Does transcranial direct current stimulation improve functional locomotion in people with Parkinson's disease? A systematic review and meta-analysis

Abstract

Purpose: The purpose of this meta-analysis was to investigate the treatment effects of transcranial direct current stimulation (tDCS) on functional locomotion in people with Parkinson's disease (PD). Methods: A systematic literature search identified 18 qualified studies that used tDCS protocols as functional locomotion rehabilitation interventions for people with PD. All included studies used either a randomized control trial or crossover designs with a sham control group. Meta-analysis quantified both (a) short-term treatment effects: change in functional locomotion between baseline and immediate posttests on 18 comparisons and (b) long-term treatment effects: change in functional locomotion between baseline and delayed retention tests on six comparisons. Moreover, we performed moderator variable analyses for comparing effect sizes between tDCS targeting multiple brain regions and tDCS targeting a single brain region. Results: Random effects model meta-analyses revealed a significant short-term treatment effect (effect size = 0.359; P = 0.001), whereas no significant long-term treatment effects were identified (effect size = 0.164; P = 0.314). In addition, tDCS protocols that targeted multiple brain regions showed relatively more positive effects on functional locomotion than protocols that targeted a single brain region. Conclusions: These meta-analytic findings indicate that tDCS protocols may show immediate positive effects on functional locomotion in people with PD. However, given the relatively low effect size, exploring more appropriate tDCS protocols (i.e., targeting multiple motor and prefrontal regions and medication condition) should be a focus in future studies.