Effects of electrical and magnetic stimulation on upper extremity function after stroke: A systematic review and network meta-analysis.

The authors rated confidence in every comparison as very low to low. The main reason was incoherence: trials that compared the treatments directly disagreed with what the indirect comparisons through a common control suggested. 41 of the 62 trials were judged to have some concerns for risk of bias and 11 were judged high risk, mostly around how participants were allocated to groups. Few trials tested repetitive peripheral magnetic stimulation or the combinations containing it, so the estimates for those treatments are imprecise. The funnel plots were asymmetric for all outcomes, which suggests smaller or negative studies may be missing. In the subgroup with less severe stroke, meaning a baseline Fugl-Meyer score of 25 or above, no intervention improved upper limb function, so these results may not apply to patients who already have good movement. The daily activities result for electrical plus brain stimulation was 30.89 points on the Barthel Index, but its confidence interval ran from 5.18 to 56.62, and it came from a small number of trials.

All authors declare that they have no conflicts of interest. The article does not state who funded the work.

Do not read the rankings as proof that adding magnetic stimulation to electrical stimulation is the strongest treatment. Confidence in every comparison was rated very low to low, the magnetic stimulation combinations rested on few trials, and none of these treatments reduced spasticity.