间歇性θ脉冲刺激改善脑卒中患者下肢运动和平衡功能的Meta分析

doi:10.3969/j.issn.1006-9771.2026.06.002

Abstract

Abstract:

Objective To systematically evaluate the effect of intermittent theta burst stimulation(iTBS)on lower extremity motor function and balance function in patients with stroke.
Methods A systematic literature search was conducted in the Cochrane Library, Embase, PubMed, Web of Science, CNKI, SinoMed, Wanfang data and VIP from inception to February 19, 2025. Randomized controlled trials comparing iTBS with conventional rehabilitation or sham iTBS in patients with post-stroke lower extremity motor and balance dysfunction were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan 5.4 and Stata 14.0.
Results A total of 16 articles involving 647 patients were included. Meta-analysis showed that iTBS improved the Fugl-Meyer Assessment-Lower Extremities score(MD=2.58, 95%CI 1.61 to 3.55, P<0.001), Berg Balance Scale score(MD=4.11, 95%CI 2.43 to 5.79, P<0.001), Barthel Index score(MD=4.95, 95%CI 0.97 to 8.92, P=0.010)and motor-evoked potential(MEP)latency(MD=-1.42, 95%CI -2.54 to -0.30, P=0.010). Subgroup analyses suggested that at subacute stage, cerebellar iTBS, more than ten treatment sessions, and 1 200 pulses per day may be more effective.
Conclusion iTBS may improve lower extremity motor function and activities of daily living in patients with stroke, and shorten MEP latency, and it may also confer potential benefits in improving balance function in these patients.

Key words: stroke, intermittent theta burst stimulation, lower extremity, motor function, balance, rehabilitation, meta-analysis

CLC Number:

R743.3

LI Xinyuan, ZHENG Jiejiao, ZHANG Tingyu, WU Xuejiao, LIANG Xiaoxiao. Effect of intermittent theta burst stimulation on lower extremity motor function and balance function in stroke patients: a meta-analysis[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(6): 631-644.

Figures/Tables 12

Table 1

Figure 1

Figure 2

Figure 3

Table 2

Basic characteristics of included literatures"

作者	患者资料			干预措施	治疗参数			治疗周期	结局指标
作者	n	年龄/岁	性别 (男/女)/n	干预措施	刺激部位	刺激强度和脉冲数	线圈类型	治疗周期	结局指标
Lin等^[12](2019)	C:10 T1:10	C:61.1±9.7 T1:60.8±8.1	C:8/2 T1:9/1	C：假刺激+常规治疗 T1：iTBS+常规治疗	M1	100%RMT；每天2400次脉冲	“8”字形线圈	每周2次，共5周	①②③④⑤
Koch等^[13](2019)	C:17 T1:17	C:65±12 T1:63±11	C:10/7 T1:11/6	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%AMT；每天1200次脉冲	“8”字形线圈	每周5次，共3周，3周后随访	②③
孔晴等^[15](2024)	C:15 T1:15	C:62.87±8.91 T1:59.60±8.85	C:9/6 T1:10/5	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%RMT；每天600次脉冲	“8”字形线圈	每周5次，共3周	①②⑥
Liao等^[16](2024)	C:12 T1:12 T2:12	C:57.08±11.28 T1:57.17±11.63 T2:58.25±14.63	C:10/2 T1:7/5 T2:9/3	C：假刺激+常规治疗 T1：iTBS+常规治疗 T2：iTBS+常规治疗	小脑/M1 小脑 M1	80%AMT；每天1200次脉冲	“8”字形线圈	每周5次，共3周，3周后随访	①②③
Zhu等^[17](2024)	C:18 T1:18	C:62.3±8.78 T1:58.6±7.24	C:13/5 T1:14/4	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%AMT；每天1200次脉冲	“8”字形线圈	每周5次，共2周	①②③④
孔晴等^[19](2023)	C:12 T1:12	C:61.25±9.00 T1:59.83±9.66	C:9/3 T1:7/5	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%RMT；每天600次脉冲	“8”字形线圈	每周5次，共3周	①②
张佳佳等^[20] (2024)	C:47 T1:49	C:58.51±6.27 T1:59.37±7.19	C:26/21 T1:27/22	C：常规治疗+感觉整合训练 T1：iTBS+常规治疗+感觉整合训练	小脑	110%RMT；每天2400次脉冲	“8”字形线圈	每周6次，共6周	①③⑥
Liao等^[21](2021)	C:15 T1:15	C:55.4±8.1 T1:51.5±9.22	C:9/6 T1:12/3	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%AMT；每天600次脉冲	“8”字形线圈	每周5次，共2周	①②③
Xie等^[22](2021)	C:18 T1:18	C:54.4±7.01 T1:52.3±8.62	C:11/7 T1:13/5	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%AMT；每天600次脉冲	“8”字形线圈	每周5次，共2周	①④⑤⑥
孙思杰等^[23](2024)	C:21 T1:21 T2:21	C:50.20±16.16 T1:50.81±13.77 T2:54.86±12.08	C:19/2 T1:19/2 T2:19/2	C：假刺激+常规治疗 T1：iTBS+常规治疗 T2：iTBS+常规治疗	小脑/M1 小脑+M1 小脑	80%AMT；每天600次脉冲	锥形线圈	每周5次，共3周	①②
彭瑾等^[24](2025)	C:21 T1:21	C:60.52±9.09 T1:60.33±8.40	C:15/6 T1:14/7	C：常规治疗 T1：iTBS+常规治疗	小脑蚓部	- 每天1200次脉冲	“8”字形线圈	每周6次，共2周	①②
王佳等^[25](2023)	C:18 T1:18	C:53.44±16.60 T1:54.83±12.57	C:12/6 T1:13/5	C：假刺激+常规治疗 T1：iTBS+常规治疗	M1	70%RMT；每天1200次脉冲	锥形线圈	每周6次，共3周	①②⑥
王淑睿等^[26](2022)	C:21 T1:21	C:54.62±7.85 T1:52.62±8.61	C:9/12 T1:11/10	C：常规治疗+悬吊训练 T1：iTBS+常规治疗+悬吊训练	小脑	80%AMT；每天1200次脉冲	“8”字形线圈	每周5次，共4周	①②③⑥
邓罗义等^[27](2024)	C:25 T1:25	C:48.28±16.77 T1:52.64±13.04	C:20/5 T1:14/11	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%RMT；每天600次脉冲	“8”字形线圈	每周5次，共3周	①②
陈静等^[28](2023)	C:16 T1:16	C:62.38±12.66 T1:58.88±15.79	C:9/7 T1:11/5	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	80%RMT；每天600次脉冲	“8”字形线圈	每周5次，共3周，3周后随访	①②③⑤
毛佳宁等^[29] (2024)	C:20 T1:20	C:60.75±13.84 T1:59.82±10.40	C:12/8 T1:14/6	C：假刺激+常规治疗 T1：iTBS+常规治疗	小脑	- 每天1200次脉冲	“8”字形线圈	每周5次，共2周	②

Table 2

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Figure 5

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结局	纳入研究数/n	样本量/n	异质性检验结果		效应模型	Meta分析结果
结局	纳入研究数/n	样本量/n	P值	I²	效应模型	MD(95%CI)	P值
FMA-LE^{[12,15-17,19-28]}	14	573	0.003	58%	随机	2.58(1.61~3.55)	<0.001
FMA-LE随访^[16,28]	2	68	0.002	90%	随机	0.04(-1.53~1.61)	0.960
BBS^{[12-13,15-17,19,21,23-29]}	14	515	<0.001	67%	随机	4.11(2.43~5.79)	<0.001
BBS随访^[13,16,28]	3	102	0.58	0%	固定	6.43(2.97~9.90)	<0.001
BI^{[12-13,16-17,20-21,26,28]}	8	320	<0.001	75%	随机	4.95(0.97~8.92)	0.010
BI随访^[13,16,28]	3	102	0.730	0%	固定	7.79(2.19~13.39)	0.006
TUGT^[12,17,22]	3	92	0.580	0%	固定	-0.93(-4.56~2.70)	0.620
10MWT^[12,22,28]	3	88	0.530	0%	固定	-0.72(-3.28~1.84)	0.580
MEP潜伏期^{[15,20,22,25-26]}	5	240	0.001	78%	随机	-1.42(-2.54~-0.30)	0.010

亚组		纳入研究数/n	异质性检验结果		效应模型	亚组分析结果
亚组		纳入研究数/n	P值	I²	效应模型	MD(95%CI)	P值
治疗时机		9	0.005	64%	随机	2.29(1.51~3.07)	<0.001
	亚急性期	8	0.310	15%		3.29(2.35~4.23)	<0.001
	慢性期	1	-	-		0.10(-1.29~1.49)	0.890
刺激靶点		16	0.002	58%	随机	2.67(1.68~3.67)	<0.001
	小脑	10	0.080	41%		2.51(1.43~3.59)	<0.001
	M1	4	0.006	76%		2.67(-0.61~5.94)	0.110
	小脑+M1	1	-	-		4.81(1.74~7.88)	0.002
	小脑蚓	1	-	-		3.29(1.74~4.84)	<0.001
治疗次数		14	0.003	58%	随机	2.58(1.61~3.55)	<0.001
	≤ 10次	4	0.460	0%		0.55(-0.61~1.71)	0.350
	>10次	10	0.050	46%		3.06(2.10~4.03)	<0.001
单日脉冲数		14	0.003	58%	随机	2.58(1.61~3.55)	<0.001
	600次	8	0.270	20%		2.12(1.18~3.07)	<0.001
	1 200次	4	0.220	32%		4.17(2.46~5.88)	<0.001
	2 400次	2	0.002	89%		1.85(-1.68~5.38)	0.300

亚组		纳入研究数/n	异质性检验结果		效应模型	亚组分析结果
亚组		纳入研究数/n	P值	I²	效应模型	MD（95% CI)	P值
治疗时机		10	<0.001	77%	随机	6.21(3.39~9.02)	<0.001
	亚急性	8	0.002	70%		7.31(3.92~10.70)	<0.001
	慢性	2	0.410	0%		0.79(-1.45~3.02)	0.490
刺激靶点		16	<0.001	62%	随机	4.13(2.49~5.76)	<0.001
	小脑	10	0.004	63%		4.34(2.16~6.52)	<0.001
	M1	4	0.008	75%		5.64(-0.57~11.85)	0.080
	小脑+M1	1	-	-		8.51(2.51~14.51)	0.030
	小脑蚓	1	-	-		2.24(0.63~3.85)	<0.001
治疗次数		14	<0.001	67%	随机	4.11(2.43~5.79)	<0.001
	≤ 10次	4	<0.001	85%		3.77(-0.76~8.30)	0.100
	>10次	10	0.040	48%		3.76(2.09~5.42)	<0.001
单日脉冲数		14	<0.001	67%	随机	4.11(2.43~5.79)	<0.001
	600次	7	0.510	0%		2.35(1.27~3.43)	<0.001
	1 200次	6	<0.001	79%		6.94(2.91~10.97)	<0.001
	2 400次	1	-	-		0.60(-1.68~2.88)	0.610

	亚组	纳入研究数/n	异质性检验结果		效应模型	亚组分析结果
	亚组	纳入研究数/n	P值	I²	效应模型	MD(95%CI)	P值
治疗时机		5	0.050	57%	随机	3.31(-1.66~8.28)	0.190
	亚急性	3	0.410	0%		5.48(0.92~10.04)	0.020
	慢性	2	0.400	0%		-1.38(-3.74~0.99)	0.250
刺激靶点		9	<0.001	72%	随机	4.97(1.08~8.86)	0.010
	小脑	7	0.890	0%		6.24(4.39~8.09)	<0.001
	M1	2	0.160	49%		2.05(-9.97~14.06)	0.740
治疗次数		8	<0.001	75%	随机	4.95(0.97~8.92)	0.010
	≤ 10次	3	0.020	76%		4.16(-3.82~12.13)	0.310
	>10次	5	0.710	0%		6.10(4.18~8.02)	<0.001
单日脉冲数		8	<0.001	75%	随机	4.95(0.97~8.92)	0.010
	600次	3	0.450	0%		5.28(1.24~9.32)	0.010
	1 200次	3	0.830	0%		8.79(1.60~15.98)	0.020
	2 400次	2	<0.001	96%		2.45(-5.26~10.15)	0.530

Effect of intermittent theta burst stimulation on lower extremity motor function and balance function in stroke patients: a meta-analysis

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