Synergistic efficacy of repetitive peripheral magnetic stimulation on central intermittent theta burst stimulation for upper limb function in patients with chronic stroke: a double-blinded, randomized controlled trial

Abstract

Abstract Background: Non-invasive techniques such as central intermittent theta burst stimulation (iTBS) and repetitive peripheral magnetic stimulation (rPMS) have shown promise to improve motor function for stroke patients. However, the combined efficacy of rPMS and central iTBS has not been extensively studied. This randomized controlled trial aimed to investigate the synergistic effects of rPMS on central iTBS in patients with stroke. Method: In this study, 28 stroke patients were randomly allocated to receive either 1200 pulses of real or sham rPMS on the radial nerve of the affected limb, followed by 1200 pulses of central iTBS on the ipsilesional hemisphere. The patients received the intervention for 10 sessions over two weeks. The primary outcome measures were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and the Action Research Arm Test (ARAT). Secondary outcomes for activities and participation included the Functional Independence Measure-Self care (FIM-Self care) and the Stroke Impact Scale (SIS). The outcome measures were assessed before and after the intervention. Results: Both groups showed significant improvement in FMA-UE and FIM-Self care after the intervention, (p<0.05). Only the rPMS + iTBS group had significant improvement in ARAT-Grasp, SIS-Strength and SIS-ADL (p<0.05). However, the change scores in all outcome measures did not differ between two groups. Conclusions: Overall, the study's findings support that rPMS may have synergistic effects on central iTBS to improve grasp function and participation. In conclusion, these findings highlight the potential of rPMS as an adjuvant therapy for central iTBS in stroke rehabilitation. Further long-term studies are needed to fully investigate the synergistic effects of rPMS on central iTBS. Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT04265365, retrospectively registered, on February 11, 2020.