Four Comparative Effectiveness of Rehabilitation Methods Combined With rTMS on Cognition, Mood, and Quality of Life in Stroke Patients.

Abstract

To conduct systematic review and network meta-analysis to evaluate the effectiveness of combining repetitive transcranial magnetic stimulation (rTMS) with various rehabilitation methods in improving cognitive function, negative mood, and quality of life in stroke patients. A systematic search was conducted across six databases to identify relevant studies. The time frame of the search was from January 1980 to September 2024. A total of 21 randomized controlled trials involving 1074 stroke patients were included in the analysis based on predefined eligibility criteria. Outcome indicators assessed included cognitive function, negative mood, and quality of life. Data were extracted and analyzed using Stata for net meta-analysis to evaluate the relative effectiveness of each combined intervention. Registration number: CRD42024603130. The results indicated that speech rehabilitation (SR) combined with rTMS was the most effective in improving cognitive function (SMD=0.40; 95% CI, -0.08 to 0.87; SUCRA=95.1%). Cognitive rehabilitation (CR) combined with rTMS was found to be the most effective in reducing negative mood (SMD=0.91; 95% CI, 0.45-3.23; SUCRA=84.5%) and improving quality of life (SMD=0.49; 95% CI, -0.33 to 1.30; SUCRA=99.4%). The combination of SR with rTMS is effective for enhancing cognitive function, whereas CR with rTMS is superior in alleviating negative emotions and improving quality of life. These findings suggest prioritizing these combined interventions in clinical rehabilitation settings.