Effectiveness of intermittent theta burst stimulation (iTBS) on Post-Stroke motor dysfunction: A Meta-Analysis of randomized controlled trials.

OBJECTIVE

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).

METHODS

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.

RESULTS

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.

CONCLUSION

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.