Combined repetitive transcranial magnetic stimulation and mirror therapy for upper limb rehabilitation in stroke survivors: A systematic review and meta-analysis.
Across seven randomized trials, combining rTMS with mirror therapy was associated with better upper-limb motor and dexterity scores after stroke. The evidence is promising, but it does not identify a best stimulation or therapy protocol.
Alashram AR.
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · Publication date: 2026-09-29
Added to site: 2026-09-30
DOI: 10.1007/s10072-026-09437-y
Electronic publication date verified in Europe PMC and Crossref. This source date is separate from the site's addition date.
- Modalities
- rTMS, TMS
- Clinical focus
- Stroke rehabilitation, Upper-limb function, Mirror therapy
- Population
- Stroke survivors with upper-limb impairment
- Sample
- 7 randomized controlled trials with 402 participants
- Intervention / method
- Combined repetitive transcranial magnetic stimulation and mirror therapy; treatment parameters varied across the included trials
- Comparator
- Control conditions used by the included randomized trials; the exact comparator mix was not available in the checked abstract
Clinician summary
Pooled effects favored combined rTMS and mirror therapy for FMA-UE (SMD 0.92, 95% CI 0.43 to 1.41) and Box and Block Test performance (SMD 1.09, 95% CI 0.49 to 1.68). The authors also reported improvements across several grip, function, impairment and tone measures.
How to interpret the findings
Only seven trials were available. The abstract urges caution, does not provide outcome-specific heterogeneity, GRADE certainty, adverse-event synthesis or the comparator mix, and states that optimal treatment parameters remain unclear.
Equipment and disclosures
The included trials used rTMS and mirror-therapy protocols, but coil models, targeting methods and mirror-therapy equipment were not available in the checked abstract.
Funding and competing-interest statements were not available in the authoritative indexed abstract checked for this summary.
Related evidence
Compare findings from the same clinical area, including mixed results.
- Efficacy of combined repetitive transcranial magnetic stimulation and occupational therapy in spinal cord injury patients: a randomized controlled clinical study. · Mixed
- EEG Biomarkers During Upper-Limb Action Observation Therapy for Stroke Rehabilitation: A Scoping Review. · Positive with limitations
- TMS-Derived Neurophysiological Measures of Corticospinal Excitability, Intracortical Excitability, and Interhemispheric Interactions Associated With Post-Stroke Motor Recovery: A Systematic Review. · Positive with limitations
Summary prepared with AI assistance. Source verification does not imply an independent replication or a clinician's endorsement. Read our review method.