Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials.
Natalia Comino-Suárez, Juan C Moreno, Julio Gómez-Soriano and 7 others
PMID 34565399WHAT IT FOUND
Adding tDCS to robotic therapy did not improve upper limb function compared to sham stimulation.
Secondary outcomes including strength, spasticity, independence, and velocity also showed no significant difference between groups.
Key findings
01There was no significant difference in overall limb function between patients receiving active tDCS plus robotic therapy and those receiving sham tDCS plus robotic therapy.
02Secondary outcomes of strength, spasticity, functional independence, and movement velocity showed no significant differences between the active and sham tDCS groups.
03A subgroup analysis suggested a potential benefit for lower limb function, but this finding is limited by the small number of studies included.
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
The included studies had small sample sizes, with only three trials having more than 30 participants. Most participants had chronic, ischaemic stroke, so results may not apply to patients in the subacute phase or those with haemorrhagic stroke. There was significant heterogeneity in tDCS parameters (intensity, electrode size, duration) and robotic devices used, making direct comparison difficult. Follow-up periods were generally short, with only one study extending to six months. Several studies had unclear or high risk of bias regarding randomisation and blinding procedures.
Declared interests
The study was funded by the Ministerio de Economía, Industria y Competitividad and the Junta de Comunidades de Castilla-La Mancha. No commercial conflicts of interest were declared.
The easy way to misread this
Do not interpret the positive signal in the lower limb subgroup analysis as proof that tDCS works for walking. This finding relied on only two studies and was not the primary outcome, so it should be viewed as a hypothesis for future research rather than a basis for clinical change.