Abstract
Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has emerged as a potential adjunct to conventional rehabilitation though findings remain inconsistent. This study investigated the efficacy of rTMS combined with conventional rehabilitation in improving motor function and spasticity after stroke through a systematic review and meta-analysis. MEDLINE, Embase, and the Cochrane Library were comprehensively searched through February 2022. Sixty-eight randomized controlled trials were included based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias and certainty of evidence were assessed using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation methodology. rTMS significantly improved upper limb motor outcomes including Fugl-Meyer assessment scores (mean difference [MD], 3.04; 95% confidence interval [CI], 1.16 to 4.92; p = 0.002), hand function (standardized MD, 0.28; 95% CI, 0.04 to 0.52; p = 0.02), and grip strength (MD, 3.61; 95% CI, 1.20 to 6.03; p = 0.003), with low-certainty evidence. It also significantly reduced upper limb spasticity (MD, -0.48; 95% CI, -0.64 to -0.33; p < 0.00001), with low-certainty evidence. No significant effects were observed for lower limb motor outcomes, and evidence for lower limb spasticity was insufficient. These findings suggest that rTMS may be considered as an adjunct to to enhance upper limb motor function and reduce spasticity in stroke rehabilitation. However, its use for lower limb recovery should be individualized based on neurological status. Further studies are needed to establish optimal protocols and long-term effects.