Effects of Transcranial Brain Stimulation Combined with Physiotherapy on Lower Limb Motor Recovery in Post-Stroke Patients: a Systematic Review and Meta-analysis.

Abstract

Introduction: Transcranial stimulation (TS) can integrate motor therapy with satisfactory results in the correction of pathological neural configurations found after stroke. The objective of the study was to synthesize evidence on the effects of TS in post-stroke patients, combined with physiotherapeutic interventions compared with no physiotherapeutic intervention, in improving gait and in reducing spasticity.

Methods: Electronic databases PubMed, Embase, Scopus, and Cochrane were searched from 2011 until February 2021. Studies were included if they were randomized clinical trials, that combined TS with physiotherapeutic intervention and were of any nature; the studies included measures related to mobility and muscle tone of the lower limbs and those that approached adults, of legal age, affected by ischemic or hemorrhagic stroke, in the acute, subacute or chronic stage of the disease. We excluded studies that contemplated other neurological diseases; studies aiming only to evaluate efficacy between TS currents and those with samples under ten individuals. Risk of bias assessment of randomized clinical trials was based on the PEDro scale. The meta- analysis was performed according to the random effect model in the R software, comparing the differences between the pre- and post-test of each variable.

Results: Five randomized controlled trials (pooled n=133) were included in the meta-analysis. The results of the 10-meters walk test (10MWT) and 6-minute walk test (6MWT) showed a small effect favoring the use of TS combined with physiotherapy in improving gait speed, while the timed up and go test (TUG) and the Functional Ambulation Category (FAC) showed a large effect. The 95% confidence interval (CI) was adopted.

Conclusion: TS combined with physical therapy intervention seems to be a useful resource for improving gait performance in post-stroke patients. TS was shown not to be effective in reducing lower limb spasticity. This review is limited by the small number of articles identified in the literature.