Academic Journal
Completion rate and safety of non-invasive brain stimulation for upper limb dysfunction after stroke: a systematic review and network meta-analysis.
| Title: | Completion rate and safety of non-invasive brain stimulation for upper limb dysfunction after stroke: a systematic review and network meta-analysis. |
|---|---|
| Authors: | Sun J; Xinxiang Medical University, Xinxiang, China., Wang Z; Xinxiang Medical University, Xinxiang, China., Huang Y; Xinxiang Medical University, Xinxiang, China., Du Y; Xinxiang Medical University, Xinxiang, China., Zhang S; Xinxiang Medical University, Xinxiang, China., Shen H; Xinxiang Medical University, Xinxiang, China., Zhang H; Xinxiang Medical University, Xinxiang, China., Feng S; Xinxiang First People's Hospital, Xinxiang, China. |
| Source: | Frontiers in neurology [Front Neurol] 2026 Sep 09; Vol. 17, pp. 1853609. Date of Electronic Publication: 2026 Sep 09 (Print Publication: 2026). |
| Publication Type: | Journal Article; Systematic Review; Network Meta-Analysis |
| Language: | English |
| Journal Info: | Publisher: Frontiers Research Foundation Country of Publication: Switzerland NLM ID: 101546899 Publication Model: eCollection Cited Medium: Internet ISSN: 1664-2295 (Electronic) Linking ISSN: 16642295 NLM ISO Abbreviation: Front Neurol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Lausanne : Frontiers Research Foundation, 2010]- |
| MeSH Terms: | Stroke*/therapy , Stroke*/complications , Stroke*/physiopathology , Upper Extremity*/physiopathology , Transcranial Magnetic Stimulation*/methods , Transcranial Magnetic Stimulation*/adverse effects , Stroke Rehabilitation*/methods , Transcranial Direct Current Stimulation*/methods , Transcranial Direct Current Stimulation*/adverse effects, Humans |
| Abstract: | Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has been widely used as an adjunctive intervention for upper limb motor recovery after stroke; however, the treatment completion rates and comparative safety profiles across different NIBS modalities have not been systematically evaluated. This systematic review and network meta-analysis aimed to assess and compare the treatment completion rates of various NIBS interventions for post-stroke upper limb rehabilitation. We systematically searched six databases and trial registries (PubMed, Embase, Cochrane CENTRAL, CINAHL, WHO ICTRP, and ClinicalTrials.gov) for randomized controlled trials (RCTs) published up to January 20, 2025, with an updated search conducted to April 15, 2026. Random-effects single-arm meta-analyses using the Freeman-Tukey double arcsine transformation were performed to pool completion rates, and a Bayesian random-effects network meta-analysis estimated relative risks (RRs) with 95% credible intervals (CrIs); treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The protocol was registered with PROSPERO (CRD420261309536). Fifty-five RCTs comprising 68 comparisons and 2,640 participants were included. The pooled intervention group completion rate was 94.9% (95% CI: 93.3-96.4%; I2 = 46.8%). The network meta-analysis showed no statistically significant differences in completion rate between any NIBS intervention and sham/control (all 95% CrIs included 1.00). SUCRA rankings indicated that intermittent theta burst stimulation (iTBS; 71.1%), bilateral rTMS (BL-rTMS; 60.9%), and dual transcranial direct current stimulation (Dual-tDCS; 58.1%) ranked highest. The overall adverse event (AE) rate was 16.4% (95% CI: 8.5-26.2%) in intervention groups, predominantly mild headache and skin tingling, with an AE-related dropout rate of only 1.1%. Subgroup analyses showed higher completion rates for tDCS (96.8%) than rTMS (93.9%), with the chronic phase highest (97.1%) and the mixed phase lowest (89.1%). The LFK index was 0.04, indicating no publication bias. In conclusion, NIBS for post-stroke upper limb rehabilitation demonstrates favorable tolerability and safety, with an overall completion rate of approximately 95%. Exploratory SUCRA rankings placed iTBS, BL-rTMS, and Dual-tDCS in the top three positions; however, these rankings should be considered hypothesis-generating rather than definitive, as four interventions were informed by only a single study, absolute differences in completion rates were minimal, and all pairwise credible intervals included 1.00. These observed phase-specific differences suggest that stroke phase may be an important factor to consider when designing adherence strategies, although prospective evaluation of tailored interventions is needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261309536, PROSPERO (Registration ID: CRD420261309536). (Copyright © 2026 Sun, Wang, Huang, Du, Zhang, Shen, Zhang and Feng.) |
| Competing Interests: | The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. |
| References: | Front Neurol. 2025 Sep 12;16:1634277. (PMID: 41018197) Brain Stimul. 2016 Sep-Oct;9(5):641-661. (PMID: 27372845) J Stroke Cerebrovasc Dis. 2016 Jul;25(7):1655-1664. (PMID: 27067882) Eur J Neurol. 2010 Sep;17(9):1203-1209. (PMID: 20402755) Ther Adv Neurol Disord. 2019 Sep 25;12:1756286419878317. (PMID: 31598137) IEEE Trans Neural Syst Rehabil Eng. 2019 Jul;27(7):1458-1466. (PMID: 31170077) PLoS One. 2025 Mar 18;20(3):e0320142. (PMID: 40100900) Restor Neurol Neurosci. 2019;37(2):167-180. (PMID: 30932903) Front Hum Neurosci. 2018 Jun 19;12:233. (PMID: 29970994) Folia Neuropathol. 2022;60(2):177-184. (PMID: 35950470) NeuroRehabilitation. 2015;37(2):181-91. (PMID: 26484510) Brain Stimul. 2015 Jul-Aug;8(4):823-30. (PMID: 25828427) Clin Rehabil. 2019 May;33(5):847-864. (PMID: 30773896) Int J Stroke. 2014 Dec;9(8):1017-25. (PMID: 25117911) J ECT. 2021 Dec 1;37(4):281-290. (PMID: 33840803) J Neurol. 2012 Jul;259(7):1399-405. (PMID: 22173953) Stroke. 2012 Jul;43(7):1849-57. (PMID: 22713491) Front Neurosci. 2023 Feb 07;17:1100464. (PMID: 36845428) J Neuroeng Rehabil. 2025 Nov 10;22(1):235. (PMID: 41214733) BMJ. 2021 Mar 29;372:n71. (PMID: 33782057) Neurorehabil Neural Repair. 2012 Nov-Dec;26(9):1072-9. (PMID: 22588639) Int J Neuropsychopharmacol. 2011 Sep;14(8):1133-45. (PMID: 21320389) Brain Stimul. 2020 Jul - Aug;13(4):979-986. (PMID: 32380449) Neuromodulation. 2017 Apr;20(3):215-222. (PMID: 28220641) J Neuroeng Rehabil. 2025 Apr 26;22(1):98. (PMID: 40287756) Stroke. 2022 Jul;53(7):2171-2181. (PMID: 35317611) J Neuroeng Rehabil. 2020 Jun 15;17(1):73. (PMID: 32539812) Arch Phys Med Rehabil. 2023 Oct;104(10):1683-1697. (PMID: 37245690) Brain Stimul. 2016 Jan-Feb;9(1):16-26. (PMID: 26433609) Front Rehabil Sci. 2022 Aug 03;3:978257. (PMID: 36189037) Brain Stimul. 2008 Jul;1(3):206-23. (PMID: 20633386) Neurorehabil Neural Repair. 2022 Dec;36(12):800-809. (PMID: 36458455) Front Aging Neurosci. 2023 Jan 13;14:1077218. (PMID: 36711205) Restor Neurol Neurosci. 2018;36(1):21-30. (PMID: 29439359) Clin Neurophysiol. 2020 Feb;131(2):474-528. (PMID: 31901449) Stroke Res Treat. 2014;2014:305236. (PMID: 25197611) Clin Rehabil. 2019 Apr;33(4):693-703. (PMID: 30618285) Ann Intern Med. 2015 Jun 2;162(11):777-84. (PMID: 26030634) Neurorehabil Neural Repair. 2009 Sep;23(7):641-56. (PMID: 19531606) Res Synth Methods. 2012 Jun;3(2):80-97. (PMID: 26062083) Neurorehabil Neural Repair. 2008 Mar-Apr;22(2):111-21. (PMID: 17876068) Neuron. 2005 Jan 20;45(2):201-6. (PMID: 15664172) Clin Neurophysiol. 2009 Dec;120(12):2008-2039. (PMID: 19833552) Arch Phys Med Rehabil. 2015 Jan;96(1):69-75. (PMID: 25218256) J Stroke Cerebrovasc Dis. 2018 Jan;27(1):1-31. (PMID: 29111342) Clin Neurophysiol. 2017 Sep;128(9):1774-1809. (PMID: 28709880) Stroke. 2012 Jan;43(1):250-2. (PMID: 22038776) Neurophysiol Clin. 2023 Jun;53(3):102895. (PMID: 37517104) J Clin Epidemiol. 2011 Feb;64(2):163-71. (PMID: 20688472) Lancet. 2002 Mar 2;359(9308):781-5. (PMID: 11888606) Int J Evid Based Healthc. 2018 Dec;16(4):195-203. (PMID: 29621038) Stat Med. 2004 Oct 30;23(20):3105-24. (PMID: 15449338) CNS Neurosci Ther. 2014 Apr;20(4):355-63. (PMID: 24422912) J Rehabil Med. 2010 Sep;42(8):758-64. (PMID: 20809058) Neurorehabil Neural Repair. 2020 Sep;34(9):856-867. (PMID: 32807013) Arch Neurol. 2012 Feb;69(2):161-7. (PMID: 21987395) J Med Internet Res. 2005 Mar 31;7(1):e11. (PMID: 15829473) Neurorehabil Neural Repair. 2011 Nov-Dec;25(9):838-46. (PMID: 21825004) J Clin Neurophysiol. 2018 Mar;35(2):166-172. (PMID: 29394175) Lancet Neurol. 2020 Apr;19(4):348-360. (PMID: 32004440) NeuroRehabilitation. 2021;48(1):83-96. (PMID: 33361618) Front Aging Neurosci. 2021 May 19;13:636184. (PMID: 34093164) J Neuroeng Rehabil. 2025 Apr 16;22(1):83. (PMID: 40241110) J Neuroeng Rehabil. 2017 Sep 13;14(1):95. (PMID: 28903772) Biomed Res Int. 2016;2016:5068127. (PMID: 27123448) Int J Stroke. 2017 Jul;12(5):444-450. (PMID: 28697708) J Rehabil Med. 2013 Sep;45(9):843-7. (PMID: 23817976) J Neuroeng Rehabil. 2023 Feb 27;20(1):27. (PMID: 36849990) J Neurol Sci. 2016 Oct 15;369:149-158. (PMID: 27653882) Clin Neurophysiol. 2021 Jan;132(1):269-306. (PMID: 33243615) BMJ. 2019 Aug 28;366:l4898. (PMID: 31462531) Brain Stimul. 2020 May - Jun;13(3):686-693. (PMID: 32289698) J Huazhong Univ Sci Technolog Med Sci. 2015 Apr;35(2):248-254. (PMID: 25877360) Stroke. 2018 Sep;49(9):2138-2146. (PMID: 30354990) Lancet Neurol. 2009 Aug;8(8):741-54. (PMID: 19608100) Ann Phys Rehabil Med. 2020 Jan;63(1):4-11. (PMID: 31158553) BMC Neurol. 2019 Apr 25;19(1):69. (PMID: 31023258) Brain Connect. 2023 Oct;13(8):453-463. (PMID: 36772802) Restor Neurol Neurosci. 2016 Nov 22;34(6):935-945. (PMID: 27689551) Restor Neurol Neurosci. 2021;39(6):419-434. (PMID: 34924405) Int J Stroke. 2013 Jan;8(1):25-32. (PMID: 23280266) Clin Neurophysiol. 2017 Jan;128(1):56-92. (PMID: 27866120) Int J Neuropsychopharmacol. 2021 Apr 21;24(4):256-313. (PMID: 32710772) CNS Neurosci Ther. 2017 Dec;23(12):940-946. (PMID: 28971620) Restor Neurol Neurosci. 2018;36(1):59-71. (PMID: 29439362) Stroke. 2001 Jun;32(6):1279-84. (PMID: 11387487) BMJ. 2006 Apr 22;332(7547):969-71. (PMID: 16627519) Int J Environ Res Public Health. 2023 Jun 09;20(12):. (PMID: 37372680) Electroencephalogr Clin Neurophysiol. 1998 Jan;108(1):1-16. (PMID: 9474057) J Biomed Phys Eng. 2021 Apr 01;11(2):175-184. (PMID: 33937125) NeuroRehabilitation. 2014;34(3):437-46. (PMID: 24473248) Eur J Neurol. 2020 Dec;27(12):2473-2482. (PMID: 32697879) Brain Stimul. 2020 Mar - Apr;13(2):329-336. (PMID: 31735645) Res Synth Methods. 2016 Mar;7(1):80-93. (PMID: 26461181) Cochrane Database Syst Rev. 2013 May 31;(5):CD008862. (PMID: 23728683) Stroke. 2024 Sep;55(9):2212-2220. (PMID: 39016009) Clin Neurophysiol. 2019 Aug;130(8):1409-1416. (PMID: 31104898) Clin Rehabil. 2017 Sep;31(9):1137-1153. (PMID: 28786336) Front Neurosci. 2016 Mar 08;10:88. (PMID: 27013950) Front Neurol. 2023 Jan 11;13:887205. (PMID: 36712422) BMJ. 2012 May 18;344:e2809. (PMID: 22611167) Clin Neurophysiol. 2017 Apr;128(4):589-603. (PMID: 28231477) Lancet Neurol. 2021 Oct;20(10):795-820. (PMID: 34487721) Sci Transl Med. 2016 Mar 16;8(330):330re1. (PMID: 27089207) BMJ. 2003 Sep 6;327(7414):557-60. (PMID: 12958120) Am J Phys Med Rehabil. 2020 Feb;99(2):99-108. (PMID: 31361620) Neurol Res Pract. 2020 Jun 16;2:17. (PMID: 33324923) |
| Contributed Indexing: | Keywords: network meta-analysis; non-invasive brain stimulation; repetitive transcranial magnetic stimulation; safety; stroke; transcranial direct current stimulation; treatment completion rate; upper limb |
| Entry Date(s): | Date Created: 20260924 Date Completed: 20260924 Latest Revision: 20260926 |
| Update Code: | 20260926 |
| PubMed Central ID: | PMC13597372 |
| DOI: | 10.3389/fneur.2026.1853609 |
| PMID: | 42780542 |
| Database: | MEDLINE |
| ISSN: | 1664-2295 |
|---|---|
| DOI: | 10.3389/fneur.2026.1853609 |