Background Robot-assisted therapy and noninvasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation. Objective This systematic review and meta-analysis aims to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper-limb motor impairment or activity in individuals with stroke. Methods This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563). Seven databases and gray literature were systematically searched by 2 reviewers, and 1176 registers were accessed. Eight randomized clinical trials with upper-limb body structure/function or activity limitation outcome measures were included. Subgroup analyses were performed according to phase poststroke, device characteristics (ie, arm support, joints involved, unimanual or bimanual training), NIBS paradigm, timing of stimulation, and number of sessions. The Grade-Pro Software was used to assess quality of the evidence. Results A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference [MD] = 0.15; 95% CI = −3.10 to 3.40; P = 0.93; I2 = 0%) and activity limitation domain (standard MD = 0.03; 95% CI = −0.28 to 0.33; P = 0.87; I2 = 0%). Conclusions According to this systematic review and meta-analysis, at the moment, there are not enough data about the benefits of NIBS as an add-on intervention to robot-assisted therapy on upper-limb motor function or activity in individuals with stroke.

1.INTRODUCTION 2.REVIEW 2.1. Motor recovery after stroke 2.2. Robotic Therapy 2.3. Models for non-invasive brain stimulation (NIBS) as add-on therapies in stroke 2.4. State of art and gaps in knowledge 3.OBJECTIVE Resumo Reis SB. Associação de terapia robótica e estimulação cerebral não-invasiva na reabilitação do membro superior pós-acidente vascular cerebral: revisão sistemática e metanálise de ensaios clínicos randomizados [dissertação]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2020. Introdução. A terapia robótica e a estimulação cerebral não invasiva são estratégias promissoras para a reabilitação pós-acidente vascular cerebral. Objetivo. Esta revisão sistemática e meta-análise objetiva avaliar a evidência da estimulação cerebral não invasiva associada à terapia robótica na melhora dos desfechos de estrutura/ função corporal e atividade do membro superior em sujeitos que sofreram acidente vascular cerebral. Método. Este estudo foi realizado de acordo com o protocolo PRISMA e previamente registrado na Plataforma PROSPERO (CRD42017054563). Sete bases de dados e literatura cinzenta foram sistematicamente consultadas por dois revisores, e 1176 registros foram acessados. Oito ensaios clínicos randomizados com desfechos de estrutura/ função corporal e atividade do membro superior foram incluídos. A análise de subgrupos foi realizada de acordo com a fase pós-acidente vascular cerebral; características do dispositivo robótico (i.e. suporte para o braço, articulações envolvidas, treino unimanual ou bimanual); paradigma da estimulação cerebral não invasiva; momento da estimulação cerebral e quantidade de sessões. O Software Grade-Pro foi utilizado para acessar a qualidade da evidência. Resultados. Um tamanho de efeito homogêneo não significativo foi encontrado tanto para o desfecho de estrutura e função corporal (diferença média 0.15, 95% CI -3.10 to 3.40; P = 0.93, I² = 0%) quanto para o desfecho de limitação da atividade (diferença média padronizada 0.03, 95% CI -0.28 to 0.33; P = 0.87, I² = 0%). Conclusão. De acordo com esta revisão sistemática e meta-análise, não há evidências de que a estimulação cerebral não invasiva associada à terapia robótica melhore o desempenho motor e a atividade do membro superior em sujeitos que sofreram acidente vascular cerebral. Descritores: Acidente vascular cerebral; Robótica; Extremidade superior; Estimulação transcraniana por corrente contínua; Estimulação magnética transcraniana; Metanálise.

Background: Robot-assisted therapy and non-invasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation. Objective: This systematic review and meta-analysis aim to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper limb motor impairment or activity in subjects with stroke. Methods: This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563 - https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=54563). Seven databases and grey literature were systematically searched by two reviewers, and 1176 registers were accessed. Eight randomized clinical trials with outcome measures of upper limb body structure/ function or activity limitation were included. Subgroup analyses were performed according to: phase post- stroke; device characteristics (i.e. arm support, joints involved, unimanual or bimanual training); NIBS paradigm; timing of stimulation and number of sessions. The Grade-Pro Software was used to assess quality of the evidence. Results: A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference 0.15, 95% CI -3.10 to 3.40; P = 0.93, I² = 0%) and activity limitation domain (standard mean difference 0.03, 95% CI -0.28 to 0.33; P = 0.87, I² = 0%). Conclusions: According to this systematic review and meta-analysis, there is a lack of evidence that NIBS, as an add-on intervention to RT, improves outcomes of upper limb motor impairments or activity in subjects with stroke.