Table 2.
Characteristics of the included studies and outcome events
| References | Country | Research type | Adjuvant therapy | Type of intervention | Age (years) | Type of stroke | Type of motor function | Management of TBS | Outcomes | Adverse event |
|---|---|---|---|---|---|---|---|---|---|---|
| Nicolo et al. [18] | Switzerland | RCT |
1. Type: PT and active motor exercises of the upper extremity 2. Dosage of therapy: 60 min/d; 15 sessions, 3 weeks |
E1: cTBS-Contra-M1 (n = 14) E2: tDCS-Contra-M1 (n = 14) C: Sham cTBS/tDCS -Contra-M1 (n = 13) |
E1: 62.4 ± 12.3 E2: 68.5 ± 10.8 C: 64.3 ± 17.7 |
Subacute 33/41 ischemic; 8/41 hemorrhagic |
Upper extremity motor function | 1. Type of stimulation: a figure of eight coil, 600 pulses, 80% of RMT of nonparetic hand muscles 2. Duration of therapy: 9 sessions, 3 weeks |
Primary outcomes: 1. UE-FMA 2. BBT 3. NHPT 4. Jamar dynamometer |
N/A |
| Vink et al. [19] | Netherlands | RCT |
1. Type: PT and OT (consisting of individualized upper limb exercises and a daily training program) 2. Dosage of therapy: 60 min/d; 14 sessions, 2 weeks |
E: cTBS-Contra-M1 (n = 28) C: sham cTBS-Contra-M1 (n = 31) |
E: 56.8 ± 12 C: 63.4 ± 12 |
Acute; 50/59 ischemic; 9/59 hemorrhagic |
Upper extremity motor function | 1. Type of stimulation: an angulated 100 mm figure-of-eight coil, 600 pulses, 70% RMT of nonparetic FDI 2. Duration of therapy: 14 sessions, 2 weeks |
Primary outcomes: 1. ARAT Secondary outcomes: 1. mRS 2. FMA 3. BI 4. NHPT 5. JTT 6. EuroQol-5D 7. Stroke Impact Scale score—upper limb |
E: 10 cases of headache, 2 cases of Muscle pain C: 1 case of Nausea, 3 cases of headache, 1 case of Sensory Impairment, 2 cases of Slowed thinking |
|
Kuzu et al [20] |
Turkey | RCT |
1. Type: PT (consisting of range of motion, stretching, strengthening exercises and daily living activities) 2. Dosage of therapy: 60 min/d; 10 sessions |
E1: cTBS-Contra-M1 (n = 7) E2: LF-rTMS-Contra-M1 (n = 7) C: sham cTBS/LF-rTMS -Contra-M1 (n = 6) |
E1: 61.3 ± 9.8 E2: 56.3 ± 11.5 C: 65.0 ± 4.6 |
Chronic; 20/20 ischemic |
Upper extremity motor function | 1. Type of stimulation: an eight-shaped 70 mm coil, 600 pulses, 80% AMT of nonparetic APB 2. Duration of therapy: 10 sessions |
Primary outcomes: 1. MAS 2. UE-FMA Secondary outcomes: 1. FIM 2. MAL 3. Brunnstrom upper extremity and hand motor recovery stage |
N/A |
| Kondo et al. [21] | Japan | NRCT |
1. Type: Intensive OT (consisting of two one-to-one training sessions and Two self-training exercises) 2. Dosage of therapy: 240 min/d; 12 sessions, 15 days |
E1: cTBS-Contra-the nonlesional hemisphere (n = 32) E2: LF-rTMS-Contra- the nonlesional hemisphere (n = 71) |
E1: 60.0 ± 14.2 E2: 62.3 ± 12.5 |
Chronic; 41/103 ischemic; 62/103 hemorrhagic |
Upper extremity motor function |
1. Type of stimulation: a 70-mm figure-8 coil, 2400 pulses, 80% AMT of FDI 2. Duration of therapy: 12 sessions, 15 days |
Primary outcomes: 1. FMA 2. WMFT | N/A |
| Talelli et al. [22] | UK | RCT (A crossover study) | N/A |
E1: cTBS-Contra-the motor hotspot E2: iTBS-Ipsil-the motor-hotspot E3: sham cTBS/Itbs-Contra/Ipsil-the motor hotspot |
57.7 ± 14.9 |
Chronic; 6/6 hemorrhagic |
Upper extremity motor function |
1. Type of stimulation: a 70 mm figure of eight coil, 600 pulses, 80% AMT 2. Experiments were conducted at intervals of at least 10 days, and the order was randomized |
Primary outcomes: 1. SRT 2. Simple reaction grip strength 3. VAS 4. I/O curves 5. RMT 6.AMT |
N/A |
| Ackerley et al. [23] | New Zealand | RCT |
1. Type: PT (consisting of strengthening, task-specific and functional tasks) 2. Dosage of therapy: 45 min/d; 10 sessions, 10 days |
E: iTBS-Ipsil-M1 (n = 9) C: sham iTBS-Ipsil-M1 (n = 9) |
E: 61(median) C: 71(median) |
Chronic; N/A |
Upper extremity motor function |
1. Type of stimulation: 600 pulses, 90% AMT of nonparetic FDI 2. Duration of therapy: daily, 10 days |
Primary outcomes: 1. ARAT 2. UE-FMA 3. Paretic FDI MEP 4. CE asymmetry 5. FA asymmetry |
N/A |
| Chen et al. [27] | China | RCT |
1. Type: Conventional PT (including limb positioning, postural training, stretching, task-oriented therapy, and sensory stimulation) 2. Dosage of therapy:50 min/d; 10 sessions, 2 weeks |
E: iTBS-Ipsil-Cerebellar (n = 16) C: sham iTBS-Ipsil-Cerebellar (n = 16) |
E: 57.38 ± 8.04 C: 51.44 ± 9.19 |
Subacute; 18/32 ischemic; 14/32 hemorrhagic |
Upper extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 600 pulses, 80% AMT of APB 2. Duration of therapy: 10 sessions, 2 weeks |
Primary outcomes: 1. MAS 2. MTS Secondary outcomes: 1. Hmax/Mmax ratio 2. MEP potential latency and amplitude 3. CMCT 4. BI |
N/A |
| Kim et al. [28] | South Korea | RCT (A crossover study) | N/A |
E1: iTBS-Ipsil-FCR hot pot E2: sham iTBS-Ipsil-FCR hot pot |
60.7 ± 8.7 |
Chronic; 12/15 ischemic; 3/15 hemorrhagic |
Upper extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 600 pulses, 80% AMT of paretic FCR 2. The two experiments were performed in a randomized order and separated by 1 week |
Primary outcomes: 1. MAS 2. MTS 5.PTA 3. H/M ratio 4. PT 5. PTA 6. work and rectified integrated EMG activity of wrist flexor |
N/A |
| Zhang et al. [29] | Chinese Hong kong | RCT |
1. Type: Robot-assisted training (consisting of the upper limb proximal joint training and distal joint training) 2. Dosage of therapy: 40 min/d; 10 sessions, 3 weeks |
E1: priming iTBS-Contra/Ipsil-the motor hotspot (n = 14) E2: nonpriming iTBS-Contra/Ipsil-the motor hotspot (n = 14) C: sham stimulation-Contra/Ipsil -the motor hotspot (n = 14) |
E1: 58.21 ± 9 E2: 59.5 ± 8.56 C: 64 ± 5.39 |
Chronic; 24/42 ischemic; 18/42 hemorrhagic |
Upper extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 600 pulses, 70% RMT 2. Duration of therapy: 10 sessions, 3 weeks |
Primary outcomes: 1. UE-FMA 2. ARAT 3. The mean velocity of movement |
N/A |
| Liao et al. [30] | China | RCT |
1. Type: PT (including trunk control training, sit-to-stand training, balance exercises, and gait training) 2. Dosage of therapy: 90 min/d; 15 sessions, 3 weeks |
E1: iTBS-Ipsil-M1 (n = 12) E2: iTBS-Ipsil-cerebellar (n = 12) C: sham iTBS-Ipsil-M1/cerebellar (n = 12) |
E1: 58.25 ± 14.63 E2: 57.17 ± 11.63 C: 57.08 ± 11.28 |
Subacute; 12/36 ischemic; 24/36 hemorrhagic |
Lower extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 1200 pulses, 80% RMT of FDI 2. Duration of therapy: 15 sessions, 3 weeks |
Primary outcomes: 1. BBS Secondary outcomes: 1. FMA-LE 2. TIS 3. BI 4. mRS 5. FAC 6. HAMD 7. HAMA |
E1: 1 case of mild headache E2: 1 case of mild vertigo |
| Xie et al. [31] | China | RCT |
1. Type: Conventional PT (including transfer, balance, and ambulation training 2. Dosage of therapy: 50 min/d; 10 sessions, 2 weeks |
E: iTBS-Ipsil-cerebellar (n = 18) C: sham iTBS-Ipsil-cerebellar (n = 18) |
E: 52.35 ± 8.62 C: 54.41 ± 7.01 |
Subacute; 20/36 ischemic; 16/36 hemorrhagic |
Lower extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 600 pulses, 80% AMT of nonparetic APB 2. Duration of therapy: 10 sessions, 2 weeks |
Primary outcomes: 1. FMA-LE Secondary outcomes: 1. 10 MWT 2. TUG 3. FAC 4. RMT 5. MEP amplitude |
N/A |
| Koch et al. [32] | Italy | RCT |
1. Type: PT (including muscle stretching, active-assisted mobilizations, progressive neuromuscular facilitation training balance exercises, and gait training) 2. Dosage of therapy: 90 min/d; 21 sessions, 3 weeks |
E: iTBS-Ipsil-cerebellar (n = 18) C: sham iTBS-Ipsil-cerebellar (n = 18) |
E: 63 ± 11 C: 65 ± 12 |
Chronic 36/36 ischemic |
Lower extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 1200 pulses, 80% AMT 2. Duration of therapy: daily, 3 weeks |
Primary outcomes: 1. BBS Secondary outcomes: 1. FMA 2.BI 3. Gait analysis(step length, step width) 4. GMFP 5. oscillatory activity |
N/A |
| Liao et al. [33] | China | RCT |
1. Type: PT (including trunk control training, sit-to-stand training, balance exercises, and gait training) 2. Dosage of therapy: 50 min/d; 15 sessions, 3 weeks |
E: iTBS-Ipsil-cerebellar (n = 15) C: sham iTBS-Ipsil-cerebellar (n = 15) |
E: 51.53 ± 9.22 C: 55.40 ± 8.10 |
Subacute and Chronic; 15/30 ischemic; 15/30 hemorrhagic |
Lower extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 600 pulses, 80% AMT 2. Duration of therapy: 10 sessions, 2 weeks |
Primary outcomes: 1. BBS Secondary outcomes: 1. TIS 2.FMA-LE 3. BI 4. CSP 5. MEP amplitude |
E: 1 case of a mild headache C: N/A |
| Lin et al. [34] |
Chinese Taiwan |
RCT |
1. Type: PT (including transfer, balance, and ambulation training) 2. Dosage of therapy: 45 min/d;10 sessions, 5 weeks |
E: iTBS-Ipsil-LE-M1 (n = 10) C: sham iTBS-Ipsil-LE-M1 (n = 10) |
E: 60.8 ± 8.1 C: 61.1 ± 9.7 |
Chronic; 16/20 ischemic; 4/20 hemorrhagic |
Lower extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 1200 pulses,100% MT 2. Duration of therapy: 10 sessions, 5 weeks |
Primary outcomes: 1. NIHSS 2. mRS 3. BRS 4. TUG 5. 10 MWT 6. FMA-LE 7. BI |
N/A |
| Wang et al. [35] | China | RCT |
1. Type: Conventional PT (including muscle strength training, balance and coordination training, walking training, and activities of daily living training) 2. Dosage of therapy: 30 min/d; 20 sessions, 4 weeks |
E: iTBS-Ipsil-cerebellar (n = 21) C: sham iTBS-Ipsil-cerebellar (n = 21) |
E: 52.62 ± 8.61 C: 54.62 ± 7.85 |
Chronic; 25/42 ischemic; 17/42 hemorrhagic |
Lower extremity motor function |
1. Type of stimulation: a 70-mm Fig. 8 coil, 600 pulses,80% AMT 2. Duration of therapy: 20 sessions, 4 weeks |
Primary outcomes: 1. FMA-LE 2. BBS 3. MBI 4. MEP potential latency |
N/A |