Abstract 438: Transcranial Direct Current Stimulation for Post‐Stroke Upper Extremity Motor Recovery: An Updated Meta Analysis

Transcranial direct current stimulation (tDCS) has been emerging as a promising intervention to address post‐stroke upper extremity motor impairment. However, trial results have been inconsistent. Chhatbar et al. conducted a meta‐analysis of randomized sham‐stimulation‐controlled clinical trials between 1980‐2014 that only included Fugl‐Meyer Upper Extremity Scale (FM‐UE) as the measurement of motor impairment. We aimed to conduct an updated meta‐analysis by including additional trials since 2014 using the same criteria to test whether positive results still hold. We conducted a PubMed and Embase search using the terms “(tDCS) AND (stroke)) AND (sham)) AND (motor)) AND (improvement) AND (Fugl)” from January 1, 2014‐ April 1st 2024. There were 72 initial records. After screening for randomized, double blinded, sham‐controlled trials using the FM‐UE with >5 stimulation sessions, 20 studies remained. Eight additional studies were included from the meta‐analysis Chhatbar et al. (7) or other literature searches (1) resulting in a total of 28 studies. The primary outcome was the mean change in the FM‐UE (baseline to post‐intervention). PEDro and JADED scores were collected to assess the quality of included trials. The 28 included studies spanned 1100 patients. 15 out of 28 studies had sufficient extractable data from the manuscript to be included in the meta‐analysis. 286 subjects underwent tDCS. 291 underwent sham stimulation. Meta‐analysis favored the active stimulation group by a standard mean difference [95% CI] of 0.44 [0.12‐0.76], z=2.71, p=0.007. Heterogeneity was measured as I2=66%, p<0.001. The mean (SD) PEDro and JADED scores for the included studies was 9.9 (1.2) and 4.5 (0.7) respectively. In this updated meta‐analysis, there is evidence to support the positive effect of tDCS in reducing post‐stroke motor impairment. The presence of statistical heterogeneity is indicative of variation between trials in the magnitude of sample estimates or the relative benefit of active stimulation group.