Effectiveness of Transcranial Magnetic Stimulation on Upper Limb Fine Motor Skills in Post-stroke Patients: A...

Stroke frequently results in persistent upper limb fine motor deficits, severely impairing daily activities. While transcranial magnetic stimulation (TMS) is increasingly applied as an adjunct therapy, its effectiveness in restoring dexterity-specific outcomes remains unclear. This systematic review and meta-analysis evaluated the effectiveness of TMS in improving fine motor skills among post-stroke patients. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, five databases (PubMed, Embase, Web of Science, Cochrane Library, Google Scholar) were searched up to March 2025. Only randomized controlled trials (RCTs) reporting upper limb fine motor outcomes in post-stroke patients undergoing TMS were included. Data were extracted and analyzed using RevMan 5.4.1, with mean differences (MDs) and 95% confidence intervals (CIs) calculated under a random-effects model. Risk of bias was assessed using the Cochrane Risk of Bias-2 (ROB-2) tool. Of 1,416 screened studies, eight RCTs met eligibility, including 257 participants (127 rTMS vs. 130 controls). Study follow-up ranged from one to two months. Four studies were rated high quality, and four showed moderate concerns. Pooled analysis demonstrated no significant improvements with rTMS over control in the Box and Block test (MD: 0.75; 95% CI -4.62 to 6.11; P = 0.79), grip strength (MD: 2.49; 95% CI -0.18 to 5.16; P = 0.07), or pinch strength (MD: 0.65; 95% CI -0.39 to 1.69; P = 0.22). Subgroup analyses and sensitivity tests confirmed these findings. Current evidence does not support a significant benefit of TMS for fine motor recovery post-stroke, despite its established role in gross motor rehabilitation. Larger, high-quality RCTs targeting dexterity-specific outcomes, stimulation parameters, and patient stratification are needed to clarify TMS's potential in fine motor rehabilitation.