Improving motor impairment after stroke using transcranial stimulation and constraint-induced movement therapy: a systematic review and meta-analysis

Abstract

Purpose: The purpose was to systematically review the combined effects of active noninvasive brain stimulation (NIBS) and constraint-induced movement therapy (CIMT) in patients with stroke (PwS). Materials and methods: Eligible studies were RCTs involving PwS, comparing NIBS+CIMT with sham NIBS+CIMT. Motor impairment was assessed with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), and functional ability with the Wolf Motor Function and Action Research Arm Test. Performance times from the motor function tests, in addition to strength measures and the Motor Activity Log (MAL) subscales, were extracted. The certainty of evidence was assessed with the GRADE. Results: Ten RCTs (n = 420, mean age: 59.6 years, 40.7% female) were included. Findings suggested that active NIBS+CIMT combinations may improve FMA-UE compared to sham NIBS + CIMT (Hedges' g: 0.55, 95% CI: 0.09-1.1.01, p: 0.02). However, the evidence was of low certainty. No significant improvements were observed in functional ability, performance time, strength, or MAL subscales between groups (p > 0.12 for all). Conclusions: Low-certainty evidence suggests that active NIBS combined with CIMT may lead to modest improvements in upper extremity motor impairment in PwS. However, further research is needed to determine whether active NIBS+CIMT combinations improve upper extremity function. > IMPLICATIONS FOR REHABILITATION center dot Combining active noninvasive brain stimulation (NIBS) with constraint-induced movement therapy (CIMT) may improve upper extremity motor impairment after stroke. center dot Active NIBS+CIMT combinations do not seem to further improve motor function in patients with stroke than sham NIBS+CIMT. center dot However, given the low certainty of evidence and high heterogeneity observed in the meta-analyses, our findings remain preliminary. center dot Further high-quality randomized controlled trials are needed before this combined approach can be recommended for routine rehabilitation practice.