Efficacy of combined vagus nerve stimulation and exercise training for upper limb recovery in people with stroke: a systematic review and meta-analysis.
Longjun Ren, Shamay Ng, Chung Raymond Chi Keung et al.
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In 30 seconds
This systematic review and meta-analysis assessed vagus nerve stimulation combined with exercise training (VNS+training) for upper-limb recovery in people with stroke. Thirteen articles were reviewed; 10 discrete studies involving 424 participants contributed to the meta-analysis. Compared with control groups, VNS+training was associated with large effects on motor impairment (g = 1.264, 95% CI = 0.727-1.800) and motor function (g = 0.728, 95% CI = 0.354-1.102), and a moderate effect on activities of daily living (g = 0.508, 95% CI = 0.190-0.826). Subgroup findings suggested larger effects when stimulation preceded training.
Key findings
- Motor impairment improved with a large effect size: g = 1.264, 95% CI = 0.727-1.800.
- Motor function showed a large effect size: g = 0.728, 95% CI = 0.354-1.102.
- Activities of daily living showed a moderate effect size: g = 0.508, 95% CI = 0.190-0.826.
- Subgroup analyses found larger effects with VNS before exercise training, including transcutaneous auricular VNS and acute/subacute stroke.
Why it matters
The pooled findings suggest that pairing VNS with exercise may support recovery across upper-limb impairment, function, and daily activities after stroke. The apparent advantage of stimulation before training may help shape future rehabilitation research, but subgroup results do not establish the best timing or approach for clinical use.
What to keep in mind
The meta-analysis included 10 studies and 424 participants; the authors call for further well-designed, adequately powered studies and direct comparisons of prior versus concurrent taVNS.