Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials

Abstract

BackgroundAs a common sequela after stroke, cognitive impairment negatively impacts patients' activities of daily living and overall rehabilitation. Non-pharmacological therapies have recently drawn widespread attention for their potential in improving cognitive function. However, the optimal choice of non-pharmacological therapies for post-stroke cognitive impairment (PSCI) is still unclear. Hence, in this study, we compared and ranked 5 non-pharmacological therapies for PSCI with a Bayesian Network Meta-analysis (NMA), to offer a foundation for clinical treatment decision-making.MethodsPubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Chinese Biomedical Medicine, China National Knowledge Infrastructure, Wangfang Database, and China Science and Technology Journal Database were searched from database inception to December 31, 2021, to collect Randomized Controlled Trials for PSCI. All of the studies were assessed (according to Cochrane Handbook for Systematic Reviews) and then data were extracted by two researchers separately. Pairwise meta-analysis for direct comparisons was performed using Revman. NMA of Bayesian hierarchical model was performed by WinBUGS and ADDIS. STATA was used to construct network evidence plots and funnel plots.ResultsA total of 55 trials (53 Two-arm trials and 2 Three-arm trials) with 3,092 individuals were included in this study. In the pair-wise meta-analysis, Transcranial Magnetic Stimulation (TMS), Virtual Reality Exposure Therapy (VR), Computer-assisted cognitive rehabilitation (CA), Transcranial Direct Current Stimulation (tDCS), and Acupuncture were superior to normal cognition training in terms of MoCA, MMSE, and BI outcomes. Bayesian NMA showed that the MoCA outcome ranked Acupuncture (84.7%) as the best therapy and TMS (79.7%) as the second. The MMSE outcome ranked TMS (76.1%) as the best therapy and Acupuncture as the second (72.1%). For BI outcome, TMS (89.1%) ranked the best.ConclusionsTMS and Acupuncture had a better effect on improving cognitive function in post-stroke patients according to our Bayesian NMA. However, this conclusion still needs to be confirmed with large sample size and high-quality randomized controlled trials.Registrationhttps://inplasy.com (No. INPLASY202260036).

Acupuncture for stroke: A bibliometric analysis of global research from 2000 to 2022

“…Post-stroke cognitive impairment (PSCI) can seriously affect the rehabilitation process and quality of life of patients. A 2022 study using Bayesian analysis of 55 randomized controlled trials found that acupuncture was the optimal treatment for post-stroke cognitive impairment [ 47 ]. Evidence from studies suggests that the potential improvement in cognitive functions following stroke through acupuncture is mediated by mechanisms such as the inhibition of inflammatory responses, enhancement of synaptic plasticity, regulation of the central cholinergic system, modulation of apoptosis and autophagy, and alteration of brain-derived neurotrophic factor and nerve growth inhibitory factor expression.…”

Is Virtual Rehabilitation Technology Ready to Be Widely Integrated in the Rehabilitation Area? An IT Governance Perspective

“…This happens even in most recent studies like Xiao et al [77], where they found that while Computer Assisted Cognitive Rehabilitation showed significant difference in Stroke patients, the use of VR did not show equivalent benefits. Furthermore, recent studies like Li et al [78] showed that other alternative techniques like acupuncture or transcranial magnetic stimulation showed more consistent results than VR use.…”

Investigate the therapeutic differences between Temporal Interference Stimulation and Transcranial Alternating Current Stimulation on Post-stroke cognitive dysfunction: A Protocol for Clinical Trial

“…The PSCI therapy mainly include drugs and non drug treatments [7][8][9] . Non-invasive brain stimulation (NIBS), as a non-drug treatment, is considered to be a promising therapeutic method with its higher safety and low-cost [10] .…”