Transcranial Direct Current Stimulation for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective: The effects of transcranial direct current stimulation (tDCS) in the treatment of knee osteoarthritis (KOA) is still unclear. The objective is to evaluate the efficacy and safety of tDCS in improving symptoms in patients with KOA. Methods: The following electronic databases were searched for eligible randomized controlled trials (RCTs): PubMed, Embase, Web of Science, and the Cochrane Library. The search was performed from the inception dates to April 30, 2023. Data extraction and quality assessment were performed by two independent reviewers. Standard mean differences (SMDs) with 95% confidence intervals (95% CIs) for pooled data were calculated. A random-effects model was used for the data analyses. The primary outcomes were pain and physical function. Secondary outcomes included stiffness, mobility performance, quality of life, pressure pain tolerance, and plasma levels of brain-derived neurotrophic factor (BDNF). Results: This meta-analysis included 13 RCTs. tDCS was significantly associated with pain decrease compared with sham tDCS (SMD = −0.62, 95% CI −0.87 to −0.37, P < 0.00001). When comparing tDCS plus other non-tDCS with sham tDCS plus other non-tDCS, there was no longer a significant association with pain decrease (SMD = −0.45, 95% CI −1.08 to 0.17, P = 0.16). The changes in physical function were not significantly different between the tDCS and sham tDCS groups (SMD = −0.09, 95% CI −0.56 to 0.38, P = 0.71). When comparing tDCS plus other non-tDCS with sham tDCS plus other non-tDCS, there was still no significant association with improvement in physical function (SMD = −0.66, 95% CI −1.63 to 0.30, P = 0.18). There was no significant difference with improvement in stiffness (SMD = −0.21, 95% CI −0.77 to 0.34, P = 0.45), mobility performance (SMD = 4.58, 95% CI −9.21 to 18.37, P = 0.51), quality of life (SMD = −7.01, 95% CI −22.61 to 8.59, P = 0.38), and pressure pain tolerance (SMD = 0.30, 95% CI −0.09 to 0.69, P = 0.13). There was a statistically significant reduction in plasma levels of BDNF (SMD = −13.57, 95% CI −24.23 to −2.92, P = 0.01). Conclusion: In conclusion, tDCS could significantly alleviate pain, but it might have no efficacy in physical function, stiffness, mobility performance, quality of life, and pressure pain tolerance among patients with KOA.