of 11 trials including 106 participants
were included.
Methods: A systematic review and meta-analysis of evidence
for tDCS for the reduction of pain (clinical and
experimental). Searches using pre-defined key terms were
conducted in MEDLINE, EMBASE, CAB Abstracts, Psych-
INFO, Cochrane Register of Controlled Trials, CINAHL, and
PeDRO databases. Reference lists of retrieved articles, journal
contents and conference proceedings were also searched.
Two reviewers independently searched and screened for study
eligibility. Controlled trials, including crossover designs,
employing tDCS for the reduction of clinical or experimental
pain published in any language prior to 31/5/2010 were
included. Studies using magnetic stimulation/pulsed currents
were excluded. Two reviewers independently evaluated risk
of bias for included trials.
Analysis: Trials with an overall high risk of bias were
included in the descriptive analysis but excluded from
the meta-analysis. Trials without pain reduction data were
excluded from the meta-analysis. A meta-analysis using a
random effects model was conducted on mean differences
and standard deviations in pain intensity.
Results: Trials investigating experimental pain in healthy
participants (5 trials, n = 81 participants) used a wide variety
of stimulation and outcome parameters, not permitting
a synthesis of results. The quality of trials was poor, with 2
trials assessed as high and 3 as unclear risk of bias. All trials
reported some pain reduction with the allocated stimulation
paradigm (anodal or cathodal stimulation modes; primary
sensory or primary motor cortex as stimulation sites). Trials
investigating chronic clinical pain (6 trials, n = 106 participants)
used anodal motor cortex stimulation of 1 mA or 2 mA
intensity, either as a single dose or on a maximum of 5 consecutive
days. A meta-analysis of 4 trials (2 with high risk
of bias were excluded) found a pooled effect size of −0.975
with a 95% confidence interval of −1.547 to −0.404.
Conclusions: There was low level evidence to support tDCS
for pain reduction in a chronic clinical pain population. Effect
sizes were small. Heterogeneity and poor quality of trials on
experimental pain did not allow a synthesis of the results.
Implications: The number and quality of the current trial
evidence is not sufficient to recommend tDCS as a treatment
for chronic pain syndromes. A high quality and effectively
powered trial is required.
Keywords: Pain; Direct current stimulation; Brain
Funding acknowledgements: None.
Ethics approval: Not required.