Theta-stimulation for the treatment of motor function and daily activity ability in the lower extremities of stroke patients: a meta-analysis

doi:10.12307/2026.616

Abstract

Abstract: OBJECTIVE: A meta-analysis was conducted to systematically evaluate the effect of intermittent theta-burst stimulation on improving lower limb motor function, balance function, and daily activity ability in stroke patients.
METHODS: A comprehensive search was conducted on randomized controlled trials on intermittent theta-burst stimulation for stroke treatment, with a cutoff date of November 2024, from major bibliographic databases including Cochrane Library, Scopus, PubMed, Embase, ProQuest, Web of Science, CNKI, China Biomedical Literature Database, VIP, and WanFang databases. The inclusion criteria were met by trials that administered intermittent theta stimulation to the cerebellum/M1, with the experimental group receiving this stimulation and the control group receiving routine rehabilitation treatment. The meta-analysis was conducted using RevMan 5.3 and Stata 16.0.
RESULTS: A total of 12 articles with 444 patients were included in the meta-analysis, which demonstrated that intermittent theta-burst stimulation can enhance the Fugl-Meyer score of the lower extremities in patients following stroke [WMD=2.87, 95% confidence interval (CI) (1.77, 3.98), P < 0.000 01] and the Berg Balance Scale score [WMD=5.79, 95% CI (3.80, 7.79), P < 0.000 01] and Modified Barthel Index [WMD=6.32, 95% CI (4.02, 8.44), P < 0.000 01]. Subgroup analysis revealed that when compared with 600 pulses, 1 200 stimulation pulses yielded a more pronounced enhancement in lower limb Fugl-Meyer scores [WMD=4.31, 95% CI (2.91, 5.71), P < 0.000 01], the Berg Balance Scale score [WMD =8.12, 95% CI (5.27, 10.98), P < 0.000 01] and the Modified Barthel Index [WMD=8.50, 95% CI (6.55, 10.45), P < 0.000 01].
CONCLUSION: Intermittent theta-burst stimulation has been demonstrated to enhance lower limb motor ability, balance function, and daily living ability scores in patients who have experienced a stroke. Among the various forms of intermittent theta stimulation, 1 200-pulse intermittent theta stimulation has been shown to yield the most significant improvements in lower limb motor ability, balance function, and daily living ability.

Key words: Theta, intermittent theta-burst stimulation, stroke, lower limbs, meta-analysis, balance, activities of daily living, motor function

CLC Number:

Hu Xin, Wan Haili, Du Liang, Li Yongjie, Xia Yuan. Theta-stimulation for the treatment of motor function and daily activity ability in the lower extremities of stroke patients: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(10): 2576-2583.

Figures/Tables 6

质性(I2=68%，P=0.000 5)，故采用随机效应模型整合分析。结果显示，与对照组相比，iTBS组脑卒中受试者的FMA-LE评分有显著提高[WMD=2.87，95%CI(1.77，3.98)，P < 0.000 01]，见图4。根据刺激总脉冲数的差异，将数据分为600脉冲和1 200脉冲2个亚组。其中，600脉冲亚组包括6项研究[18-20，24，27，29]，共220例，各研究间异质性较小(P=0.21，I2=30%)，采用固定效应模型。数据表明600脉冲数的iTBS能够有效改善脑卒中患者下肢运动功能[WMD=1.70，95%CI(0.77，2.63)，P=0.000 3]。 1 200脉冲亚组包括4项研究[22，23，25，28]，共150例，各研究间异质性较小(P=0.13，I2=44%)，采用固定效应模型。数据表明1 200脉冲数的iTBS也能够提高脑卒中患者下肢运动功能[WMD=4.31，95%CI(2.91，5.71)，P < 0.000 01]。两个亚组间存在显著异质性(P=0.002)，其中1 200脉冲数亚组具有最高的效应量。 2.4.2 BBS评分共11篇文献报告了BBS评分[9-28]，共计408例受试者。因数据存在显著异质性(I2=82%，P < 0.000 01)，故采用随机效应模型整合分析。结果显示，与对照组相比，iTBS组脑卒中患者BBS评分有显著改善[WMD=5.79，95%CI(3.80，7.79)，P < 0.000 01]，见图5。根据刺激总脉冲数的差异，将数据分为600脉冲和1 200脉冲2个亚组。其中，600脉冲亚组包括6项研究[18-20，24-25，27]，共220例，各研究间异质性较小(P=0.65，I2=0%)，采用固定效应模型。数据表明600脉冲数的iTBS能够有效改善脑卒中患者的平衡功能[WMD=2.68，95%CI(1.59，3.77)，P < 0.000 01]。1 200脉冲亚组包括5项研究[21-23，26，28]，共188例，各研究间异质性较大(P < 0.000 01，I2=84%)，采用随机效应模型。数据表明1 200脉冲数的iTBS也能够提高脑卒中患者的平衡功能[WMD=8.12，95%CI(5.27，10.98)，P < 0.000 01]。两个亚组间效应量存在显著差异(P=0.000 5)，其中1 200脉冲数亚组具有最高的效应量。 2.4.3 MBI 共10篇文献报告了MBI[18-22，24-28]，总计372例受试者。因数据存在显著异质性(I2=66%，P=0.001)，故采用随机效应模型整合分析。结果显示，与对照组相比，iTBS组脑卒中患者的MBI评分有明显改善[WMD=6.23，95%CI(4.02，8.44)，P < 0.000 01]，见图6。根据刺激总脉冲数的差异，将数据分为600脉冲和1 200脉冲2个亚组。其中，600脉冲亚组包括5项研究[18-20，24，27]，共184例，各研究间异质性较小(P=0.81，I2=0%)，采用固定效应模型。数据表明600脉冲数的iTBS能够有效改善脑卒中患者的日常活动能力[WMD=2.90，95%CI (1.22，4.59)，P=0.000 7]。1 200脉冲亚组包括5项研究[21，22，25-26，28]，共188例，各研究间异质性较小(P=0.26，I2=22%)，采用固定效应模型。数据表明1 200脉冲数的iTBS也能够提高脑卒中患者的日常活动能力[WMD=8.50，95%CI(6.55，10.45)，P < 0.000 01]。两个亚组间效应量存在显著差异(P < 0.000 01)，其中1 200脉冲数亚组具有最高的效应量。 2.4.4 发表偏倚检验采用egger检验，结果显示，FMA-LE评分(t=1.14，P=0.282)，BBS评分(t=1.40，P=0.192)，MBI(t=0.87，P=0.409)均不存在明显的偏倚。 2.4.5 敏感性分析采用依次排除法进行敏感性分析，结果显示FMA-LE评分、BBS评分及MBI指标较为稳定，见图7。"

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