Table 1.
Key characteristics of the studies included in the systematic review.
| Reference | Country | Treatment | Number of patients (M/F) | Age (Mean ±SD) | Months/weeks/ days post-stroke (Mean ±SD) | Type of stroke (I/H) | Affected limb (L/R) | NIBS | Therapy protocol | Outcome measures |
|---|---|---|---|---|---|---|---|---|---|---|
| Jil et al. (15) | Korea | I: MT + rTMS C: MT C2: Sham MT |
I: 12 (7/5) C: 11 (7/4) C2: 12 (8/4) |
I: 54.73 ± 7.88 C: 50.53 ± 8.02 C2: 52.45 ± 8.08 |
I: 9.20 ± 4.01, Mo C: 8.23 ± 3.09, Mo C2: 9.23 ± 4.29, Mo | I: 7/5 C: 6/5 C2: 6/5 |
I:4/8 C:5/6 C2:5/7 | High-frequency (10 Hz) rTMS, ipsilesional | I: 15-min MT, 15 min of 10 Hz rTMS on the hotspot of the lesional hemisphere; C: 15-min MT; C2: 15-min sham therapy after covering the mirror with a white cloth. Intervention: 5 sessions/week for 6 weeks. | FMA-UE; BBT; MEP-CL; MEP amplitude |
| Cho and Cha (16) | Korea | I: Prior-tDCS + MT C: tDCS + sham MT |
I: 14 (8/6) C: 13 (7/6) | I: 58.29 ± 10.67 C: 60.38 ± 10.19 |
I: 13.2 ± 5.1, Mo C: 15.5 ± 7.8, Mo | I: 9/5 C: 8/5 |
I: 8/6 C: 6/7 | Anodal tDCS, ipsilesional, Anode: C3 and C4,Cathode: supraorbital area of the non-paretic side, 2 mA | I: 20-min anodal tDCS, 5-min rest, 20-min MT; C: 20-min anodal tDCS, 20-min sham therapy after covering the mirror with a white cloth. Intervention: 3 sessions/week for 6 weeks | FMA-UE; BBT; Jebsen-Taylor test; Grip strength |
| Liu et al. (18) | China | I: Prior-rTMS + TOMT C: TOMT C2: Conventional treatment |
I: 30 (16/14) C: 30 (14/16) C2: 30 (17/13) | I: 58.30 ± 14.65 C: 56.00 ± 14.23 C2: 58.63 ± 13.45 |
I: 128.73 ± 4.71, D C: 133.87 ± 26.01, D C2: 133.50 ± 24.23, D | I: 30/0 C: 30/0 C2: 30/0 |
I: 10/20 C: 11/19 C2: 12/18 | low-frequency (1Hz) rTMS, contralesional | I: 15 min of 1 Hz rTMS on the hotspot of the contralesional hemisphere, followed by 30-min task-oriented MT; C: 30-min task-oriented MT; C2: Conventional treatment. Intervention: 6 sessions/week for 4 weeks | FMA-UE; MBI; MEP-CL; CMCT |
| Yang et al. (11) | China | I: Prior- MT + rTMS I2: Prior- rTMS + MT C: MT |
I: 15 (15/0) I2: 14 (14/0) C: 15 (15/0) | I: 60.7 ± 12.3 I2: 55.3 ± 5.6 C: 57.2 ± 9.0 |
I: 60.7 ± 12.3, D I2: 105.2 ± 16.4, D C: 120.0 ± 33.3, D | I: 11/4 I2: 9/5 C: 10/5 |
I: 11/4 I2: 9/5 C: 10/5 | High-frequency (10Hz) rTMS, ipsilesional | I: 50-min MT, followed by 10 min of 10 Hz rTMS on M1 of the lesional hemisphere; I2: 10 min of 10 Hz rTMS on M1 of the lesional hemisphere, followed by 50-minute MT; C: 60-min MT. Intervention: 5 sessions/week for 4 weeks | FMA-UE; MEP-CL; CMCT; MI; FTHUE-HK |
| Kim and Yim (17) | Korea | I: rTMS + TOMT C: rTMS |
I: 8 (4/4) C: 12 (4/8) |
I: 51 ± 2.98 C: 74.11 ± 2.88 |
I: 1.63 ± 0.74, Mo C: 1.75 ± 0.62, Mo | I: 7/5 C: 5/3 |
I: 5/7 C: 2/6 | High-frequency (20Hz) rTMS, ipsilesional | I: 15 min of 20 Hz rTMS on the lesional hemisphere, 20-min task-oriented mirror therapy; C: 15 min of 20Hz rTMS on the lesional hemisphere. Intervention: 5 sessions/week for 2 weeks | BBT; Hand grip and pinch grip strength; RMT; MEP-CL; MEP amplitude |
| Li et al. (20) | China | I: Prior-rTMS + MT C: rTMS |
I: 30 (17/13) C: 30 (16/14) | I: 55.4 ± 10.3 C: 56.8 ± 9.7 |
I: 24.7 ± 10.2, D C: 23.6 ± 11.8, D | I: 30/0 C: 30/0 |
I: 11/19 C: 12/18 | low-frequency (1Hz) rTMS, contralesional | I: 20 min of 1Hz rTMS on the hotspot of the contralesional hemisphere, followed by 30-min MT; C: 20 min of 1 Hz rTMS on the hotspot of the contralesional hemisphere, followed by 30-min conventional occupational therapy. Intervention: 6 sessions/week for 4 weeks | FMA-UE; MI; MEP-CL; CMCT |
| Jin et al. (19) | China | I: Prior-tDCS + MT I2: Concurrent-tDCS + MT C: Sham-tDCS + MT |
I: 10 (2/8) I2: 10 (3/7) C: 10 (1/9) | I: 59.00 ± 9.80 I2: 58.70 ± 7.92 C: 57.50 ± 7.08 |
I: 19.44 ± 8.25, Mo I2: 20.46 ± 11.13, Mo C: 22.16 ± 8.15, Mo | I: 8/2 I2: 4/6 C: 8/2 |
I: 6/4 I2: 2/8 C: 3/7 | Bilateral tDCS; Cathodal: the contralesional hemisphere (C3), Anodal: the ipsilateral M1, 2 mA | I: 30-min bilateral tDCS, followed by 30-min MT; I2: Bilateral tDCS was applied for 30 min at the same time as the 30-min MT; C: Sham stimulation randomly prior to or concurrent with MT. Intervention: 5 sessions/week for 2 weeks | FMA-UE; ARAT; BBT |
| Chen et al. (21) | China | I: Prior- tDCS + MT C: MT C2: tDCS |
I: 26 (13/13) C: 26 (10/16) C2: 26 (12/14) | I: 59.32 ± 8.59 C: 62.46 ± 7.92 C2: 61.31 ± 9.13 |
I: 58.92 ± 17.30, D C: 64.93 ± 16.02, D C2: 62.81 ± 18.14, D | I: 15/11 C: 12/14 C2: 13/13 |
I: 10/16 C: 9/17 C2: 8/18 | Anodal tDCS, Anode: hotspot, Cathode: contralateral superior orbital rim, 2 mA | I: 20-min anode tDCS, followed by 30-min MT; C: 20-min anode tDCS; C2: 30-min MT. Intervention: 5 sessions/week for 3 weeks | FMA-UE; MBI; MEP-CL; CMCT |
| Wang (23) | China | I: Concurrent-tDCS + MT C: tDCS C2: MT C3: Conventional treatment |
I: 30 (15/15) C: 30 (16/14) C2: 30 (17/13) C3: 30 (16/14) | I: 55.15 ± 7.30 C: 55.92 ± 7.66 C2: 53.30 ± 6.17 C3: 54.22 ± 8.26 |
10 days to 3 months | I: 16/14 C: 18/12 C2: 16/14 C3: 17/13 |
I: 13/17 C: 16/14 C2: 14/16 C3: 15/15 | Anode tDCS, Anode: Ipsilateral cerebral hemisphere MI, Cathode: contralateral shoulder, 2 mA | I: Anode tDCS was applied for 20 min at the same time as the 20-min MT; C: 20-min anode tDCS; C2: 20-min MT; C3: Conventional treatment. Intervention: 5 sessions/week for 4 weeks | FMA-UE; MBI; ARAT; NIHSS |
| Liao et al. (22) | China | I: Prior- tDCS + MT C: Concurrent-tDCS + MT C2: Sham tDCS + MT |
I: 8 (5/3) C: 12 (8/4) C2: 8 (8/0) | I: 60.18 ± 4.84 C: 52.04 ± 8.68 C2: 56.45 ± 9.88 |
I: 19.63 ± 12.28, Mo C: 21.92 ± 11.83, Mo C2: 38.13 ± 36.98, Mo | I: 6/2 C: 7/5 C2:7/1 |
I: 6/2 C: 7/5 C2: 8/0 | Anode tDCS, Anodic: iM1, Cathodic: contralateral supraorbital region, 1–2 mA | I: 20-min anodal tDCS on iM1, followed by 20-min MT with sham tDCS and 20-min MT alone. C: 20 -min sham tDCS, followed by 20-min MT concurrently with anodal tDCS on iM1 and 20-min MT alone. C2: 20-min sham tDCS, followed by 20-min MT concurrently with sham tDCS and 20-min MT alone. Intervention: 5 sessions/week for 4 weeks | FMA-UE; NEADL: Kinematic Variables |
| Li (24) | China | I: rTMS + MT C: MT |
I: 40 (22/18) C: 42 (23/19) | I: 59.10 ± 12.31 C: 57.60 ± 9.27 |
I: 31.64 ± 7.69, D C: 30.52 ± 7.19, D | NR | I: 22/18 C: 20/22 | In the recovery phase, High-frequency (10Hz) rTMS, ipsilesional; In the acute phase, low-frequency (1 Hz) rTMS, contralesional | I: 15 min of 1 or 10 Hz rTMS on M1 of the contralesional or ipsilesional hemisphere, 20-min AM and 20-min PM MT; C: 20-min AM and 20-min PM MT. Intervention: 6 sessions/week for 3 weeks | FMA-UE; MBI; MEP-CL; CMCT; MAS; NIHSS |
| Yu and Chen (12) | China | I: tDCS + TOMT C: tDCS C2: Conventional treatment |
I: 45 (22/23) C: 45 (24/21) C2: 45 (20/25) | I: 57.8 ± 11.2 C: 58.6 ± 12.3 C2: 60.4 ± 10.7 |
I: 62.9 ± 13.2, D C: 61.7 ± 12.6, D C2: 63.6 ± 11.6, D | I: 26/19 C: 28/17 C2: 31/14 |
I: 15/30 C: 18/27 C2: 16/29 | Anodal tDCS, Anode: hotspot, Cathode: contralateral superior orbital rim, 2 mA | I: 20-min anodal tDCS on iM1, 40-min MT; C: 20-min anodal tDCS; C2: Conventional treatment. Intervention: 5 sessions/week for 6 weeks | FMA-UE; MBI; MEP-CL; CMCT |
AM, ante meridiem; ARAT, Action Research Arm Test; BBT, Box and Blocks Test; C, control; CL, cortical latency; CMCT, central motor conduction time; D, days; F, female; FMA-UE, Fugl Meyer Assessment Upper Extremity; FTHUE-HK, Functional Test For The Hemiplegic Upper Extremity – Hong Kong Version; H, hemorrhagic; I, ischemic; I, intervention; iM1, ipsilateral M1; L, left; M, male; MAS, Modified Ashworth Scale; MBI, modified Barthel Index; MEP, motor evoked potential; MI, motricity Index; Mo, months; MT, mirror therapy; NIBS, noninvasive brain stimulation; NIHSS, National Institute of Health stroke scale; NR, not reported; PM, post meridiem; R, right; RMT, resting motor threshold; rTMS, repetitive transcranial magnetic stimulation; SD, Standard Deviation; tDCS, transcranial direct current stimulation; TOMT, task-oriented mirror therapy.