NONINVASIVE BRAIN STIMULATION TECHNIQUES FOR SPASTICITY AND UPPER LIMB MOTOR FUNCTION IN STROKE PATIENTS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Research Objective: The objective of this study was to compare the efficacy of various Noninvasive Brain Stimulation (NIBS) techniques in improving upper limb motor recovery and reducing spasticity among individuals with stroke. A systematic evaluation and Network Meta-Analysis (NMA) were conducted to provide evidence-based support for clinical rehabilitation. Research Design: A literature search was conducted using the PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases, up to March 2025. The study was carried out using meta-analysis and NMA, with data analysis performed using R version 4.3.1 and RevMan 5.4. This research complied with the Preferred Reporting Items for Systematic Reviews and Network Meta-Analyses (PRISMA) standards and underwent registration in PROSPERO (registration number: CRD42025638691). Findings: Fourteen randomized controlled trials (RCTs) incorporating 467 stroke subjects were selected for the analysis. The meta-analysis indicated that tDCS combined with RP was the most effective in improving FMA-UE scores (Standardized Mean Difference [SMD][Formula: see text] [Formula: see text] [Formula: see text]0.74, 95% Confidence Interval [CI][Formula: see text] [Formula: see text] [Formula: see text]0.22, 1.26; [Formula: see text]), while iTBS combined with OT showed the greatest improvement in ARAT scores ([Formula: see text], 95% [Formula: see text], 0.79; [Formula: see text]). Additionally, rTMS combined with RP demonstrated significant efficacy in reducing spasticity (MAS score) ([Formula: see text], 95% [Formula: see text], −0.74; [Formula: see text]). NMA further revealed that tDCS combined with rehabilitation training and iTBS combined with OT were more effective in enhancing motor function, whereas rTMS combined with RP was most effective in spasticity relief. Conclusions: NIBS technology has shown significant efficacy in stroke rehabilitation, particularly in the recovery of upper limb motor function and spasticity relief. The combination of tDCS with rehabilitation training, iTBS with OT, and rTMS with RP, through various protocols, can be tailored to meet individual rehabilitation goals. Future studies should focus on optimizing NIBS intervention protocols and investigating their underlying biological mechanisms, in conjunction with neuroimaging and other techniques, to facilitate more precise clinical applications.