Chen Hongmei, Xiao Kaimin, Yang Xinwei, Yin Zhixue, Wu Yujie, Fu Guoshuang, Xia Yutong, Liang Bilin, Wang Ying, Liu Tianzhu, Chen Li
Department of Neurology, People's Hospital of Ganxian District, Ganzhou, China.
Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Neurol Sci. 2025 Aug 30. doi: 10.1007/s10072-025-08441-y.
This meta-analysis attempted to rigorously delineate the efficacy of intermittent theta burst stimulation (iTBS) as a neuromodulatory intervention for post-stroke motor impairments by integrating evidence exclusively from randomized controlled trials (RCTs).
Seven databases, namely, PubMed, Web of Science, Embase, the Cochrane Library, Wanfang, VIP, and China National Knowledge Infrastructure (CNKI), were searched. Eligible studies covered RCTs that directly compared the influences of iTBS with sham or placebo interventions in cases recovering from stroke. Two independent reviewers conducted screened the studies, extracted the data, and assessed the risk of bias. Primary outcome measures involved the Fugl-Meyer Assessment (FMA), Barthel Index (BI), and Berg Balance Scale (BBS). The Modified Ashworth Scale (MAS), assessing muscle tone and spasticity, was regarded as a secondary outcome. A random-effects model was employed to account for between-study variability.
Totally, 19 RCTs satisfied inclusion criteria, collectively substantiating that iTBS yields statistically and clinically significant improvements in upper extremity motor control (FMA), static balance capacity (BBS), functional independence in activities of daily living (BI), and fine motor performance assessed by the Action Research Arm Test (ARAT) relative to control interventions. Conversely, the meta-analysis revealed a lack of significant benefit of iTBS on lower limb motor outcomes, dynamic mobility as assessed by the Timed Up and Go (TUG) test, and neuromuscular tone measured by the MAS.
iTBS exhibited a significant therapeutic benefit in boosting the motor function in the upper limbs, assessed by the FMA, as well as static balance, activities of daily living, and performance on the action research arm test in stroke rehabilitation. However, its influences on lower limb motor function, muscle spasticity (as assessed by the MAS), and dynamic balance could be limited and not statistically significant.
本荟萃分析试图通过专门整合来自随机对照试验（RCT）的证据，严格界定间歇性theta爆发刺激（iTBS）作为一种神经调节干预措施对中风后运动障碍的疗效。
检索了七个数据库，即PubMed、Web of Science、Embase、Cochrane图书馆、万方、维普和中国知网（CNKI）。符合条件的研究包括直接比较iTBS与假刺激或安慰剂干预对中风康复患者影响的RCT。两名独立评审员对研究进行筛选、提取数据并评估偏倚风险。主要结局指标包括Fugl-Meyer评估（FMA）、Barthel指数（BI）和Berg平衡量表（BBS）。评估肌张力和痉挛的改良Ashworth量表（MAS）被视为次要结局。采用随机效应模型来考虑研究间的变异性。
共有19项RCT符合纳入标准，共同证实相对于对照干预措施，iTBS在改善上肢运动控制（FMA）、静态平衡能力（BBS）、日常生活活动中的功能独立性（BI）以及通过动作研究臂测试（ARAT）评估的精细运动表现方面具有统计学和临床意义上的显著改善。相反，荟萃分析显示iTBS对下肢运动结局、通过定时起立行走测试（TUG）评估的动态移动能力以及通过MAS测量的神经肌肉张力没有显著益处。
iTBS在中风康复中对通过FMA评估的上肢运动功能、静态平衡、日常生活活动以及动作研究臂测试表现具有显著的治疗益处。然而，其对下肢运动功能、肌肉痉挛（通过MAS评估）和动态平衡的影响可能有限且无统计学意义。
