TY - JOUR
T1 - Effectiveness of anodal transcranial direct current stimulation to improve muscle strength and motor functionality after incomplete spinal cord injury
T2 - a systematic review and meta-analysis
AU - de Araújo, Amanda Vitória Lacerda
AU - Ribeiro, Felipe Piccarone Gonçalves
AU - Massetti, Thais
AU - Potter-Baker, Kelsey A.
AU - Cortes, Mar
AU - Plow, Ela Bhatt
AU - da Silva, Talita Dias
AU - Tonks, James
AU - Anghinah, Renato
AU - Magalhães, Fernando Henrique
AU - Fregni, Felipe
AU - de Mello Monteiro, Carlos Bandeira
N1 - Publisher Copyright:
© 2020, The Author(s), under exclusive licence to International Spinal Cord Society.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Study design: Systematic review and meta-analysis. Objectives: We aimed to investigate the effects of anodal transcranial direct current stimulation (tDCS) against sham on muscle strength and motor functionality after incomplete spinal cord injury (iSCI). Setting: University of São Paulo, Brazil. Methods: A preplanned protocol was registered (PROSPERO, CRD42016050444). Pubmed, Embase, Web of Science, Cochrane Central Library and BVS databases were searched independently by two authors up to March 2018. Cochrane Collaboration’s Tool was used for the risk of bias assessments. Generic inverse variance and random-effects model were used to calculate pooled effect sizes (ES), 95% confidence intervals (CIs) and p-values in meta-analyses. Results: Six randomized clinical trials met inclusion criteria (n = 78 iSCI individuals) and were included in the meta-analysis. Results showed a marginal significant pooled effect of active tDCS in improving motor functionality with a small ES (SMD = 0.26, 95% CI = −0.00 to 0.53, p = 0.05, I2 = 0%). On the other hand, the pooled effect of active tDCS on muscle strength did not reach statistical significance, in parallel with a small ES (SMD = 0.35, 95% CI = −0.21 to 0.92, p = 0.22, I2 = 0%) when compared with sham tDCS. No significant adverse events were reported. Conclusions: Overall, there was a significant effect of tDCS in improving motor functionality following iSCI. However, a small ES and the marginal p-value suggest that these results should be interpreted with caution. Further high-quality clinical trials are needed to support or refute the use of tDCS in daily clinical practice.
AB - Study design: Systematic review and meta-analysis. Objectives: We aimed to investigate the effects of anodal transcranial direct current stimulation (tDCS) against sham on muscle strength and motor functionality after incomplete spinal cord injury (iSCI). Setting: University of São Paulo, Brazil. Methods: A preplanned protocol was registered (PROSPERO, CRD42016050444). Pubmed, Embase, Web of Science, Cochrane Central Library and BVS databases were searched independently by two authors up to March 2018. Cochrane Collaboration’s Tool was used for the risk of bias assessments. Generic inverse variance and random-effects model were used to calculate pooled effect sizes (ES), 95% confidence intervals (CIs) and p-values in meta-analyses. Results: Six randomized clinical trials met inclusion criteria (n = 78 iSCI individuals) and were included in the meta-analysis. Results showed a marginal significant pooled effect of active tDCS in improving motor functionality with a small ES (SMD = 0.26, 95% CI = −0.00 to 0.53, p = 0.05, I2 = 0%). On the other hand, the pooled effect of active tDCS on muscle strength did not reach statistical significance, in parallel with a small ES (SMD = 0.35, 95% CI = −0.21 to 0.92, p = 0.22, I2 = 0%) when compared with sham tDCS. No significant adverse events were reported. Conclusions: Overall, there was a significant effect of tDCS in improving motor functionality following iSCI. However, a small ES and the marginal p-value suggest that these results should be interpreted with caution. Further high-quality clinical trials are needed to support or refute the use of tDCS in daily clinical practice.
UR - https://www.scopus.com/pages/publications/85079732821
U2 - 10.1038/s41393-020-0438-2
DO - 10.1038/s41393-020-0438-2
M3 - Review article
C2 - 32066873
AN - SCOPUS:85079732821
SN - 1362-4393
VL - 58
SP - 635
EP - 646
JO - Spinal Cord
JF - Spinal Cord
IS - 6
ER -