Optimizing Repetitive Transcranial Magnetic Stimulation (rTMS) Protocols for Upper Limb Motor Recovery in Post-Stroke...

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a noninvasive intervention aimed at enhancing neuroplasticity and supporting motor recovery in stroke survivors. This meta-analysis examines the efficacy of rTMS in enhancing upper limb motor function and independance in daily activities, utilizing key assessment tools such as the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Modified Barthel Index (MBI), and Action Research Arm Test (ARAT).MethodsA systematic review of 10 studies involving 382 participants was conducted. Outcomes were analyzed for mean differences (MD) and 95% confidence intervals (CI) using forest plots. Subgroup analyses examined the influence of stroke stage and session length. Evidence quality was assessed using the GRADE framework.ResultsrTMS significantly improved motor performance, with the FMA-UE showing the most consistent and clinically meaningful gains, where the overall standardized mean difference (SMD) was 1.28 (95% CI: 1.82 to 0.74, p < 0.0001, I² = 0%), particularly during subacute and subacute-to-chronic stages. Furthermore, protocols with 15-20 sessions yielded significantly better outcomes (SMD = 1.50, 95% CI: 1.90 to 1.10, p < 0.001) than shorter protocols. ARAT results were less consistent, indicating challenges in fine motor recovery, particularly in chronic stroke populations.ConclusionThis meta-analysis confirms that rTMS effectively enhances upper limb motor function and independence in post-stroke patients. Tailored protocols during subacute stages optimize recovery, though further research is needed to refine protocols and explore long-term outcomes.