Data_Sheet_1_Comparative efficacy of different repetitive transcranial magnetic stimulation protocols for lower extremity motor function in stroke patients: a network meta-analysis.docx

BackgroundLower extremity motor dysfunction is one of the most severe consequences after stroke, restricting functional mobility and impairing daily activities. Growing evidence suggests that repetitive transcranial magnetic stimulation (rTMS) can improve stroke patients’ lower extremity motor function. However, there is still controversy about the optimal rTMS protocol. Therefore, we compared and analyzed the effects of different rTMS protocols on lower extremity motor function in stroke patients using network meta-analysis (NMA).MethodsWe systematically searched CNKI, WanFang, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library databases (from origin to 31 December 2023). Randomized controlled trials (RCTs) or crossover RCTs on rTMS improving lower extremity motor function in stroke patients were included. Two authors independently completed article screening, data extraction, and quality assessment. RevMan (version 5.4) and Stata (version 17.0) were used to analyze the data.ResultsA total of 38 studies with 2,022 patients were eligible for the NMA. The interventions included HFrTMS-M1, LFrTMS-M1, iTBS-Cerebellum, iTBS-M1, dTMS-M1, and Placebo. The results of NMA showed that LFrTMS-M1 ranked first in FMA-LE and speed, and HFrTMS-M1 ranked first in BBS, TUGT, and MEP amplitude. The subgroup analysis of FMA-LE showed that HFrTMS-M1 was the best stimulation protocol for post-stroke time > 1 month, and LFrTMS-M1 was the best stimulation protocol for post-stroke time ≤ 1 month.ConclusionConsidering the impact of the stroke phase on the lower extremity motor function, the current research evidence shows that HFrTMS-M1 may be the preferred stimulation protocol to improve the lower extremity motor function of patients for post-stroke time > 1 month, and LFrTMS-M1 for post-stroke time ≤ 1 month. However, the above conclusion needs further analysis and validation by more high-quality RCTs.Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier (CRD42023474215).

背景：脑卒中后，下肢运动功能障碍是极为严重的后果之一，它限制了患者的功能性移动能力，并损害了日常活动。越来越多的证据表明，重复经颅磁刺激（rTMS）能够改善脑卒中患者的下肢运动功能。然而，关于rTMS最佳方案仍存在争议。因此，本研究通过网络荟萃分析（NMA）比较并分析了不同rTMS方案对脑卒中患者下肢运动功能的影响。方法：我们对CNKI、万方、VIP、CBM、PubMed、Embase、Web of Science和Cochrane Library数据库（自起始至2023年12月31日）进行了系统检索。纳入了关于rTMS改善脑卒中患者下肢运动功能的随机对照试验（RCTs）或交叉RCTs。两位作者独立完成了文献筛选、数据提取和质量评估。使用RevMan（版本5.4）和Stata（版本17.0）对数据进行了分析。结果：共有38项研究，涉及2022名患者，符合NMA的要求。干预措施包括HFrTMS-M1、LFrTMS-M1、iTBS-Cerebellum、iTBS-M1、dTMS-M1和安慰剂。NMA结果显示，在FMA-LE和速度方面，LFrTMS-M1位列第一，而在BBS、TUGT和MEP振幅方面，HFrTMS-M1排名第一。FMA-LE的亚组分析显示，对于脑卒中后时间超过1个月的患者，HFrTMS-M1是最佳的刺激方案，而对于脑卒中后时间不超过1个月的患者，LFrTMS-M1是最佳的刺激方案。结论：考虑到脑卒中阶段对下肢运动功能的影响，当前的研究证据表明，对于脑卒中后时间超过1个月的患者，HFrTMS-M1可能是首选的刺激方案，而对于脑卒中后时间不超过1个月的患者，LFrTMS-M1则是更佳的选择。然而，上述结论需要通过更多高质量RCTs的进一步分析和验证。系统评价注册：www.crd.york.ac.uk/prospero/，标识符（CRD42023474215）。