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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Rheumatol. Feb 28, 2023; 11(1): 1-12
Published online Feb 28, 2023. doi: 10.5499/wjr.v11.i1.1
Transcranial direct current electrical stimulation in combination with aerobic exercise: A pilot study in post-COVID-19 systemic autoimmune rheumatic patients
Rafael Giovani Missé, Alexandre Moura dos Santos, Isabela Bruna Pires Borges, Marlise Sítima Mendes Simões, Lorenza Rosa Silvério, Bruna Lindoso Correia, Ana Wook Sook Kim, Aline Marques Caetano, Sandra Gofinet Pasoto, Carla Gonçalves Schahin Saad, Diogo Souza Domiciano, Clarice Tanaka, Julia Maria D’Andrea Greve, Abrahão Fontes Baptista, Samuel Katsuyuki Shinjo
Rafael Giovani Missé, Alexandre Moura dos Santos, Isabela Bruna Pires Borges, Marlise Sítima Mendes Simões, Lorenza Rosa Silvério, Bruna Lindoso Correia, Ana Wook Sook Kim, Aline Marques Caetano, Sandra Gofinet Pasoto, Carla Gonçalves Schahin Saad, Diogo Souza Domiciano, Samuel Katsuyuki Shinjo, Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
Clarice Tanaka, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Núcleo de Assistência e Pesquisa em Neuromodulação, Sao Paulo, Brazil
Julia Maria D’Andrea Greve, Laboratório de Estudos do Movimento, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
Author contributions: Missé RG, dos Santos AM, Borges IBP contributed to data collection, statistical analysis, manuscript writing; Simões MSM, Silvério LR, Correia BL, Kim AWS, Caetano AM contributed to data collection, manuscript writing; Pasoto SG, Saad CGS, Domiciano DS, Tanaka C, Greve JMA, Baptista AF, Shinjo SK contributed to manuscript writing, study supervision.
Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) #2020/10691-4 to AMS, #2019/11776-6 to SKS, #2019/12155-5 to RGM, #2019/11367-9 to IBPB; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) #303379/2018-9 to SKS; Faculdade de Medicina da USP to SKS.
Institutional review board statement: The manuscript was reviewed and accepted by Institutional review board.
Clinical trial registration statement: This study was registered by Hospital das Clínicas HCFMUSP in ClinicalTrials.gov. The registration number is (NCT04890483).
Informed consent statement: All study patients was informed by the study main investigator and written the consent before the study.
Conflict-of-interest statement: All the authors inform no conflicts of interest.
Data sharing statement: This is available if requested for review and open data policy.
CONSORT 2010 statement: The authors have read the CONSORT Statement—checklist of items, and the manuscript was prepared and revised according to the CONSORT Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Rafael Giovani Missé, MSc, Academic Research, Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3 Andar, Sala 3184, CEP 01246-000, Sao Paulo, Brazil. rafael.gmisse@fm.usp.br
Received: May 4, 2022
Peer-review started: May 4, 2022
First decision: May 31, 2022
Revised: June 1, 2022
Accepted: February 1, 2023
Article in press: February 1, 2023
Published online: February 28, 2023
Processing time: 298 Days and 15.7 Hours
BACKGROUND
Systemic autoimmune rheumatic diseases (SARDs) are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue. Patients with SARDs and post-coronavirus disease 2019 (COVID-19) syndrome experience aggravation of symptoms. In this context, it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.
AIM
To assess the efficacy of transcranial direct current stimulation (tDCS) for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.
METHODS
This study included nine patients with different types of SARDs. All patients had reverse transcription-polymerase chain reaction (RT-PCR) test confirmed COVID-19 as well as significant, persistent fatigue and pain that began to worsen after infection. Anodal tDCS was administered in five daily sessions (2mA, 20 min). Concomitantly, patients were involved in aerobic exercise program. All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline (within one week before tDCS protocol), and one week after tDCS protocol. During all procedures, the patients’ treatments remained unchanged.
RESULTS
The sample comprised eight women and one man with a mean age of 48.7 ± 9.6 years. After the tDCS protocol, pain and fatigue significantly improved on the visual analog scale (P < 0.05). The physical function also improved 9.5 ± 2.7 vs 6.8 ± 0.8 (P = 0.001) for timed-up-go-test and 10.3 ± 3.7 vs 15.1 ± 4.0 (P = 0.037) for sit-to-stand test. None of the patients experienced any adverse events.
CONCLUSION
The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function, and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.
Core Tip: In the present study, we assessed the efficacy of five daily transcranial direct current stimulation (tDCS) sessions for the treatment of fatigue and pain-associated post-coronavirus disease 2019 (COVID-19) syndrome in nine patients with different systemic autoimmune rheumatic diseases (SARDs). After the tDCS protocol, pain and fatigue significantly improved on the visual analog scale. The physical function also improved 9.5 ± 2.7 vs 6.8 ± 0.8 (P = 0.001) for timed-up-go-test and 10.3 ± 3.7 vs 15.1 ± 4.0 (P = 0.037) for sit-to-stand test. None of the patients experienced any adverse events. In conclusion, tDCS in combination with aerobic exercise was effective in improving physical function, and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.
