Journal CME August 2025, Effects of electrical and magnetic stimulation on upper extremity function after stroke: A systematic review and network meta-analysis-PM R - 2025 - Keesukphan - Effects of electrical and magnetic stimulation on upper

PM R - 2025 - Keesukphan - Effects of electrical and magnetic stimulation on upper

Pdf Summary

This systematic review and network meta-analysis evaluated the efficacy of electrical and magnetic stimulation therapies—namely repetitive peripheral magnetic stimulation (rPMS), neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), transcranial magnetic stimulation (TMS), and their combinations—in improving upper extremity function, activities of daily living (ADL), and spasticity in poststroke patients.<br /><br />A comprehensive literature search up to July 2022 identified 62 randomized controlled trials involving 1476 stroke patients. The primary outcome was upper extremity function assessed mainly by the Fugl-Meyer Assessment (FMA). Secondary outcomes included ADL measured by the Barthel Index (BI) and muscle spasticity evaluated via the Modified Ashworth Scale (MAS).<br /><br />Network meta-analysis revealed that NMES combined with rPMS (NMESrPMS) was most effective in improving upper extremity function, producing a clinically meaningful improvement in FMA scores (mean difference ~14.7 points versus conventional rehabilitation). NMES alone was the second most effective intervention, followed by NMES combined with TMS (NMESTMS), TMS, and FES—all showing significant benefits compared to conventional rehabilitation. Subgroup analyses indicated NMESrPMS was especially beneficial in acute/subacute and severe stroke cases, while NMES was most effective in chronic stroke.<br /><br />For ADL, TMS combined with NMES had the highest probability of benefit, followed by TMS and FES. However, none of the examined interventions demonstrated significant effects on spasticity compared to conventional rehabilitation.<br /><br />Despite these promising findings, the overall quality of evidence was low to very low due to concerns about study heterogeneity, bias, and inconsistency. rPMS studies were limited, and cost and accessibility of rPMS and TMS devices may restrict their clinical use, while NMES offers a more affordable alternative.<br /><br />In conclusion, NMES combined with rPMS may provide the greatest improvements in poststroke upper extremity motor function, with NMES plus TMS potentially enhancing daily living activities. However, no therapies significantly improved spasticity. Further well-designed, high-quality randomized trials are necessary to confirm these results and inform clinical practice.

Keywords

poststroke rehabilitation

upper extremity function

repetitive peripheral magnetic stimulation

neuromuscular electrical stimulation

functional electrical stimulation

transcranial magnetic stimulation

activities of daily living

muscle spasticity

network meta-analysis

randomized controlled trials