Effectiveness of transcranial direct current stimulation on balance and gait in patients with multiple sclerosis: systematic review and meta-analysis of randomized clinical trials.
Rafael Nombela-Cabrera, Soraya Pérez-Nombela, Juan Avendaño-Coy and 4 others
PMID 37875941WHAT IT FOUND
tDCS improved walking speed and functional gait compared to sham, but did not improve static balance or patient-reported walking difficulty.
The benefit was moderate, but evidence quality is low due to high variability between studies and potential publication bias.
Key findings
01tDCS produced a statistically significant improvement in functional gait compared to sham stimulation.
02There was no significant difference between tDCS and sham for static balance measured by the Berg Balance Scale.
03There was no significant difference between tDCS and sham for perceived walking difficulty measured by the MSWS-12.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
High heterogeneity between studies (I-squared up to 69%) makes the results difficult to generalize. Potential publication bias was detected using Egger's test, suggesting that small studies with negative results may be missing. Blinding success was not adequately assessed in any of the included studies, so participants may have known whether they received active or sham stimulation. The sample sizes for specific outcomes were small (e.g., 56 participants for balance), leading to wide confidence intervals and imprecise estimates. All studies combined tDCS with other therapies (exercise, physiotherapy), so it is impossible to separate the specific contribution of tDCS from the concurrent treatment.
Declared interests
No specific funding sources or conflicts of interest were reported in the provided text sections.
The easy way to misread this
Do not interpret the improvement in the Timed Up and Go test as a clinically meaningful gain for individual patients. The 1.17-second average improvement is below the minimal detectable change of 10.6 seconds established for MS patients, and the evidence quality is low due to high variability and potential bias.