Effects of transcranial direct current stimulation combined with gait-oriented motor training on disability, quality of life, and motor function in individuals with subacute stroke: a randomized controlled trial.

BACKGROUND: Stroke is a leading cause of long-term disability, with the sub-acute phase (1-6 months post-stroke) being critical for recovery. While gait-oriented motor training is widely used in rehabilitation, its efficacy may be enhanced by adjunctive neuromodulation through transcranial direct current stimulation (tDCS). However, evidence remains limited regarding the combined impact of these approaches on both functional and quality-of-life outcomes in sub-acute stroke patients. AIM: To assess the effectiveness of tDCS combined with gait-oriented motor training on disability, quality of life, motor function, and balance in individuals with sub-acute stroke. DESIGN: A prospective, parallel-group, randomized controlled trial. SETTING: Outpatient rehabilitation clinics affiliated with King Khalid University, Saudi Arabia. POPULATION: Fifty-seven participants (aged 18-80 years) with medically stable, first-ever ischemic or hemorrhagic sub-acute stroke and lower limb motor deficits. METHODS: Participants were randomized into an intervention group (tDCS + gait-oriented motor training, N.=29) or a control group (gait-oriented motor training only, N.=28). tDCS was administered at 2 mA for 20 minutes, three times per week for four weeks. Primary outcomes were stroke-specific health-related quality of life (Stroke Impact Scale, SIS) and general functioning/disability (WHODAS 2.0), in line with WHO's ICF framework. Secondary outcomes included motor function (Fugl-Meyer Assessment), balance (Berg Balance Scale), and mobility (Timed Up and Go test). Assessments occurred at baseline, post-intervention, and at three-month follow-up. RESULTS: The intervention group showed significantly greater improvements than the control group across all primary and secondary outcomes (P<0.01). Effect sizes were moderate to large (Cohen's d=0.44-1.2). Improvements in motor function and balance were positively correlated with gains in independence and social participation. CONCLUSIONS: The combination of tDCS and gait-oriented training significantly improves motor function, participation, and self-perceived social and emotional functioning in sub-acute stroke rehabilitation and demonstrates sustained effects over time. CLINICAL REHABILITATION IMPACT: This integrated intervention provides a viable and effective strategy for enhancing motor recovery, balance, and quality of life in stroke patients, supporting its incorporation into routine outpatient rehabilitation protocols.