Ma Zhenchao, Pan Huijuan, Bi Ranran, Li Zhenhua, Lu Weichen, Wan Ping
School of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
Department of Rehabilitation Medicine, Shanghai Ruijin Rehabilitation Hospital, Shanghai, 200023, China.
Neurol Sci. 2025 May;46(5):2007-2017. doi: 10.1007/s10072-024-07961-3. Epub 2025 Jan 2.
Repetitive transcranial magnetic stimulation (rTMS) has shown potential in alleviating hemiplegic shoulder pain (HSP) and improving upper limb function, yet its efficacy remains debated. This study aims to assess the effectiveness of rTMS for HSP through a systematic review and meta-analysis.
Four databases were searched with the keywords "rTMS" and "HSP". Adults aged 18 years and older with post-stroke HSP were included. The primary outcomes were pain scores and upper limb function scores, and the secondary outcomewas the incidence of adverse events. The risk of bias was assessed through the ROB tool in Review Manager 5.4.1, and statistical analysis was primarily conducted through this software.
A total of 52 articles were identified from PubMed, Embase, Cochrane Library, and CNKI. Following literature screening, 11 studies were included in the analysis. The quality of the included studies was moderate.The studies encompassed 584 patients with post-stroke HSP and their average age was 62. The analysis revealed that rTMSwas significantly more effective in relieving pain compared to the control group (SMD = -1.14, p < 0.01), and low-frequency rTMSwas superior to high-frequency rTMS. In terms of improving upper limb function, rTMSwas also significantly more efficacious compared to the control group (SMD = 2.20, p < 0.01), and low-frequency and high-intensity rTMSwere more beneficial.
This study highlights the potential efficacy of rTMS. However, the heterogeneity among included studies, limited sample sizes, and lack of long-term follow-up data restrict the generalizability of the results.
重复经颅磁刺激（rTMS）已显示出缓解偏瘫肩痛（HSP）和改善上肢功能的潜力，但其疗效仍存在争议。本研究旨在通过系统评价和荟萃分析评估rTMS治疗HSP的有效性。
使用关键词“rTMS”和“HSP”检索四个数据库。纳入年龄在18岁及以上的中风后HSP成人患者。主要结局为疼痛评分和上肢功能评分，次要结局为不良事件发生率。通过Review Manager 5.4.1中的ROB工具评估偏倚风险，主要通过该软件进行统计分析。
从PubMed、Embase、Cochrane图书馆和中国知网共识别出52篇文章。经过文献筛选，11项研究纳入分析。纳入研究的质量为中等。这些研究涵盖584例中风后HSP患者，平均年龄为62岁。分析显示，与对照组相比，rTMS在缓解疼痛方面显著更有效（标准化均数差[SMD]=-1.14，p<0.01），低频rTMS优于高频rTMS。在改善上肢功能方面，与对照组相比，rTMS也显著更有效（SMD=2.20，p<0.01），低频和高强度rTMS更有益。
本研究突出了rTMS的潜在疗效。然而，纳入研究之间的异质性、样本量有限以及缺乏长期随访数据限制了结果的普遍性。
