Superior treatment efficacy of neuromodulation rehabilitation for upper limb recovery after stroke: a meta-analysis

ABSTRACTABSTRACTBackground This study aims to explore the treatment efficacy of different motor rehabilitation interventions for upper limb impairment recovery.Research Design & Methods Publications were searched in PubMed and Embase. 4 grouped motor rehabilitation treatments (training, technological intervention, pharmacological intervention, and neuromodulation) were compared. The change of the Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE) was applied to assess upper limb function after stroke.Results 56 studies including 5292 patients were identified. A significant difference was found among the 4 groups (P = 0.02). Neuromodulation interventions had the best treatment efficacy among the 4 types of interventions (P < 0.01). Among neuromodulation interventions, acupuncture, electric, or magnetic intervention all had therapeutic efficacy for stroke upper limb recovery, without significant subgroup difference (P = 0.34). Stroke patients with mild upper limb impairment might not benefit from motor rehabilitation (P = 0.14).Conclusion Neuromodulation interventions might have the best therapeutic efficacy among motor rehabilitation treatments for upper limb impairment after stroke. It is a potential treatment direction for upper limb recovery among stroke patients. However, since a large proportion of the original studies are low to very low-quality evidence, large-scale RCTs should be conducted in the future to validate current findings and assess treatment effects based on patient characteristics.KEYWORDS: Motor rehabilitationmeta-analysisstroketreatmentupper limb function Article highlights Neuromodulation intervention might be the most effective motor rehabilitation treatment for stroke upper limb impairment recovery.Acupuncture, electric, and magnetic neuromodulation treatments might have similar therapy efficacy.Patients with mild stroke upper limb impairment might not benefit from motor rehabilitation treatments.Patients in acute, subacute, and chronic stroke stages might all benefit from motor rehabilitation treatments.Declaration of interestThe authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Author contributionsJ Zhi: Conceptualization; review and editing. Q Liao: Conceptualization; writing – original draft; formal analysis; writing – review and editing. Y He: Software; writing – review and editing. W Xu: Methodology; writing – review and editing. D Zhu: Writing – review and editing. Lin Shao: Writing – original draft; Writing – review and editing. All authors read and approved the final manuscript for publication.Data availability statementFindings in this meta-analysis were all drawn from publicly available information, as referenced within the text of the publication. No additional data repository is necessary.Additional informationFundingThis study was supported by the funding from Zhejiang Medical and Health Research Project [2021ZH048].