Efficacy of non-invasive brain stimulation combined with constraint-induced movement therapy on upper extremity function in patients who had a stroke: protocol for a systematic review and meta-analysis of randomised controlled trials.

Abstract

Stroke remains a leading cause of death and long-term disability worldwide, with the majority of survivors experiencing functional impairments, particularly affecting the upper extremities (UEs). Although clinically widespread rehabilitation methods, such as physical and occupational therapy, provide some benefits, their efficacy in restoring UE function is often limited. Constraint-induced movement therapy (CIMT) is widely recognised as one of the most effective physical therapy interventions for improving motor outcomes in the paretic UE. Meanwhile, non-invasive brain stimulation (NIBS) has demonstrated promising results in facilitating neuroplasticity and enhancing UE recovery. The combination of NIBS and CIMT (NIBS-CIMT) may offer synergistic benefits, further promoting functional improvements. This meta-analysis aims to evaluate the efficacy of NIBS-CIMT in enhancing UE function in patients who had a stroke based on evidence from randomised controlled trials (RCTs). Published RCTs will be included if the experimental group received NIBS-CIMT in adult patients who had a stroke. Five electronic databases-Cochrane Library, Scopus, PubMed, Web of Science and Embase-will be systematically searched from inception to June 2025. The outcome of interest is UE motor recovery. A comprehensive search of grey literature will also be conducted. Two independent reviewers will perform study selection, data extraction and quality assessment. The risk of bias will be evaluated using the Cochrane Collaboration's Risk of Bias tool. The quality of evidence will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation framework. Ethical approval is not required for this study, as it involves the review of previously published data. The findings will be submitted to a peer-reviewed journal for publication, aiming to provide clinically relevant evidence to support decision-making by healthcare professionals and guideline developers in the management of UE rehabilitation for adult patients who had a stroke. CRD420251083201.