Ahmed, IshtiaqMustafaoglu, RustemRossi, SimoneCavdar, Fatih A.Agyenkwa, Seth KwamePang, Marco Y. C.Straudi, Sofia2024-05-252024-05-252023100003-99931532-821X10.1016/j.apmr.2023.04.0272-s2.0-85162849109https://doi.org/10.1016/j.apmr.2023.04.027https://hdl.handle.net/20.500.14517/1337Mustafaoğlu, Rüstem/0000-0001-8549-4449; AGYENKWA, SETH KWAME/0000-0003-1183-5727; Pang, Marco Yiu Chung/0000-0003-1652-8945; MUSTAFAOGLU, RUSTEM/0000-0001-7030-0787; Straudi, Sofia/0000-0002-2061-9922; rossi, simone/0000-0001-6697-9459; Cavdar, Fatih Aykut/0000-0003-1972-0502Objective: To compare the efficacy of non-invasive brain stimulation (NiBS) such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), theta-burst stimulation (TBS), and transcutaneous vagus nerve stimulation (taVNS) in upper limb stroke rehabilitation. Data Sources: PubMed, Web of Science, and Cochrane databases were searched from January 2010 to June 2022. Data Selection: Randomized controlled trials (RCTs) assessing the effects of "tDCS", "rTMS", "TBS", or "taVNS" on upper limb motor function and performance in activities of daily livings (ADLs) after stroke. Data Extraction: Data were extracted by 2 independent reviewers. Risk of bias was evaluated with the Cochrane Risk of Bias tool. Data Synthesis: 87 RCTs with 3750 participants were included. Pairwise meta-analysis showed that all NiBS except continuous TBS (cTBS) and cathodal tDCS were significantly more efficacious than sham stimulation for motor function (standardized mean difference [SMD] range 0.421.20), whereas taVNS, anodal tDCS, and both low and high frequency rTMS were significantly more efficacious than sham stimulation for ADLs (SMD range 0.54-0.99). NMA showed that taVNS was more effective than cTBS (SMD:1.00; 95% CI (0.02-2.02)), cathodal tDCS (SMD:1.07; 95% CI (0.21-1.92)), and Physical rehabilitation alone (SMD:1.46; 95% CI (0.59-2.33)) for improving motor function. P-score found that taVNS is best ranked treatment in improving motor function (SMD: 1.20; 95% CI (0.46-1.95)) and ADLs (SMD:1.20; 95% CI (0.45-1.94)) after stroke. After taVNS, excitatory stimulation protocols (intermittent TBS, anodal tDCS, and HF-rTMS) are most effective in improving motor function and ADLs after acute/sub-acute (SMD range 0.53-1.63) and chronic stroke (SMD range 0.39-1.16). Conclusions: Evidence suggests that excitatory stimulation protocols are the most promising intervention in improving upper limb motor function and performance in ADLs. taVNS appeared to be a promising intervention for stroke patients, but further large RCTs are required to confirm its relative superiority.eninfo:eu-repo/semantics/openAccessBrain stimulationMotor recoveryRehabilitationStrokeUpper limbReviewQ1Q11041016831697WOS:00108876540000137245690