Repetitive Transcranial Magnetic Stimulation for Post-Stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis

Repetitive Transcranial Magnetic Stimulation for Post-Stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Repetitive Transcranial Magnetic Stimulation for Post-Stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis Mei Xue, Zhen Wang, Jia-Jia Yun, Ya-lei Li, Yu Yang, Xiao-Han Yang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8144851/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background The rehabilitative management of post-stroke shoulder-hand syndrome (SHS) is a complex clinical challenge. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has been widely used to enhance neurological recovery after stroke. However, its therapeutic value in SHS remains unclear, and strong evidence-based support is still lacking. This study aims to systematically evaluate the rehabilitative efficacy of rTMS for post-stroke SHS, in order to inform clinical practice with scientific evidence. Methods Using a combination of medical subject headings and free-text terms, we conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, CSTJ, and SinoMed to identify randomized controlled trials (RCTs) up to July 24, 2025. The Cochrane RoB-I tool was used to assess risk of bias, and statistical analysis was performed with Review Manager 5.4.1. Result A total of 12 RCTs involving 885 patients were included. Meta-analysis indicated that, compared to controls, rTMS produced significantly greater improvements in pain, edema, activities of daily living (ADL), and upper extremity motor function in post-stroke SHS patients. Subgroup analysis showed that at 30 days post-intervention, improvements in ADL ability and upper limb function were greater than those observed at 14 days post-intervention. Additionally, subgroup analysis suggested that an rTMS intervention frequency of 3 Hz produced the greatest improvement in patient symptoms. Conclusion rTMS has a positive effect on alleviating pain and edema and improving ADL and upper limb motor function in post-stroke SHS patients, and these benefits are optimal with longer-duration rTMS at 3Hz. System overview registration ID: CRD420251135339 Repetitive transcranial magnetic stimulation Stroke Shoulder hand syndrome Meta-analysis Systematic review Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Full Text Additional Declarations No competing interests reported. Table 1 is available in the Supplementary Files section. Supplementary Files Table1.docx Table 1 Characteristics of the randomized controlled studies. SupplementaryAttachment1.docx Supplementary Attachment 1 Search strategy terms. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 13 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviews received at journal 25 Feb, 2026 Reviewers agreed at journal 22 Feb, 2026 Reviewers agreed at journal 22 Feb, 2026 Reviews received at journal 21 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviews received at journal 16 Dec, 2025 Reviewers agreed at journal 15 Dec, 2025 Reviewers agreed at journal 13 Dec, 2025 Reviewers invited by journal 11 Dec, 2025 Editor assigned by journal 25 Nov, 2025 Submission checks completed at journal 25 Nov, 2025 First submitted to journal 18 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8144851","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":561285485,"identity":"ba872dc3-32dc-431c-b8b8-af8c83893d60","order_by":0,"name":"Mei Xue","email":"","orcid":"","institution":"Yuhuangding Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mei","middleName":"","lastName":"Xue","suffix":""},{"id":561285489,"identity":"973ab147-914d-4729-869c-cb31f633113b","order_by":1,"name":"Zhen Wang","email":"","orcid":"","institution":"Shandong 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6","display":"","copyAsset":false,"role":"figure","size":6174366,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot analysis of subgroups for VAS(a), BI(b), FMA-UE(c)intervention with rTMS at different frequencies.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8144851/v1/d9054affa5247ba9faeb0d7b.jpg"},{"id":98747383,"identity":"bec42802-3252-4826-9973-d2d3922551b3","added_by":"auto","created_at":"2025-12-22 08:51:39","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":4237005,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot for Edema Score(a), SHSS(b).\u003c/p\u003e","description":"","filename":"Figure7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8144851/v1/481d728310189b7558d2e2bc.jpg"},{"id":98797870,"identity":"9ee300aa-4f3d-475f-8505-8d813e3400e2","added_by":"auto","created_at":"2025-12-22 13:59:17","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":26134398,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8144851/v1_covered_48a22960-7e07-478c-ad8b-fa389c0a73ac.pdf"},{"id":98747360,"identity":"a39a9b6b-1bf8-4b06-9fb1-417f630fbf5a","added_by":"auto","created_at":"2025-12-22 08:51:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21792,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTable 1 \u003c/strong\u003eCharacteristics of the randomized controlled studies.\u003c/p\u003e","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8144851/v1/d19ab01ff405a7e252e09d36.docx"},{"id":98777464,"identity":"96e1d146-601a-474a-91c3-ace018fa2b09","added_by":"auto","created_at":"2025-12-22 12:27:27","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16634,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary Attachment 1 \u003c/strong\u003eSearch strategy terms.\u003c/p\u003e","description":"","filename":"SupplementaryAttachment1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8144851/v1/ef863919ad9dd4b481f24f57.docx"}],"financialInterests":"\u003cp\u003eNo competing interests reported.\u003c/p\u003e\n\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e","formattedTitle":"Repetitive Transcranial Magnetic Stimulation for Post-Stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Repetitive transcranial magnetic stimulation, Stroke, Shoulder hand syndrome, Meta-analysis, Systematic review","lastPublishedDoi":"10.21203/rs.3.rs-8144851/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8144851/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe rehabilitative management of post-stroke shoulder-hand syndrome (SHS) is a complex clinical challenge. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has been widely used to enhance neurological recovery after stroke. However, its therapeutic value in SHS remains unclear, and strong evidence-based support is still lacking. This study aims to systematically evaluate the rehabilitative efficacy of rTMS for post-stroke SHS, in order to inform clinical practice with scientific evidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing a combination of medical subject headings and free-text terms, we conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, Wanfang, CNKI, CSTJ, and SinoMed to identify randomized controlled trials (RCTs) up to July 24, 2025. The Cochrane RoB-I tool was used to assess risk of bias, and statistical analysis was performed with Review Manager 5.4.1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 12 RCTs involving 885 patients were included. Meta-analysis indicated that, compared to controls, rTMS produced significantly greater improvements in pain, edema, activities of daily living (ADL), and upper extremity motor function in post-stroke SHS patients. Subgroup analysis showed that at 30 days post-intervention, improvements in ADL ability and upper limb function were greater than those observed at 14 days post-intervention. Additionally, subgroup analysis suggested that an rTMS intervention frequency of 3 Hz produced the greatest improvement in patient symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003erTMS has a positive effect on alleviating pain and edema and improving ADL and upper limb motor function in post-stroke SHS patients, and these benefits are optimal with longer-duration rTMS at 3Hz.\u003c/p\u003e\n\u003cp\u003eSystem overview registration ID: CRD420251135339\u003c/p\u003e","manuscriptTitle":"Repetitive Transcranial Magnetic Stimulation for Post-Stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 08:51:33","doi":"10.21203/rs.3.rs-8144851/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-13T18:08:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T20:51:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-26T00:41:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294138386029215528065411528846694909916","date":"2026-02-26T00:32:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-25T18:01:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176982027546144682861609061952853776001","date":"2026-02-22T15:12:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316319846565690601105067436012845271219","date":"2026-02-22T10:08:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-22T04:11:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"16119513635250318047468575349363927018","date":"2026-02-20T17:39:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339522620742926201319779161534761888896","date":"2026-02-20T17:35:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T15:51:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153915000688717123222272166903675282706","date":"2025-12-15T13:41:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84604039653634343105102862209530659983","date":"2025-12-13T18:26:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-11T17:52:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-25T17:28:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-25T17:27:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Medical Research","date":"2025-11-18T11:35:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-medical-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejmr","sideBox":"Learn more about [European Journal of Medical Research](http://eurjmedres.biomedcentral.com)","snPcode":"40001","submissionUrl":"https://submission.nature.com/new-submission/40001/3","title":"European Journal of Medical Research","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a4b8f9ee-cb04-44c9-b171-b11024733de2","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T00:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 08:51:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8144851","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8144851","identity":"rs-8144851","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}