Effects of Intermittent Theta Burst Stimulation on Motor, Gait, and Functional Outcomes in Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

To evaluate the effects of intermittent theta burst stimulation (iTBS) on motor function, gait, pain level, sensory function, independence, and spasticity in individuals with spinal cord injury (SCI). Five databases (PubMed, Cochrane Library, EMBASE, Web of Science, and ClinicalTrials.gov) were searched from inception to February 2025. Two reviewers independently identified the relevant articles. The included studies were randomized control trials (RCTs) evaluating iTBS in individuals with SCI. Two reviewers independently extracted data, including author, publication year, sample size, mean age, interventions, follow-up period, and statistical measures. The risk of bias was assessed by RoB 2.0. Any disagreement was resolved with a senior reviewer. A total of six RCTs involving 116 patients were included. Compared with sham iTBS, iTBS showed significant improvements in Lower Extremity Motor Score (LEMS) (mean difference [MD]: 7.13, 95% confidence interval [CI]: 0.71 to 13.56, p = 0.03), step length (MD: 7.99, 95% CI: 5.45 to 10.53, p < 0.001), pain measures (standardized MD [SMD]: 2.77, 95% CI: 0.05 to 5.5, p = 0.05), Spinal Cord Independence Measure (SCIM) (MD: 15.42, 95% CI: 6.72 to 24.13, p < 0.001), and Modified Ashworth Scale (MAS) (MD: -2.89, 95% CI: -5.76 to -0.02, p = 0.05). However, no significant differences were observed in Upper Extremity Motor Score (UEMS) (MD: -5.83, 95% CI: -12.44 to 0.78, p = 0.08), walking speed (MD: 0.03, 95% CI: -0.0 to 0.07, p = 0.08), or Extremity Sensory Score (ESS) (SMD: 0.13, 95% CI: -0.43 to 0.7, p = 0.64). iTBS may offer beneficial effects on lower-limb motor function, step length, pain, functional independence, and spasticity in patients with SCI. However, no improvements were observed in walking speed or sensory function. Further trials are needed to validate the efficacy of iTBS.