Combined repetitive transcranial magnetic stimulation and mirror therapy for upper limb rehabilitation in stroke survivors: A systematic review and meta-analysis
In brief
Combined brain stimulation and mirror therapy improved arm function after stroke in seven trials
Across seven randomized trials involving 402 stroke survivors, adding repetitive magnetic brain stimulation to mirror therapy improved arm movement and hand dexterity compared with control treatments. The review also found gains in grip and other measures, but the evidence is preliminary, and the best treatment settings remain unclear; larger, higher-quality trials are needed before the approach's role in rehabilitation is settled.
- Journal
- Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Q1)
- Published
- 29 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Anas R Alashram
- PMID
- 42809058
- DOI
- 10.1007/s10072-026-09437-y
Why clinicians should know about it
- Picked for Rehabilitation (paper of the day, 30 September 2026): Meta‑analysis of combined rTMS + mirror therapy for post‑stroke arm
Abstract
Upper limb impairments are among the most prevalent consequences of stroke. Recently, repetitive transcranial magnetic stimulation (rTMS) and mirror therapy (MT) have been used in stroke rehabilitation. This systematic review aims to examine the effects of combining rTMS and MT on the upper limb in patients with stroke and define the optimal treatment parameters, if possible. "PubMed, MEDLINE, Scopus, CINAHL, PEDro, EMBASE, REHABDATA, and Web of Science" were searched until March 2026. Randomized controlled trials evaluating the effectiveness of combined rTMS and MT on the upper limb poststroke were included. The Cochrane Risk of Bias 2 (RoB 2) and the GRADE were employed to evaluate risk of bias and certainty of evidence, respectively. Meta-analysis and subgroup analysis were performed. Seven RCTs (402 participants) met the inclusion criteria. Significant improvements in the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) (SMD = 0.92, 95% CI: 0.43-1.41, p = 0.0002) and the Box and Block Test (BBT) (SMD = 1.09, 95% CI: 0.49-1.68, p = 0.0003) were reported. Other outcomes demonstrated improvements in pinch grip, hand grip, functional performance, motor impairment, and muscle tone. The preliminary findings suggest that combining rTMS and MT has potential effects on enhancing upper limb function poststroke; however, these results should be interpreted with caution. The most effective treatment parameters remain unclear. Further high-quality studies are warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.