Table 1.

Characteristics of studies investigating the effects of rPMS alone or in combination with rTMS

		Population				rPMS protocol						Motor outcomes
Study	Design	Group size	Chronicity	Severity of hemiplegia	Type of stroke	Protocol	Intensity	Duration	Stimulation targets	Control	Combined intervention	Clinical	Neural	Assessment timepoints
Struppler et al., 2009	Single-group	rPMS (n = 52)	Subacute-chronic (2 weeks–10 years)	Unclear	37 ischemic and 10 hemorrhagic strokes, 5 traumatic brain injury	rPMS-4500 20 Hz Figure-of-eight coil	Induced smooth movement of finger extension	15 min, 1 session	Finger extensor of the paretic upper limb	No	No	MAS	No	Baseline, post. follow-up at 2, 4, 24, 48, and 72 h
Krewer et al., 2014	Parallel	rPMS (n = 31) Sham (n = 32)	Subacute to chronic (≥ 2 weeks)	Unclear	60 stroke and 3 traumatic brain injury	rPMS-5000 25 Hz Butterfly coil	10% above the level that evoked a wrist or elbow movement taken at rest	2 times/day, 5 days/week, 2 weeks, 20 sessions	Flexors and extensors of the paretic wrist and elbow	Sham coil	Upper limb occupational therapy	FMA-UE MTS	No	Baseline, post, 2 weeks post
Yang et al., 2018	Parallel	rPMS (n = 15) Control (n = 15)	Acute to subacute (≤ 1 month)	Mild to moderate (muscle strength ≤ 3)	19 ischemic and 11 hemorrhagic strokes	Unclear dose 5HZ Figure-of-eight coil	100% RMT	Once a day, 5 days/week, 4 weeks, 20 sessions	Paretic supraspinatus and deltoids	Electrode stimulation	Conventional rehabilitation	FMA-UE US	No	Baseline, post
Obayashi et al., 2020	Parallel	rPMS (n = 10) Control (n = 9)	Acute (0–14 days)	Severe	16 ischemic and 3 hemorrhagic strokes	3 × 10 consecutive stimulations per muscle 30HZ Circular coil	70% MSO	Once every other day, 3 days per week, 3–32 sessions	Paretic extensor digitorum communis, extensor carpi radialis, flexor digitorum superficialis, triceps brachii, biceps brachii, and anterior or middle head of deltoid	Conventional physiotherapy	Conventional physiotherapy	WMFT FMA-UE BBT	No	Baseline, post
Fujimura et al., 2020	Single-group	rPMS (n = 12)	Subacute to chronic (≥ 1 month)	Mild to severe (FMA-UE: 2–33/66)	5 ischemic and 7 hemorrhagic strokes	rPMS-6000 per muscle 30HZ	Any further increase would become uncomfortable	Once a day, 5 days/week, 4 weeks, 20 sessions	Paretic supraspinatus, posterior deltoid/infraspinatus muscles	No	Conventional rehabilitation	FMA ROM NRS AHI	No	Baseline, post
Chen X et al., 2020	Parallel	rPMS (n = 16) LF-rTMS (n = 19)	Subacute	Unclear	35 ischemic strokes	Unclear doses of rPMS 30HZ Parabolic coil	20 -40% of MSO	10 sessions, 2 weeks	Extensor muscles and shoulder muscles of the paretic upper extremity	LF-rTMS	Upper limb occupational therapy	BI FMA-UE	No	Baseline, mid, post, 1 month post, 3 months post
Chen S et al., 2020	Parallel	rPMS (n = 16) Sham (n = 16)	Subacute to chronic (≥ 2 weeks)	Unclear function level	10 ischemic and 22 hemorrhagic strokes	rPMS-750, 5 Hz (MAS ≥ 1+) rPMS-5100, 20 Hz (MAS<1+) Parabolic coil	Muscle contraction threshold	1 session	Paretic shoulder adductors, extensors, elbow and wrist extensors and flexors	Sham coil	No	FMA-UE MAS MTS	EEG	Baseline, 1 session post, 24 h post
Nahas et al., 2022	Parallel	piTBS (n = 25) Sham (n = 11)	Chronic (≥ 6 months)	Unclear	Unclear	piTBS-600 50 Hz-iTBS Figure-of-eight coil	Supra-threshold intensity inducing visible muscle contraction	Once every other day, 8 sessions	Belly of paretic biceps brachii, wrist and finger flexor	Sham coil	Physical therapy	MAS	No	Baseline, post
Jiang et al., 2022	Parallel	rPMS (n = 24) Control (n = 20)	Acute-subacute (1–4 weeks)	Severe	33 ischemic and 12 hemorrhagic strokes	rPMS-2400 20HZ Circular coil	15–30% MSO inducing 30° elbow/45° wrist extension	Once a day, 2 weeks, 14 consecutive sessions	Belly of the paretic triceps brachii and extensor digitorum muscles	Conventional physiotherapy	Conventional physiotherapy	FMA-UE MBI	No	Baseline, post
Fawaz et al., 2023	Parallel	rPMS (n = 40) Sham (n = 40)	Subacute to chronic (≥ 6 weeks)	Mild to severe Shoulder abductors muscle power > grade 2)	No information	rPMS-4500 per muscle 30 Hz Circular/butterfly coil	Average 35 and 45% above the level that evoked wrist movement taken at rest	5 sessions/ week, 3 weeks, 15 sessions	Paretic shoulder abductors, elbow and wrist extensors and supinator muscle	Sham coil	Intensive upper limb occupational therapy	FMA-UE FIM ROM US	No	Baseline, post
Ke et al., 2023	Parallel	HF-rPMS (n = 13) Sham (n = 13)	Acute-subacute (4.5–42.5 days)	Severe (FMA-UE: 4-25.5/66)	26 hemorrhage strokes, 22 basal ganglia/ 4 thalami involved	rPMS-1800, 20 Hz Figure-of-eight coil	40–60% of MSO inducing significant movement of the paretic upper limb	Once a day, 10 consecutive sessions	Centre of axilla (stimulating the brachial plexus) and the popliteal fossa of paretic side (synchrous)	Sham coil	Conventional rehabilitation	FMA-UE MRC	No	Baseline, post
Fujimura et al., 2024	Parallel	rPMS (n = 22) Control (n = 24)	Acute-subacute (34 ± 23 (median = 31)) days)	Severe	23 ischemic and 23 hemorrhagic strokes	rPMS-6000 each muscle 30 Hz Circular coil	Maximum intensity without inducing pain or discomfort (0.65 ~ 0.9T)	Once a day, 6 weeks, 42 consecutive sessions	Paretic supraspinatus, posterior deltoid/infraspinatus muscles	Conventional rehabilitation	Conventional rehabilitation	FMA-UE ROM AHI NRS MAS	No	Baseline, post, 6-week follow up
Qin et al., 2023	Parallel	rPMS + LF-rTMS (n = 20) LF-rTMS (n = 15) Control (n = 14)	Subacute (1–6 months)	Mild to moderate (Brunnstrom stages 3–5)	49 ischemic strokes	rPMS-1200 10 Hz Figure-of-eight coil Delivered immediately after LF-rTMS.	Minimum intensity inducing subtle visible muscle contractions	Once a day, 5 days/week, 8 weeks; 40 sessions	Erb’s point of the paretic upper limb	LF-rTMS Conventional rehabilitation	Conventional rehabilitation	FMA-UE MBI MAS	fMRI	Baseline, post
Wu et al., 2023	Parallel	rPMS + HF-rTMS (n = 15) HF-rTMS + sham rPMS (n = 15) rPMS + sham HF- rTMS (n = 15) Sham (n = 15)	Subacute (2 weeks–6 months)	Moderate to severe (Brunnstrom stages I–III)	27 ischemic and 33 hemorrhagic strokes	rPMS-1000 10HZ Circular coil Delivered after rTMS	The lowest stimulation intensity that can trigger muscle contraction	Once a day, 5 days/week 3 weeks 15 sessions	Paretic C5-T1 nerve root	HF-rTMS rPMS Sham coil	Conventional rehabilitation	FMA-UE WMFT MBI Brunnstrom stage	No	Baseline, post, 3-month follow up
Yang et al., 2023	Case-series	rPMS + HF-rTMS (n = 4)	Chronic (7–12 months)	Unclear	4 hemorrhagic strokes Frontal and temporal lobe (n = 1) and basal ganglia (n = 3)	rPMS-750, 5 Hz (MAS ≥ 1+) rPMS-5100, 20 Hz (MAS<1+) Figure-of-eight Unclear performing order	100% RMT	Once a day, 15 days, 15 sessions	Flexor and extensor of the paretic elbow and wrist	No	Traditional rehabilitation	MAS NRS Grip, pinch strength	No	Baseline, post
Liang et al., 2024	Pilot	rPMS + HF-rTMS (n = 15) HF-rTMS (n = 15) Sham (n = 15)	Subacute (< 3 months)	Unclear	21 infarction and 24 hemorrhagic strokes	rPMS-1200 5 Hz Double-ended circular coil, delivered 20 ms after rTMS (paired)	80% RMT	Once a day, 5 days/week 4 weeks, 20 sessions	Paretic seventh cervical nerve root	rTMS Sham coil	Physiotherapy	FMA-UE FCA BI	TMS (MEP, RMT, SICI)	Baseline, post
Change et al., 2024	Parallel	rPMS + iTBS (n = 14) Sham rPMS + iTBS (n = 14)	Subacute to chronic (≥ 7 days)	Mild to severe FMA-UE(28.6 ± 21.3, 33.4 ± 19.7)	10 infarction and 18 hemorrhagic strokes	piTBS-600 5 Hz Figure-of-eight coil Delivered 10 min before central iTBS	Intensity inducing muscle contraction of extensor carpi radialis muscle	Once a day, 5 days/week, 2 weeks 10 sessions	Radial nerve of the paretic upper limb (radial groove)	Sham coil (low-intensity level at 5% of the MSO)	Cmprehensive rehabilitation	FMA-UE ARAT FIM-Selfcare SIS	No	Baseline, post

Abbreviations: RMT: Resting motor threshold; MSO: Maximum stimulator output; HF/LF: High/Low Frequency; FMA-UE: Fugl-Meyer Assessment Upper Extremity Score; BI: Barthel Index; MBI: Modified Barthel Index; MAS: Modified Ashworth scale; MTS: Modified Tardieu scale; ARAT: Action research arm rest; BBT: Block and Box Test; MRC: Medical Research Council scale; WMFT: Wolf motor function test; ROM: Range of motion; US: Ultrasound; NRS: Numerical Rating Scale; FIM: Functional Independence Measure; FCA: Comprehensive Functional Assessment; SIS: Stroke Impact Scale; EEG: Electroencephalography; fMRI: Functional magnetic resonance imaging; AHI: Acromion-humerus interval; piTBS: Peripheral intermittent theta burst stimulation; TMS: Transcranial magnetic stimulation; MEP: Motor evoked potential; SICI: Short interval intracortical inhibition