Can cerebellar noninvasive brain stimulation improve lower limb function in stroke? Evidence from meta-analyses based on ICF.

PURPOSE: Lower limb dysfunction following a stroke substantially hinders mobility and independence. Cerebellar noninvasive brain stimulation (NIBS) has exhibited potential in enhancing lower limb functionality post-stroke. Our study aims to evaluate the effects from both statistical and clinical significance based on the International Classification of Functioning, Disability, and Health (ICF).

MATERIALS AND

METHODS

We systematically searched PubMed, Embase, Web of Science, and Cochrane Library. With meta-analyses and network meta-analyses conducted. Data extraction and analyses based on Cochrane Handbook and ICF.

RESULTS

Fifteen studies (n = 579 patients) were enrolled. Cerebellar NIBS revealed statistically significant differences in "Activity" components, including the Berg Scale (MD = 4.37), Timed Up and Go Test (TUG; MD = 3.32), and Barthel index (BI; MD = 8.01). However, no significant differences were noted in "Body" Functions (FMA-LL; MD = 2.97), with high-dose intermittent theta-burst stimulation indicating a potentially large effect size (MD = 5.26 vs. 0.68). The post-hoc network meta-analysis showed no statistical difference between electrical and magnetic cerebellar NIBS in "Activity" components.

CONCLUSIONS

As per the low-to-moderate level evidence, cerebellar NIBS demonstrated statistically significant improvements in the "Activity" components (Berg, TUG, and BI), albeit these improvements did not translate into clinically meaningful differences, except for BI.