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

Abstract

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). 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. Ten RCTs (<i>n</i> = 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 (<i>p</i> > 0.12 for all). 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.