https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0301-7
- Bernhard ElsnerEmail author,
- Gert Kwakkel,
- Joachim Kugler and
- Jan Mehrholz
Journal of NeuroEngineering and Rehabilitation201714:95
© The Author(s). 2017
Received: 13 February 2017
Accepted: 30 August 2017
Published: 13 September 2017
Abstract
Background
Transcranial Direct Current
Stimulation (tDCS) is an emerging approach for improving capacity in
activities of daily living (ADL) and upper limb function after stroke.
However, it remains unclear what type of tDCS stimulation is most
effective. Our aim was to give an overview of the evidence network
regarding the efficacy and safety of tDCS and to estimate the
effectiveness of the different stimulation types.
Methods
We performed a systematic
review of randomised trials using network meta-analysis (NMA), searching
the following databases until 5 July 2016: Cochrane Central Register of
Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, Web of
Science, and four other databases. We included studies with adult people
with stroke. We compared any kind of active tDCS (anodal, cathodal, or
dual, that is applying anodal and cathodal tDCS concurrently) regarding
improvement of our primary outcome of ADL capacity, versus control,
after stroke. PROSPERO ID: CRD42016042055.
Results
We included 26 studies with
754 participants. Our NMA showed evidence of an effect of cathodal tDCS
in improving our primary outcome, that of ADL capacity (standardized
mean difference, SMD = 0.42; 95% CI 0.14 to 0.70). tDCS did not improve
our secondary outcome, that of arm function, measured by the Fugl-Meyer
upper extremity assessment (FM-UE). There was no difference in safety
between tDCS and its control interventions, measured by the number of
dropouts and adverse events.
Conclusion
Comparing different forms of
tDCS shows that cathodal tDCS is the most promising treatment option to
improve ADL capacity in people with stroke.
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