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Comparative efficacy of different noninvasive brain stimulation protocols on upper-extremity motor function and activities of daily living after stroke: a systematic review and network meta-analysis

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Abstract

The objectives of the study were to systematically evaluate the rehabilitation effect of noninvasive brain stimulation (NIBS) on upper extremity motor function and activities of daily living in stroke patients and to prioritize various stimulation protocols for reliable evidence-based medical recommendations in patients with upper extremity motor dysfunction after stroke. Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM were searched to collect all randomized controlled trials (RCTs) of NIBS to improve upper extremity motor function in stroke patients. The retrieval time was from the establishment of all databases to May 2023. According to the Cochrane system evaluation manual, the quality of the included studies was evaluated, and the data were extracted. Statistical analysis was carried out by using RevMan 5.3, R 4.3.0, and Stata 17.0 software. Finally, 94 RCTs were included, with a total of 5546 patients. Meta-analysis showed that NIBS improved the Fugl-Meyer assessment (FMA) score (mean difference (MD) = 6.51, 95% CI 6.20 ~ 6.82, P < 0.05), MBI score (MD = 7.69, 95% CI 6.57 ~ 8.81, P < 0.05), ARAT score (MD = 5.06, 95% CI 3.85 ~ 6.27, P < 0.05), and motor evoked potential (MEP) amplitude. The modified Ashworth scale score (MD =  − 0.37, 95% CI − 0.60 to − 0.14, P < 0.05), National Institutes of Health Stroke Scale score (MD =  − 2.17, 95% CI − 3.32 to − 1.11, P < 0.05), incubation period of MEP (MD =  − 0.72, 95% CI − 1.06 to − 0.38, P < 0.05), and central motor conduction time (MD =  − 0.90, 95% CI − 1.29 to − 0.50, P < 0.05) were decreased in stroke patients. Network meta-analysis showed that the order of interventions in improving FMA scores from high to low was anodal-transcranial direct current stimulation (tDCS) (surface under the cumulative ranking curve (SUCRA) = 83.7%) > cathodal-tDCS (SUCRA = 80.2%) > high-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (SUCRA = 68.5%) > low-frequency (LF)-rTMS (SUCRA = 66.5%) > continuous theta burst stimulation (cTBS) (SUCRA = 54.2%) > bilateral-tDCS (SUCRA = 45.2%) > intermittent theta burst stimulation (iTBS) (SUCRA = 34.1%) > sham-NIBS (SUCRA = 16.0%) > CR (SUCRA = 1.6%). In terms of improving MBI scores, the order from high to low was anodal-tDCS (SUCRA = 88.7%) > cathodal-tDCS (SUCRA = 85.4%) > HF-rTMS (SUCRA = 63.4%) > bilateral-tDCS (SUCRA = 56.0%) > LF-rTMS (SUCRA = 54.2%) > iTBS (SUCRA = 32.4%) > sham-NIBS (SUCRA = 13.8%) > CR (SUCRA = 6.1%). NIBS can effectively improve upper extremity motor function and activities of daily living after stroke. Among the various NIBS protocols, anodal-tDCS demonstrated the most significant intervention effect, followed by cathodal-tDCS and HF-rTMS.

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Funding

This work was supported by the National Key R&D Program of China (Grant Nos.: 2018YFC2001600 and 2018YFC2001604); National Natural Science Foundation of China (Grant Nos.: 82272583, 82172554, 82272589, 81871836); Shanghai Health Care Commission (Grant No.: 2022JC026); Shanghai Science and Technology Committee (Grant No.: 22010504200); Shanghai Rising-Star Program (Grant No.: 23QA1409200); Shanghai Youth Top Talent Development Plan; Shanghai “Rising Stars of Medical Talent” — Distinguished Young Medical Talent Program; and Shanghai Talent Development Fund (2021074).

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  1. Ling-Ling Li and Jia-Jia Wu contributed equally to this work.

Authors and Affiliations

  1. Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China

    Ling-Ling Li, Jia-Jia Wu, Kun-Peng Li, **g **, Yun-Ting **ang, Xu-Yun Hua, Mou-**ong Zheng & Jian-Guang Xu

  2. Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China

    Jia-Jia Wu

  3. School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China

    Ling-Ling Li, Kun-Peng Li, **g **, Yun-Ting **ang & Jian-Guang Xu

  4. Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China

    Xu-Yun Hua & Mou-**ong Zheng

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Contributions

Ling-Ling Li: writing—original draft, methodology; Jia-Jia Wu: methodology, project administration, writing—review and editing; Kun-Peng Li: formal analysis, methodology, writing—review and editing; **g **: formal analysis, methodology, writing—review and editing; Yun-Ting **ang: investigation, methodology, writing—review and editing; Xu-Yun Hua: conceptualization, funding acquisition, project administration, supervision; Mou-**ong Zheng: conceptualization, funding acquisition, project administration, supervision; Jian-Guang Xu: conceptualization, funding acquisition, project administration, supervision. All authors contributed to the article and approved the submitted version.

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Correspondence to Xu-Yun Hua, Mou-**ong Zheng or Jian-Guang Xu.

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Li, LL., Wu, JJ., Li, KP. et al. Comparative efficacy of different noninvasive brain stimulation protocols on upper-extremity motor function and activities of daily living after stroke: a systematic review and network meta-analysis. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07437-4

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