Application of Neuromodulation Techniques in the Treatment of Proprioceptive Disorders After Stroke: A Meta-Analysis of Randomized Controlled Trials.

Abstract

Background and Objective: After a stroke, proprioceptive disorders can impair patients' ability to perceive the speed and direction of movement accurately and promptly, as well as the spatial position of their limbs. This impairment often leads to motor dysfunction, including balance and postural control deficits, which severely affect patients' activities of daily living (ADLs) and quality of life. Neural plasticity is a key factor influencing poststroke functional recovery. In recent years, neuromodulation techniques targeting the enhancement of neural plasticity have emerged as a major research focus. This study aims to conduct a meta-analysis of the efficacy of neuromodulation techniques in treating proprioceptive disorders in stroke patients. Methods: A systematic search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science for studies investigating the effects of neuromodulation techniques on proprioceptive impairment in stroke patients. The search spanned from the inception of each database to December 2024. The primary outcome measure was the change in proprioception. Results: In this meta-analysis, a total of nine randomized controlled trials (RCTs) were included. One study compared two different neuromodulation techniques, resulting in the extraction of 10 distinct datasets. Overall, 360 patients were involved in these studies. Specifically, 182 patients in the treatment group received neuromodulation techniques combined with conventional rehabilitation, while 178 patients in the control group received conventional rehabilitation alone. The meta-analysis revealed no significant difference in the efficacy of neuromodulation techniques combined with conventional rehabilitation compared to conventional rehabilitation alone(standardized mean difference [SMD] = 0.221,95% CI = -0.194 to 0.636, p=0.296). The subgroup analysis based on the stage of the stroke course revealed no significant differences between the two groups(acute stage: SMD = 0.303, 95% CI = -1.300 to 1.905, p=0.711; subacute stage: SMD = 0.351, 95% CI = -0.200 to 0.903, p=0.212; chronic phase: SMD = -0.047, 95% CI = -0.634 to 0.539, p=0.874). Subgroup analysis based on the types of neuromodulation techniques revealed that three specific techniques, electroacupuncture, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), were effective in improving proprioceptive disorders after stroke electroacupuncture group: SMD = -0.504, 95% CI = -1.006 to -0.002, p=0.049; rTMS group: SMD = 1.207, 95% CI = 0.246-2.168, p=0.014; tDCS group: SMD = 0.894, 95% CI = 0.323-1.465, p=0.002). Conclusion: No statistically significant difference was found in the efficacy of neuromodulation techniques for treating proprioceptive disorders after stroke. Additionally, no significant differences were observed in the intervention across different stages of stroke. However, subgroup analysis indicated that electroacupuncture, rTMS, and tDCS may be effective in managing proprioceptive disorders poststroke. Therefore, it is recommended to prioritize these techniques in clinical practice.