The Impact of Transcranial Direct Current Stimulation on Upper-Limb Motor Performance in Healthy Adults: A Systematic Review and Meta-Analysis

Ronak Patel, James Ashcroft, Ashish Patel, Hutan Ashrafian, Adam J Woods, Harsimrat Singh, Ara Darzi, Daniel Richard Leff, Ronak Patel, James Ashcroft, Ashish Patel, Hutan Ashrafian, Adam J Woods, Harsimrat Singh, Ara Darzi, Daniel Richard Leff

Abstract

Background: Transcranial direct current stimulation (tDCS) has previously been reported to improve facets of upper limb motor performance such as accuracy and strength. However, the magnitude of motor performance improvement has not been reviewed by contemporaneous systematic review or meta-analysis of sham vs. active tDCS. Objective: To systematically review and meta-analyse the existing evidence regarding the benefits of tDCS on upper limb motor performance in healthy adults. Methods: A systematic search was conducted to obtain relevant articles from three databases (MEDLINE, EMBASE, and PsycINFO) yielding 3,200 abstracts. Following independent assessment by two reviewers, a total of 86 articles were included for review, of which 37 were deemed suitable for meta-analysis. Results: Meta-analyses were performed for four outcome measures, namely: reaction time (RT), execution time (ET), time to task failure (TTF), and force. Further qualitative review was performed for accuracy and error. Statistically significant improvements in RT (effect size -0.01; 95% CI -0.02 to 0.001, p = 0.03) and ET (effect size -0.03; 95% CI -0.05 to -0.01, p = 0.017) were demonstrated compared to sham. In exercise tasks, increased force (effect size 0.10; 95% CI 0.08 to 0.13, p < 0.001) and a trend towards improved TTF was also observed. Conclusions: This meta-analysis provides evidence attesting to the impact of tDCS on upper limb motor performance in healthy adults. Improved performance is demonstrable in reaction time, task completion time, elbow flexion tasks and accuracy. Considerable heterogeneity exists amongst the literature, further confirming the need for a standardised approach to reporting tDCS studies.

Keywords: healthy; meta-analysis; motor; performance; systematic review; transcranial direct-current stimulation (tDCS).

Copyright © 2019 Patel, Ashcroft, Patel, Ashrafian, Woods, Singh, Darzi and Leff.

Figures

Figure 1
Figure 1
Prisma Flow diagram detailing exclusions throughout each stage of study selection to yield a total of 86 articles for systematic review, 37 of which were meta-analysable. *2 studies (Waters-Metenier et al., ; Apšvalka et al., 2018) provided data for both reaction time and execution time.
Figure 2
Figure 2
Methodological heterogeneity of selected studies showing variability in (A) current density, (B) stimulation duration, and (C) montage arrangement. Bottom left pie chart illustrates the spread of the target area for stimulation. Bottom right pie chart illustrates the corresponding reference electrode location during motor cortex stimulation. PPC, Posterior Parietal Cortex; SMA, Supplementary Motor Area; PMC, Pre-motor Cortex; PFC, Prefrontal Cortex; SOR, Supraorbital Region; HD, High-Definition.
Figure 3
Figure 3
Forest Plot illustrating effect sizes from the comparison in reaction time between tDCS vs. sham. Positive values indicate an increase in reaction time following anodal tDCS whilst negative values indicate a decrease in reaction time. Grey boxes represent the weight given to each study. Error bars represent 95% confidence intervals.
Figure 4
Figure 4
Forest Plot illustrating effect sizes from the comparison in total task time between tDCS vs. sham. Positive values indicate an increase in time taken following anodal tDCS whilst negative values indicate a decrease in time taken. Grey boxes represent the weight given to each study. Error bars represent 95% confidence intervals.
Figure 5
Figure 5
Forest Plot illustrating effect sizes from the comparison in time to elbow flexion task failure between anodal tDCS vs. sham tDCS. Positive values indicate an increase in time to failure following tDCS whilst negative values indicate a decrease in time. Grey boxes represent the weight given to each study. Error bars represent 95% confidence intervals.
Figure 6
Figure 6
Forest Plot illustrating effect sizes from the comparison in strength between (A) anodal tDCS and (B) sham tDCS vs. baseline. Positive values indicate an increase strength following each intervention whilst negative values indicate a decrease in strength. Grey boxes represent the weight given to each study. Error bars represent 95% confidence intervals.
Figure 7
Figure 7
Risk of bias in all 37 studies included for quantitative analysis.

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