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  • Vagus nerve stimulation paired with rehabilitation for motor function, mental health and activities of daily living after stroke: a systematic review and meta-analysis

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Cerebrovascular disease
Original research
Vagus nerve stimulation paired with rehabilitation for motor function, mental health and activities of daily living after stroke: a systematic review and meta-analysis
  1. Yong Gao1,
  2. Yi Zhu2,
  3. Xiao Lu2,
  4. Nannan Wang3,
  5. Shizhe Zhu2,
  6. Jianqiu Gong1,
  7. Tong Wang2,
  8. Shao-Wen Tang3
  1. 1 Department of Rehabilitation, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
  2. 2 Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
  3. 3 Department of Epidemiology and Biostatistics, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China
  1. Correspondence to Dr Shao-Wen Tang, Department of Epidemiology and Biostatistics, Nanjing Medical University School of Public Health, Nanjing, Jiangsu, China; tomswen{at}njmu.edu.cn; Dr Tong Wang, Department of Rehabilitation, Jiangsu Province People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China; wangtong60621{at}163.com

Abstract

Objective Vagus nerve stimulation (VNS) plus rehabilitation (Rehab) has shown a potential effect on recovery with a stroke. We systematically synthesised studies examining VNS+Rehab for improving motor function, mental health and activities of daily living (ADL) postintervention and at the end of follow-up in patients with a stroke.

Methods The search was performed in electronic databases EMBASE, Medline, EBSCO, Cochrane Library, PubMed, PsycINFO, CINAHL, CNKI, and WANFANG and three clinical trial registries from inception to February 2022. Randomised controlled trials (RCTs) applied VNS+Rehab in stroke were included.

Results Seven RCTs involving 263 (analysed) participants was included. The effect size of VNS+Rehab over Rehab for motor function was medium postintervention (g=0.432; 95% CI 0.186 to 0.678) and large at the end of follow-up (g=0.840; 95% CI 0.288 to 1.392). No difference was found in the effect of VNS+Rehab over traditional rehabilitation for ADL, mental health or safety outcomes. Subgroup analyses revealed larger effects for patients received taVNS (transcutaneous auricular VNS) devices (at acute/subacute phase of stroke, with lower VNS stimulation frequency or pluses per session, greater VNS on-off time or sessions, higher VNS intervention weekly frequency).

Conclusion The results suggest VNS+Rehab showed better motor function outcomes in patients after stroke, while no better than Rehab on mental health or ADL. Combinations of phase of stroke, specific parameters of VNS and VNS intervention frequency are key modulators of VNS effects.

Trial registration number CRD42022310194

  • STROKE
  • REHABILITATION
  • ELECTRICAL STIMULATION
  • META-ANALYSIS

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/jnnp-2022-329275

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • YG, YZ, XL and NW are joint first authors.

    • Correction notice This article has been corrected since it was published online. On page 2, in METHODS-->Statistical analysis section, “The magnitude of Hedges’ g was corrected from, "small ≤0.2, medium >0.2 and ≤ 0.5, and large >0.50" to "small<0.3, medium≥0.3 and <0.6, and large≥0.60."

    • Contributors YG, YZ, XL and NW contributed equally to this paper and are joint first authors. YG, TW and S-WT are joint senior authors. YG and S-WT designed the study. YG and YZ searched the literature. YZ, XL and YG contributed to data collection. YG, XL and S-WT conceptualised and performed the analysis. YZ and JQG supervised the study. QCJ and YZ described included studies and communicated with coauthors, with oversight from S-WT, and TW, YG and SZZ generated the figures. NW and YG verified data and analyzed the data under the supervision of S-WT. S-WT, TW and YG participated in the whole process. YG wrote the first draft of the manuscript. S-WT, TW and YG are responsible for the overall content as the guarantor. All authors contributed to writing of this manuscript. All authors read and approved the final manuscript.

    • Funding National Key R&D Program of China (2018YFC2001600, 2018YFC2001603), Zhejiang Province Public Welfare Technology Application Research Project of China (2020ZH05) and Shaoxing Bureau of Science and Technology (2018C30063).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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