Repetitive Transcranial Magnetic Stimulation for the Treatment of Lower Limb Dysfunction in Patients Poststroke: A Systematic Review with Meta-Analysis

Abstract Purpose To investigate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in recovery of lower limb dysfunction in patients poststroke. Participants and Methods Cochrane Central Register of Controlled Trials, Medline, ISI web of knowledge, EBSCO, Embase, Cumulative Index to Nursing and Allied Health Literature and Scopus. Results Fifteen trials with 385 patients were included. Results showed that rTMS had a significant effect on balance (standard mean difference [SMD] = .38; 95% confidence interval [CI], .07: .69; I2 = 51%) and mobility (SMD: −.67; 95% CI, −1.08: −.26; I2 = 72%). However, rTMS had no significant immediate effects on the lower limb subscale of the Fugl-Meyer Assessment (FMA-L) (SMD = .01; 95% CI, −.29: .31; I2 = 0%). Continued effects of rTMS was also found to be significant during the follow-up period (SMD = .46; 95% CI, .09: .84; I2 = 14%). Conclusion rTMS was found to result in positive effects on mobility, balance and long-term prognosis of FMA-L. However data indicated that there is insufficient evidence for the effectiveness of rTMS in improving lower limb function.