Effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on aphasia in cerebrovascular accident patients: Protocol of a systematic review and meta-analysis

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation approach, might be a promising technique in the management of aphasia after cerebrovascular accidents (CVA). This protocol of systematic review (SR) aims to investigate the effectiveness and safety of rTMS in patients with aphasia after CVA. METHODS: The following databases will be searched: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP), WanFang Data, and China Biology Medicine (CBM) from inception to August 2019. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS for aphasia patients after CVA will be included. Primary outcome will include Boston Diagnostic Aphasia Examination (BDAE). Secondary outcomes will include Aphasia Battery of Chinese (ABC), Aachen Aphasia Test (AAT), Aphasia Quotient (AQ), the Western Aphasia Battery (WAB), Standard Language Test of Aphasia (SLTA), Aphasia Severity Rating Scale (ASRS), Concise China Aphasia Test Scale (CCAT), Amsterdam-Nijmegen Everyday Language Test (ANELT), or other related outcomes. Adverse events such as headache, tinnitus, anxiety, fatigue, or epileptic seizure will be considered as safety measurement. Studies screening, data extraction, and methodological quality assessment will be performed independently by two reviewers. Meta-analysis will be conducted with Review Manager 5.3 software and R software 3.6.1. RESULTS: This study will provide a high-quality synthesis of RCTs on the effectiveness and safety of rTMS as an adjuvant therapy in the treatment of aphasia. CONCLUSION: The conclusion of this study will help clinicians and patients with aphasia after CVA to make decision. ETHICS AND DISSEMINATION: No privacy health information will be collected, thus formal ethics approval is not required. The findings of this SR will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42019144587.