Transcranial direct current electrical stimulation in combination with aerobic exercise: A pilot study in post-COVID-19 systemic autoimmune rheumatic patients

Table 1 General characteristics of the systemic autoimmune rheumatic disease patients

Patient	Sex	Age (yr)	BMI (kg/m²)	Disease	Disease duration (yr)	Prednisone (mg/d)	IS	Other medications	Comorbidities	Physical activity levels	Initial disease status
#1	F	56	31.7	ASSD	6	0	MTX, LFN	Amitriptyline	SAH	Moderate	MMT-8 = 80; MYOACT = 0
#2	F	39	37.4	RA	15	5	TOF, MTX	Gabapentin, dipyrone	DLP, FM	Low	DAS28 = 5.4; CDAI = 28
#3	F	43	34.3	RA	21	5	TOF, MTX	Dipyrone	SAH, DLP	Low	DAS28 = 5.7; CDAI = 45
#4	F	55	30.4	RA	4	15	TOF	Dipyrone	-	Moderate	DAS28 = 3.2; CDAI = 3
#5	F	29	29.0	SLE	12	5	MMF	Dipyrone	-	Low	SLEDAI = 4
#6	M	56	23.7	SpA	22	0	-	Meloxicam	-	Low	BASDAI = 3.5; ASDAS = 2.5
#7	F	46	35.6	SpA	26	5	MTX, CZP	Tramadol	SAH	Low	BASDAI = 5.6; ASDAS = 3.0
#8	F	53	26.8	SSj	6	0	HCQ	Dipyrone	SAH	Low	ESSDAI = 2
#9	F	57	26.2	SSj	13	0	HCQ	Sertraline	SAH, FM	Low	ESSDAI = 2

ASSD: Antisynthetase syndrome; AZA: Azathioprine; BMI: Body mass index; CPZ: Certolizumab pegol; DLP; Dyslipidemia; F: Female; FM: Fibromyalgia; HCQ: Hydroxychloroquine; IS: Immunosuppressives; LFN: Leflunomide; M: Male; MMF: Mycophenolate mofetil; MTX: Methotrexate; RA: Rheumatoid arthritis; SAH: Systemic arterial hypertension; SLE: Systemic erythematous lupus; SpA: Spondyloarthritis; SSj: Sjögren’s syndrome; tDCS: Transcranial direct current electrical stimulation; TOF: Tofacitinib.

Table 2 Individual data related to the effects of transcranial direct current electrical stimulation on the visual analog scale for pain, fatigue and fatigue severity

Variables		Patients
		#1	#2	#3	#4	#5	#6	#7	#8	#9
Pre-tDCS	Fatigue, VAS, (0.0-10)	8	5	7	10	3	3	7	2	3
Post-tDCS		3	3	3	6	2	2	2.5	0	3
Δ (%)		-62.5	-40	-57.1	-40	-33.3	-33.3	-64.2	-100	0
Pre-tDCS	Pain, VAS, (0.0-10)	5	5	6	8	2	8	6	4	5
Post-tDCS		0	2	2	4	1	2	1.5	0	3
Δ (%)		-100	-60	-66.6	-50	-50	-75	-75	-100	-40
Pre-tDCS	FSS, (0.0-7.0)	6	5	5	5	5	5	4	3	4
Post-tDCS		3	3	3	3	2	4	0	3	1
Δ (%)		-50	-40	-40	-40	-60	-20	-100	0	-75

Data were expressed as individual value and the percentual change were calculated by the formula: Δ (%) (Post-tDCS-Pre-tDCS)/Pre-tDCS*100. tDCS: Transcranial direct current electrical stimulation.

Table 3 Fatigue, physical function and muscle strength before transcranial direct current electrical stimulation, after transcranial direct current electrical stimulation, and after one month of follow-up

	Pre-tDCS	Post-tDCS	P value
MFIS (domains)
Physical (0-36)	23.2 ± 2.2	19.1 ± 1.8	0.332
Cognitive (0-40)	21.0 ± 5.6	21.6 ± 6.3	0.974
Psychosocial (0-8)	4.3 ± 2.9	3.7 ± 1.3	0.864
FACIT (domains)
Physical well-being (0-28)	15.4 ± 5.0	20.1 ± 5.0	0.987
Family and social well-being (0-28)	16.4 ± 3.6	17.0 ± 3.7	0.964
Emotional well-being (0-24)	16.3 ± 4.4	19.3 ± 4.4	0.521
Functional well-being (0-28)	15.3 ± 6.1	17.6 ± 3.9	0.683
Physical function
Timed-Up-Go test (s)	9.5 ± 2.7	6.8 ± 0.8	0.001
Sit-To-Stand test (repetitions)	10.3 ± 3.7	15.1 ± 4.0	0.037
Strength
Handgrip (kg)	21.1 ± 5.7	24.5 ± 8.3	0.522

pre-tDCS vs post-tDCS. EQ-5D: Health-related quality of life; FACIT: Fatigue Assessment Chronic Illness Therapy MFIS: Modified Fatigue Impact Scale; tDCS: Transcranial direct current electrical stimulation; VAS: Visual Analogue Score.