Table 1.

Summary of potential benefits in motor functioning after using TMS therapy after stroke in RCTs with a valid measure of the methodological quality of clinical trials using the PEDro scale.

Study, Year	Stage of Stroke	Application Area, High/Low Frequency	Outcome, Measures	Main Findings
Chieffo et al. [71], 2021 PEDro: none	RCT, n = 12, Chronic	Primary Motor Cortex, HF-rTMS	FMA, Ashworth Scale, 10 m Walk Test, 6 min Walk Test	Spasticity significantly decreased only after the real rTMS. Bilateral HF-rTMS combined with cycling improved lower-limb motor function.
Kim et al. [72], 2020 PEDro: none	RCT, n = 77, Subacute	Primary Motor Cortex, LF-rTMS	BBT, FMA, FTT, Brunnstrom, Grip Strength	Real and sham rTMS did not differ significantly among patients within three months post-stroke. Location of stroke lesions should be considered for future clinical trials.
Khedr et al. [73], 2005 PEDro: none	RCT, n = 26, Acute	Primary Motor Cortex, rTMS	Scandinavian Stroke, Barthel Scale, NIHSS	Real rTMS improved patient scores more than sham.
Kirton et al. [74], 2008 PEDro: none	RCT, n = 10, Chronic (paediatric)	Primary Motor Cortex, LF- rTMS	MAUEF	rTMS improved hand function in pediatric score.
Liepert et al. [75], 2000 PEDro: none	RCT, n = 13, Chronic	Primary Motor Cortex, TMS mapping	MAL, ADL	After treatment, the muscle-output-area size in the affected hemisphere was significantly enlarged, corresponding to greatly improved motor performance of the paretic limb.
Fridman et al. [76], 2004 PEDro: none	RCT, n = 9, Chronic	Primary Motor Cortex, Dorsal Premotor Cortex (PMd), Ventral Premotor Cortex (PMv), TMS mapping	MRC	The dorsal premotor cortex of the affected hemisphere can reorganize to control basic parameters of movement usually assigned to M1 function.
Kim et al. [77], 2016 PEDro: none	RCT, n = 43, Subacute	Primary Motor Cortex, TMS mapping	FMA, Barthel Index	Potential advantages in predicting motor and ambulation recovery.
Choi et al. [78], 2018 PEDro: none	RCT, n = 24, Chronic	Primary Motor Cortex, HF-rTMS	NRS, MI-UL, MBC	HF-rTMS could be used as a beneficial therapeutic tool to manage hemiplegic shoulder pain.
Long et al. [14], 2018 PEDro: none	RCT, n = 62, Subacute	Primary Motor Cortex, LF-rTMS HF-rTMS	FMA, WMFT	Exhibited improvement in terms of the FMA score and the log WMFT time at the end of the treatment and 3 months later. Better improvement was found in the LF-HF rTMS group than in the LF-rTMS and sham groups. Combining HF-rTMS and LF-rTMS protocol in the present study was tolerable and more beneficial for motor improvement than the use of LF-rTMS alone.
Cha et al. [79], 2017 PEDro: 7/10	RCT, n = 30, Subacute	No data, rTMS	MEP, Peak Torque, 10 m Walk Test	Improvement of motor function recovery.
Kirton et al. [80], 2016 PEDro: 7/10	RCT, n = 45, Perinatal	Primary Motor Cortex, LF-rTMS	AHA, Melbourne Assessment, PedsQL, ABILHAND-Kids, Grip Strength, BBT	Assisting Hand Assessment gains at 6 months were additive and the largest with rTMS + CIMT. Quality-of-life scores improved. CIMT and rTMS increased the chances of improvement as part of complex rehabilitation.
Noh et al. [81], 2019 PEDro: 6/10	RCT, n = 22, Subacute	Primary Motor Cortex, LF-rTMS	Brunnstrom Stage, FMA, MFT, Grip Strength, MEP	Distal upper-extremity function, as measured by MFT and grip power, was improved.
Tosun et al. [82], 2017 PEDro: 6/10	RCT, n = 25, Acute/Subacute	Primary Motor Cortex, LF-rTMS	fMRI	LF-rTMS with or without NMES seemed to facilitate motor recovery in the paretic hand.
Abo et al. [83], 2014 PEDro: 6/10	RCT, n = 66, No data	No data, LF-rTMS	FMA, WMFT	FMA was significantly higher in both groups after the 15-day treatment compared with the baseline. Changes in Fugl–Meyer Assessment scores and Functional Ability Score of Wolf Motor Function Test were significantly higher in the NEURO group than in the constraint-induced movement therapy group.
Malcolm et al. [84], 2007 PEDro: 5/10	RCT, n = 19, Chronic	Primary Motor Cortex, HF-rTMS	WMFT, MAL, BBT	Participants demonstrated significant gains on the primary outcome measures: WMF and MAL, and on secondary outcome measures including BBT. Participants receiving rTMS failed to show differential improvement on either primary outcome measure. CIT can have a substantial effect, it provided no support for adjuvant use of rTMS.

Abbreviations: RCT: Randomized controlled trial; rTMS: Repetitive Transcranial Magnetic Stimulation; FMA: Fugl–Meyer Assessment; BBT: Box and Blocks Test; FTT: Finger Tapping Test; NIHSS: The National Institutes of Health Stroke Scale; MAUEF: The Melbourne Assessment of Upper Extremity function; MAL: Motor Activity LOG; ADL: Activities of Daily Living; MRC: Medical Research Council; MI-UL: Motricity Indices Upper Limb; MBC: Modified Brunnstrom Classification; NRS: Numeric Rating Scale; WMFT: Wolf Motor Function Test; MEP: Motor Evoked Potential Testing; AHA: Assisting Hand Assessment; MFT: Motor Function Test.