Effect of transcranial magnetic stimulation combined with upper-limb training for improving function after stroke: A systematic review and meta-analysis

• Published in: Journal of the neurological sciences 2016
• Main Authors: Graef, Patricia, Dadalt, Maria Luísa Rocha, da S. Rodrigues, Daiana Amaral M, Stein, Cinara, Pagnussat, Aline S
• Format: Article
• Language: English
• Subjects: Neurology
• ISSN: 0022-510X
• DOI: 10.1016/j.jns.2016.08.016

Abstract Background Several neuromodulation treatments have been developed, and their effects have been studied in recent years in order to improve neurological rehabilitation after a stroke. The association between upper-limb training and repetitive transcranial magnetic stimulation (rTMS) has provoked controversies and produced inconclusive results. Objective The purpose of this study was to investigate the effects of rTMS combined with upper-limb training versus sham rTMS combined with upper-limb training on the upper-limb recovery after a stroke. Methods A systematic review with meta-analysis was performed. The eligible studies were randomized controlled trials with stroke subjects, and the outcomes were related to upper-limb motor/functional status and spasticity. Results A total of 3234 citations were identified, and 11 studies were included. The meta-analysis included eight studies with 199 participants and did not show any difference between groups, neither for upper-limb function nor for spasticity (upper-limb function [0.03 (95% CI: − 0.25 to 0.32; I2 0%)] and Modified Ashworth Scale [ − 0.31 (95% CI: − 0.78 to 0.17; I2 43%)]). Conclusion The current state of the literature is not enough to support the hypothesis that a combination of rTMS and upper-limb training has a stronger effect on upper-limb function than upper-limb training alone.