Effect of theta burst stimulation on lower extremity motor function improvement and balance recovery in patients with stroke: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: To investigate the therapeutic benefits of theta burst stimulation on lower-limb motor dysfunction and balance recovery in patients with stroke.

Methods: A literature search was performed across CNKI, CBM, WanFang, VIP, PubMed, Embase, Cochrane Library, and Web of Science until November 2023. The Methodological quality of included studies was assessed by using the Cochrane risk-of-bias tool and the PEDro scale, and the meta-analysis was performed by using RevMan 5.3 software. Two independent researchers screened the literature and extracted basic information on participants, interventions, comparisons, outcomes, and studies.

Results: Eight studies, including cTBS and iTBS, with 290 participants meeting the inclusion criteria for this systematic review, and 7 studies including only iTBS with 230 participants were included in this meta-analysis. The methodological quality of the studies included ranged from moderate to high. The results showed iTBS had significantly higher scores on the Berg Balance Scale (BBS) than the control group. (MD = 4.57, 95% CI: 1.76 to 7.38, Z = 3.19, P = .001). Subgroup analysis showed CRB-iTBS markedly improved BBS scores (MD = 4.52, 95% CI: 1.78 to 7.27, Z = 3.23, P = .001), whereas LE M1-iTBS did not exhibit a significant enhancement in BBS scores (MD = 6.10, 95% CI: -7.34 to 19.53, Z = 0.89, P = .37); iTBS showed no significant increase in lower-limb motor function (FMA-LE) (MD = 1.80, 95% CI: -1.10 to 4.69, Z = 1.22, P = .22). Subgroup analysis revealed both CRB-iTBS and LE M1-iTBS interventions were not effective in improving FMA-LE (MD = 3.15, 95% CI: -4.70 to 11.00, Z = .79, P = .43; MD = 1.05, 95% CI: -2.20 to 4.30, Z = .63, P = .53); iTBS significantly reduced the MEP latency (P = .004), but did not show a significant improvement in walking performance (10 MWT), mobility (TUG), or activities of daily living [M(BI)] (P > .05).

Conclusion: Based the current study, iTBS can increase patients' balance function. The CRB-iTBS protocol is more effective than the LE M1-iTBS protocol. Additionally, iTBS may be a promising therapy tending to enhance lower-limb motor function, walking performance, mobility, and activities of daily living.

Figure 1.

Flow chart for screening included studies.

Figure 2.

Bias risk of included systematic review in literature. “+”:low bias risk; “?”:unclear risk; “-”:high bias risk.

Figure 3.

Effect of iTBS on recovery of lower limb motor function in stroke patients(A), and sensitivity analysis considering LE M1-iTBS and CRB-iTBS stimulation(B). FMA-LE = the Fugl-Meyer Assessment of Motor Recovery for lower extremity; LE M1-iTBS = iTBS stimulates the primary motor cortex innervating the lower limbs; CRB-iTBS = iTBS stimulates cerebellar.

Figure 4.

Effect of iTBS on balance recovery in stroke patients(A); Sensitivity analysis considering LE M1-iTBS and CRB-iTBS stimulation(B). BBS = Berg Balance Scale; LE M1 = the primary motor cortex innervating the lower limbs; CRB = cerebellum.

Figure 5.

Effect of iTBS on walking time(A) and functional mobility(B) in stroke patients. 10MWT = 10-m walk test(s); TUG = Timed Up and Go test.

Figure 6.

Effect of iTBS on level of independence in daily living[(M)BI] in stroke patients. (M)BI = (modified) Barthel Index.

Figure 7.

Effect of iTBS on Corticospinal Excitability in stroke patients. MEP latency = motor evoked potentials latency.