Combined Transcranial Direct Current Stimulation and Robotic-Assisted Gait Training for Balance Rehabilitation Poststroke: A Systematic Review and Meta-Analysis.

BACKGROUND AND PURPOSE: Balance impairments are among the most common motor impairments in patients with neurological disorders. Transcranial direct current stimulation (tDCS) and robotic-assisted gait training (RAGT) have recently been used in stroke rehabilitation. This review aims to investigate the effects of combined tDCS and RAGT on balance ability in patients with stroke.

METHODS

Multiple databases, including PubMed, SCOPUS, Embase, Cochrane Library, REHABDATA, and Web of Science, were searched from inception to June 2025. The risk of bias across the included studies was assessed using the "Physiotherapy Evidence Database (PEDro)" scale. Statistical analysis was carried out using "Comprehensive Meta-Analysis Version 4 software".

RESULTS

Five studies met the eligibility criteria. In total, 207 patients with stroke (mean age 60.73 years, 43% female) were included in this review. The median score on the PEDro scale is 9 with 95% range: 6-10 and IQR: 2. Based on three studies, the meta-analysis on combining tDCS with RAGT for balance in post-stroke patients showed a small, non-significant effect (Berg Balance Scale; SMD = 0.329, 95% CI: -0.622 to 1.279, p = 0.498). Heterogeneity was moderate (I2 = 63%, Q = 5.347, p = 0.069) with a prediction interval of -1.233 to 1.892. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE: tDCS combined with RAGT appears safe and well-tolerated, but its effectiveness on balance post-stroke remains inconclusive. The meta-analysis showed a small, non-significant effect with substantial heterogeneity. Although some studies reported significant improvements, variability across protocols and outcomes limits firm conclusions. Further high-quality research is needed to clarify the benefits.