Can cerebellar noninvasive brain stimulation improve lower limb function in stroke? Evidence from meta-analyses based on ICF

PURPOSE: Lower limb dysfunction following a stroke substantially hinders mobility and independence. Cerebellar noninvasive brain stimulation (NIBS) has exhibited potential in enhancing lower limb functionality post-stroke. Our study aims to evaluate the effects from both statistical and clinical significance based on the International Classification of Functioning, Disability, and Health (ICF). MATERIALS AND METHODS: We systematically searched PubMed, Embase, Web of Science, and Cochrane Library. With meta-analyses and network meta-analyses conducted. Data extraction and analyses based on Cochrane Handbook and ICF. RESULTS: = 579 patients) were enrolled. Cerebellar NIBS revealed statistically significant differences in "Activity" components, including the Berg Scale (MD = 4.37), Timed Up and Go Test (TUG; MD = 3.32), and Barthel index (BI; MD = 8.01). However, no significant differences were noted in "Body" Functions (FMA-LL; MD = 2.97), with high-dose intermittent theta-burst stimulation indicating a potentially large effect size (MD = 5.26 vs. 0.68). The post-hoc network meta-analysis showed no statistical difference between electrical and magnetic cerebellar NIBS in "Activity" components. CONCLUSIONS: As per the low-to-moderate level evidence, cerebellar NIBS demonstrated statistically significant improvements in the "Activity" components (Berg, TUG, and BI), albeit these improvements did not translate into clinically meaningful differences, except for BI.