# Comparison of the effects of transcranial direct current stimulation combined with different rehabilitation interventions on motor function in people suffering from stroke-related symptoms: a systematic review and network meta-analysis

## TL;DR

This study compares how combining transcranial direct current stimulation with different rehabilitation methods affects motor recovery in stroke patients.

## Contribution

It identifies the most effective tDCS-based rehabilitation strategies for specific motor functions using network meta-analysis.

## Key findings

- BCIT combined with tDCS was most effective for upper limb motor function in stroke patients.
- Mirror therapy with tDCS improved arm mobility and lower limb motor ability best.
- Acupuncture and moxibustion with tDCS was optimal for balance improvement in stroke patients.

## Abstract

This study employs network meta-analysis to assess the efficacy of transcranial direct current stimulation (tDCS) combined with different rehabilitation approaches in enhancing motor function in people suffering from stroke-related symptoms (PSSS). The objective is to determine the most effective tDCS-based rehabilitation approach and offer valuable evidence to guide clinical decision-making.

This study included randomized controlled trials (RCTs) published before September 23, 2024. We conducted a systematic search across eight databases: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China Biology Medicine (SinoMed), Wanfang, and VIP. Network meta-analysis (NMA) was conducted utilizing R Studio and Stata 15.0 for data analysis.

A total of 74 RCTs were included in this study, encompassing 4,335 PSSS and 11 intervention strategies. The NMA revealed that brain-computer interface therapy (BCIT) in combination with tDCS [surface under the cumulative ranking curve (SUCRA) = 88.34%] was the most effective tDCS-based intervention for improving the Fugl-Meyer Assessment for Upper Extremity score in PSSS. Mirror therapy (MT) in combination with tDCS (SUCRA = 85.96%) was identified as the optimal intervention for enhancing the Action Research Arm Test score in PSSS. MT + tDCS (SUCRA = 84.29%) was the best approach for improving the Fugl-Meyer Assessment for Lower Extremity score. Additionally, acupuncture and moxibustion (AM) in combination with tDCS (SUCRA = 77.16%) was the most effective intervention for increasing the Berg Balance Scale score in PSSS. The two-dimensional clustering analysis showed that MT + tDCS (SUCRA = 75.83%/85.96%) was the optimal tDCS-based rehabilitation strategy for treating upper limb motor dysfunction in PSSS, while AM+tDCS (SUCRA = 76.94%/77.16%) was the best tDCS-based rehabilitation strategy for improving lower limb motor dysfunction in PSSS.

BCIT+tDCS was identified as the optimal tDCS-based rehabilitation strategy for improving upper limb motor ability in PSSS, MT + tDCS was the most effective intervention for enhancing arm mobility, MT + tDCS was the best protocol for improving lower limb motor ability, while AM+tDCS was the best strategy for improving balance ability. Furthermore, MT + tDCS was the optimal tDCS-based rehabilitation approach for treating upper limb motor dysfunction, whereas AM+tDCS was the most effective strategy for addressing lower limb motor dysfunction in PSSS. Future studies may focus on investigating the therapeutic effects of MT combined with tDCS on Berg Balance Scale score in PSSS, as well as the effects of AM combined with tDCS on Action Research Arm Test score, in order to further explore the therapeutic potential of these two intervention strategies.

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024621998, Identifier PROSPERO CRD42024621998.