Objective:

To comprehensively assess and compare treatment completion rates across non-invasive brain stimulation (NIBS) modalities for upper limb rehabilitation in stroke patients.

Approach:

• Statistical Analysis: Completion rates were pooled using random-effects single-arm meta-analyses with the Freeman-Tukey double arcsine transformation; Bayesian random-effects network meta-analysis estimated relative risks (RRs) and 95% credible intervals (CrIs).

Key Findings:

• The overall pooled completion rate for NIBS interventions was 94.9%.
• No NIBS intervention showed a statistically significant difference from sham/control in completion rates.
• The adverse event (AE) rate across intervention groups was 16.4%, with mild headache and skin tingling being the most common.
• Completion rates were higher for tDCS (96.8%) compared to rTMS (93.9%).
• Chronic stroke phase had the highest completion rate (97.1%), while the mixed phase had the lowest (89.1%).
• Intermittent theta burst stimulation (iTBS), bilateral rTMS (BL-rTMS), and dual transcranial direct current stimulation (Dual-tDCS) were the highest-ranked interventions.

Limitations:

• The findings are hypothesis-generating rather than definitive due to minimal absolute completion-rate differences.
• Four interventions were informed by only one study, limiting the robustness of the rankings.
• Every pairwise credible interval included 1.00, indicating no clear superiority among interventions.

Conclusion:

Stroke phase may be an important consideration in designing adherence strategies.

Sources:

• Systematic Review Registration