Effectiveness of transcranial direct current stimulation on hand dexterity in stroke patients: a protocol for a systematic review and meta-analysis

Lulwa Alabdulaali*, Lydia Hickman, T David Punt, Ned Jenkinson

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Introduction: Hand dexterity is the ability to execute the skilful movements using the hand and fingers. It is commonly impaired poststroke resulting in a profound deterioration in the quality of life for patients with stroke. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation, which has gained a popularity as an adjunct therapy in recovering motor dysfunction poststroke. Promising results have been gained from applying tDCS in combination with motor rehabilitation, however, the outcome of tDCS on the upper limb motor function poststroke has been varied. Different results are potentially related to the discrepancy of the area of brain stimulation. Therefore, we aim to enhance the application of tDCS to improve its effectiveness in recovering hand dexterity through testing our hypothesis that stimulating the primary motor cortex could improve fine dexterity more than gross dexterity.

Methods and analysis: This protocol has been reported according to Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. CENTRAL, MEDLINE, EMBASE, SCOPUS, Web of Science and CINAHL databases will be searched with no restriction in language and publication date. The selected studies will be randomised controlled trial investigating the effect of tDCS alone or in combination with motor rehabilitation in improving hand dexterity of patients with stroke with upper limb hemiparesis. The outcomes of interest are fine and gross hand dexterity measures. Two independent reviewers will assess the eligibility of the study, extract data and appraise the methodological quality. The data will be pooled in a meta-analysis if applicable or interpreted narratively. Grading of Recommendations, Assessment, Development and Evaluation approach will be used to assess the overall quality of evidence for the fine and gross dexterity measures.

Ethics and dissemination: Ethical approval is not required for this study. The dissemination plan is to publish the results in a peer-review journal and presenting results in a conference.

PROSPERO registration number: CRD42021262186.

Original languageEnglish
Article numbere056064
Number of pages7
JournalBMJ open
Issue number2
Publication statusPublished - 16 Feb 2022

Bibliographical note

Funding Information:
Funding No funds were received in support of this work. This study is a part of Lulwa Alabdulaali PhD, which is supported by a scholarship from Imam Abdulrahman Bin Faisal University, Saudi Arabia.


  • neurology
  • rehabilitation medicine
  • stroke

ASJC Scopus subject areas

  • General Medicine


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