Efficacy comparison of seven non-invasive brain stimulation techniques for upper limb motor dysfunction after stroke: a Bayesian network meta-analysis and systematic review.

Abstract

<h4>Background</h4>Stroke frequently causes upper limb dysfunction, impairing daily activities and quality of life. This study evaluates seven repetitive transcranial magnetic stimulation and transcranial direct current stimulation protocols for improving upper limb motor function, muscle tone, and daily living in stroke patients, providing evidence for optimizing non-invasive brain stimulation therapy.<h4>Methods</h4>Computerized searches were conducted in the VIP database (VIP), Wan-fang database, China National Knowledge Infrastructure (CNKI), PubMed, SinoMed Database (CBM), Cochrane Library, and Web of Science databases to identify publicly published randomized controlled trials on different non-invasive brain stimulation techniques for upper limb motor dysfunction after stroke. The search period was up to November 2024. The Cochrane Risk of Bias tool (version 5.4.0) was used to assess the quality of the included studies. R software (version 4.1.1) was used to perform Bayesian network meta-analysis for data comparison and ranking.<h4>Results</h4>A total of 28 studies were included, with a total sample size of 1,340 patients, encompassing 7 non-invasive brain stimulation techniques. Probability ranking results indicated the following: for Fugl-Meyer Assessment for Upper Extremity (FMA-UE), the top three rankings were high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) (29%), continuous theta burst stimulation (cTBS) (27%), and anodal transcranial direct current stimulation (aDCS) (17.5%); for Barthel Index (BI), the top three were aDCS (71.5%), low-frequency repetitive transcranial magnetic stimulation(LF-rTMS) (20.9%), and HF-rTMS (4.4%); for Wolf Motor Function Test (WMFT), the top three were aDCS (63.6%), cTBS (13%), and HF-rTMS (9.1%); for Modified Ashworth Scale (MAS), the top three were intermittent theta burst stimulation (iTBS) (42%), LF-rTMS (24%), and cTBS (16%); for Action Research Arm Test (ARAT), the top three were iTBS (72.6%), aDCS (22.3%), and LF-rTMS (2.8%).<h4>Conclusion</h4>Based on the network meta-analysis results and probability ranking evidence, HF-rTMS is most likely to be the most effective intervention for restoring motor function (FMA-UE); aDCS may rank first for both activities of daily living (BI) and motor task performance (WMFT); iTBS appears beneficial for improving muscle tone regulation (MAS) and fine motor ability (ARAT). However, the results for ARAT (6 studies) and MAS (9 studies), based on a smaller number of studies, should be interpreted with caution due to limited evidence.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251019764.