SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1630876
This article is part of the Research TopicNew approaches for central nervous system rehabilitation - Volume IIView all 7 articles
Effectiveness of Dual-Site Transcranial Magnetic Stimulation on Motor Function and Activities of Daily Living in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Provisionally accepted
- 1Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
- 2Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
- 3Department of Obstetrics and Gynecology, Quan Zhou Women's and Children's Hospital, Quanzhou, China
- 4Department of Cardiovascular Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
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Dual-site transcranial magnetic stimulation (TMS) has emerged as a promising neuromodulation technique in stroke rehabilitation. By targeting multiple brain regions, dual-site TMS may enhance neuroplasticity more effectively than single-site stimulation. However, its clinical efficacy remains uncertain.To systematically evaluate the effects of dual-site TMS in improving motor function and activities of daily living (ADL) in patients with strokeWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) following PRISMA guidelines. Seven electronic databases were searched from inception to February 19, 2024. Studies comparing dual-site TMS with single-site TMS, sham dual-site TMS, or routine rehabilitation in stroke patients were included. Outcomes included Fugl-Meyer Assessment (FMA), FMA-Upper Limb (FMA-UL), Action Research Arm Test (ARAT), Barthel Index (BI), Modified Barthel Index (MBI), Wolf Motor Function Test (WMFT), and others.Methodological quality was assessed using the PEDro scale. Meta-analyses were performed using a random-effects model.Fourteen RCTs involving 724 participants were included. Dual-site TMS significantly improved upper limb motor function compared with single-site TMS (MD = 7.07, 95% CI: 1.46 to 12.68, P < 0.001) and sham dual-site TMS (MD = 14.45, 95% CI: 6.23 to 22.66, P < 0.001). ADL outcomes also favored dual-site TMS over single-site TMS (MD = 9.90, 95% CI: 7.82 to 11.98, P < 0.001) and sham dual-site TMS (MD = 21.13, 95% CI: 9.37 to 32.88, P < 0.001). Subgroup analyses suggested enhanced benefits in subacute phase stroke and in protocols with >20 sessions. Sensitivity analysis confirmed robustness of findings. No serious adverse events were reported.Dual-site TMS combined with routine rehabilitation is more effective than single-site TMS or sham dual-site TMS in improving motor function and ADL among stroke patients. These findings support its clinical application as an adjunct to conventional therapy. Further high-quality trials are needed to optimize stimulation protocols and confirm long-term effects.
Keywords: Transcranial Magnetic Stimulation, Motor function, Activities of Daily Living, Stroke, Systematic review
Received: 18 May 2025; Accepted: 26 Jun 2025.
Copyright: © 2025 Qin, Hong, Wang, Zhang, Zhuang, Hong and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jiawei Qin, Department of Rehabilitation Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
Shanshan Hong, Department of Obstetrics and Gynecology, Quan Zhou Women's and Children's Hospital, Quanzhou, China
Liling Zheng, Department of Cardiovascular Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
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