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

Kaiqi ZhengWeidong LiangPengcheng LiuLiang Guo^*

• South China Normal University, Guangzhou, China

AbstractBackground: 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.Methods: 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.Results: 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.Conclusions: 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.