The Effect of Concurrent Transcranial Direct Current Stimulation and Robotic Training of the Upper Limb in Stroke Recovery: A Systematic Review and Meta-analysis

Objectives: Transcranial direct current stimulation and robotic therapy (RT) are two modalities in neurorehabilitation for the improvement of upper limb function in stroke patients. However, the additional effects of the concurrent application of these two techniques compared to RT alone on upper limb function in stroke patients have not been studied yet. We analyzed the effectiveness of concurrent tDCS and RT compared to RT alone on upper limb motor function in stroke patients. Methods: A systematic search of PubMed, Scopus, Web of Science, CENTRAL, EMBASE, and Physiotherapy Evidence Database was performed from 2000 to January 1, 2021. The quality of the included studies was evaluated using the Cochrane risk-of-bias assessment tool. All statistical analyses were performed in STATA software, version 14, and the Mean±SD was used as the pooled statistics. Results: The result showed that concurrent tDCS and RT had moderate but non-significant pooled effect sizes for upper limb Fugl-Meyer assessment (SMD=0.31, 95% CI, -0.20%, 0.83%, I2=84.1%).  Discussion: According to the results of this study, no difference was obtained in the efficacy of concurrent tDCS and RT compared to RT alone on upper limb function in stroke survivors.