Combination of noninvasive brain stimulation and constraint-induced movement therapy in patients with stroke: a systematic review and meta-analysis

ABSTRACT

Introduction

Constraint-induced movement therapy (CIMT) and noninvasive brain stimulation (NIBS) are used to counteract learned nonuse phenomenon and imbalance in interhemispheric inhibition following stroke. The aim of this study is to summarize the available evidence on the effects of combining NIBS with CIMT in patients with stroke.

Method

PubMed, Embase, Web of Science (WoS), PEDro, OTSeeker, and CENTRAL were searched for randomized controlled trials comparing the use of NIBS+CIMT with sham NIBS+CIMT. Data on variables such as time since stroke and mean scores and standard deviations on outcomes assessed such as motor function were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risk of bias and methodological quality of the included studies.

Results

The results showed that both NIBS+CIMT and sham NIBS+CIMT improved all outcomes post-intervention and at follow-up. However, NIBS+CIMT is superior to sham NIBS+CIMT at improving level of motor impairment (SMD = 1.75, 95% CI = 0.49 to 3.01, P = 0.007) post-intervention and hand function (SMD = 1.21, 95% CI = 0.07 to 2.35, P = 0.04) at follow-up.

Conclusions

The addition of NIBS to CIMT seems to provide additional benefits to the recovery of function following stroke.

KEYWORDS:

• Stroke
• brain stimulation
• learned nonuse
• interhemispheric inhibition
• constraint-induced movement therapy

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution

Conception and design were done by AA, TWLW, TVC, and SSMN; Analysis and interpretation of the data were done by AA, TWLW, and SSMN; the drafting of the paper was done by AA; revising it critically for intellectual content was done by AA, TWLW, TVC and SSMN; and the final approval of the version to be published was carried out by AA, TWLW, TVC and SSMN and all authors agree to be accountable for all aspects of the work.

Data availability statement

All data for this study have been included within the manuscript.

Additional information

Funding

This work was supported by research funding from the Research Centre for Chinese Medicine Innovation of the Hong Kong Polytechnic University (Ref No. P0041139) awarded to Professor S Ng and her team and by the PolyU Distinguished Postdoctoral Fellowship Scheme.