Efeito do treino de locomação combinado com estímulação transcraniana por corrente contínua nos parâmetros espaço-temporais de marcha em pacientes com acidente vascular cerebral: revisão sistemática e metanálise.

Abstract

Introduction: Stroke is one of the leading causes of long-term functional disability, affecting spatiotemporal parameters of gait such as speed, stride time, cadence, and stance time, which are crucial for autonomy and quality of life. Transcranial direct current stimulation (tDCS) combined with gait training has been investigated in stroke patients and appears to be safe and feasible for outcomes related to gait and mobility. However, to date, there is no systematic review evaluating the effectiveness of tDCS and/or defining the optimal protocol for improving spatiotemporal gait parameters. Objective: The objective of this systematic review was to assess whether tDCS associated with gait training is superior in improving gait parameters compared to no intervention, gait training alone, or sham intervention in stroke patients. Methodology: This is a systematic review, with the search strategy based on the PICO framework (population: stroke; intervention: tDCS; comparison: any control group; outcomes: spatiotemporal gait parameters). Searches were conducted in PubMed, Scopus, Embase, Web of Science, and Cinahl, including controlled clinical trials that used tDCS combined with gait-specific training/assessment. Article selection was performed by two blinded evaluators and a third when necessary. Two authors also independently assessed the risk of bias for each study. The GRADE and the PeDRO scale were used to assess the quality of the evidence associated with specific outcomes, and meta-analysis was conducted to obtain the combined effect estimate of the intervention using a random-effects model. Results: A total of 1139 studies were identified, with 15 included in the qualitative analysis and 7 in the meta-analysis. The use of tDCS, whether alone or combined with a control group (sham), showed an improvement in average gait speed (m/s) (MD = 0.04; 95% CI, 0.00 - 0.08; p = 0.03; I2 = 29%), especially when combined with task-oriented training/multicomponent (MD= 0.06, 95% CI 0.05, 0.07; p <0.001; I2 = 0%). There was also an increase in the percentage of stance phase on the affected side (MD, 1.78; 95% CI, 0.91 - 2.64; p<0.001; I2 = 0%) when tDCS was combined with task-oriented training/multicomponent (BBS/ TUG/ 10MWT). Conclusion: The application of tDCS in stroke, in combination with other types of gait training interventions, especially task-oriented training and multicomponent exercises, tends to be beneficial for improving spatiotemporal gait parameters.