Meta-Analysis of Functional Electrical Stimulation Combined with Occupational Therapy on Post-Stroke Limb Functional Recovery and Quality of Life

Introduction: This study aimed to investigate whether functional electrical stimulation (FES) and transcranial direct current stimulation (tDCS) enhanced the effect of occupational therapy (OT) on post-stroke limb functional recovery and quality of life, using direct and network meta-analysis. Methods: A computerized search was conducted in databases such as Medline, Web of Science, Embase, CNKI (China National Knowledge Infrastructure), Wanfang Data, and VIP Information for prospective randomized controlled trials on OT, FES, and tDCS for improving post-stroke limb motor function and quality of life, with the search cutoff date of July 1, 2023. Results: Following the screening process, a total of 8 research articles were incorporated, encompassing 358 participants. Among these, 177 individuals underwent OT exclusively, while 181 individuals underwent a combined regimen of OT alongside electromagnetic therapy. In terms of the intervention methods, the control group received OT treatment only, while the experimental group employed tDCS in 5 studies and FES in 3 studies. Within these investigations, Fugl-Meyer Assessment (FMA) scores were reported in 8 studies. The aggregated mean difference (MD) for FMA scores was 5.08 (95% confidence interval [CI]: 2.46, 7.71), with a specific MD of 2.77 (95% CI.: 1.46, 4.09) for the tDCS subgroup and 9.04 (95% CI.: 5.34, 12.73) for the FES subgroup. Notably, FES combined with OT exhibited significant advantages in enhancing FMA scores when compared to the combination of tDCS and OT. Furthermore, four studies provided data on modified Barthel Index (MBI) scores, yielding a collective MD of 7.20 (95% CI.: 4.44, 9.95). Conclusion: In patients with stroke, both FES combined with OT and tDCS combined with OT exhibit substantial enhancements in limb function and quality of life compared to OT alone. Notably, FES combined with OT yields superior clinical benefits when compared to the amalgamation of tDCS and OT.