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Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis

Spinal Cord volume 61, pages 587–599 (2023)Cite this article

Subjects

Abstract

Study design

A systematic review and meta-analysis of clinical trials.

Objectives

To determine the effect of non-invasive transcutaneous spinal direct current stimulation (tsDCS) on spasticity, activity limitations and participation restrictions in various upper motor neuron diseases.

Methods

Six databases including CINAHL plus, Cochrane CENTRAL, Embase, MEDLINE, SCOPUS and Web of Science were searched for the relevant records from January 2008 to December 2022. Two reviewers independently selected and extracted data on spasticity, activity limitations and participation restrictions. The risk of bias was evaluated using the PEDro scale while the GRADE approach established the certainty of the evidence.

Results

Eleven studies were identified of which 5 (45.5%) were rated as having a low risk of bias and 8 (72.7%) were meta-analyzed. The meta-analyses did not show any significant differences between cathodal (SMD = −0.67, 95% CI = −1.50 to 0.15, P = 0.11, I2 = 75%, 6 RCTs) or anodal (SMD = 0.11, 95% CI = −0.43 to −0.64, p = 0.69, I2 = 0%, 2 RCTs) and sham tsDCS for spasticity. There was also no significant difference between active and sham tsDCS for activity limitations (SMD = −0.42, 95% CI = −0.04 to 0.21, p = 0.2, I2 = 0%, 2 RCTs) and participation restrictions (MD = −8.10, 95% CI = −18.02 to 1.82, p = 0.11, 1 RCT).

Conclusions

The meta-analysis of the available evidence provides an uncertain estimate of the effect of cathodal tsDCS on spasticity, activity limitation and participation restriction. It might be very helpful, or it may make no difference at all. However, considering the level of the evidence and the limitation in the quality of the majority of the included studies, further well-designed research may likely change the estimate of effect.

Trial registration

PROSPERO CRD42021245601.

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Data availability

The datasets analysed during this review are openly available within the article and its supplementary files.

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Authors and Affiliations

  1. Department of Medical Rehabilitation (Physiotherapy), Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria

    Auwal B. Hassan & Mamman A. Masta

  2. Department of Physiotherapy, Monash University, Melbourne, VIC, Australia

    Abubakar T. Salihu

  3. Peninsula Allied Health Centre, University of Plymouth, Plymouth, UK

    Hilary Gunn & Jonathan Marsden

  4. Department of Physiotherapy, Bayero University Kano, Kano, Nigeria

    Auwal Abdullahi & Rufa’i Y. Ahmad

  5. Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, College of Sciences, Health and Engineering, La Trobe University, Bundoora, VIC, 3085, Australia

    Musa S. Danazumi

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Contributions

ABH conceived and designed the study with inputs from MSD, ATS, and AA. ATS searched the literature and uploaded the records to Covidence. ABH and MAM screened the studies against the eligibility criteria, extracted the data and assessed the methodological quality of the included studies, while MSD settled the disagreements. ABH did the qualitative synthesis, and MSD and ATS did the meta-analysis. ABH wrote up the Manuscript which was critically reviewed by AA and MSD. The project was supervised by JM, HG, and RYA. All authors contributed to the article and approved the submitted version.

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Correspondence to Musa S. Danazumi.

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Hassan, A.B., Salihu, A.T., Masta, M.A. et al. Effect of transcutaneous spinal direct current stimulation on spasticity in upper motor neuron conditions: a systematic review and meta-analysis. Spinal Cord 61, 587–599 (2023). https://doi.org/10.1038/s41393-023-00928-9

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