Non-Invasive Neuromodulation for Post-Stroke Anxiety Symptoms: An Umbrella Review and Evidence Mapping of Systematic Reviews and Meta-Analyses

Post-stroke anxiety can impair rehabilitation, participation, and quality of life. This umbrella review mapped systematic reviews on non-invasive neuromodulation for anxiety symptoms after stroke. PubMed, Web of Science, the Cochrane Library, and Embase were searched from inception through June 1, 2026. Published reviews with quantitative anxiety results were eligible, including reviews in which anxiety was secondary to pain, sleep disturbance, or depression. Reporting completeness, methodological quality, and certainty of evidence were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. Seven reviews were mapped, comprising six pairwise meta-analyses and one Bayesian network meta-analysis. Selected estimates suggested symptom improvement, whereas others showed no clear difference. All reviews had low or critically low methodological quality. Interpretation was limited by overlapping trials, small outcome-specific sample sizes, heterogeneous interventions, and inconsistencies across source reports. Anxiety-score changes in populations recruited for other post-stroke conditions do not establish a direct effect on clinically defined post-stroke anxiety. Source-level population eligibility and certainty judgments require particular scrutiny when mixed neurological populations contribute to pooled estimates. Non-invasive neuromodulation remains investigational for post-stroke anxiety. Current evidence does not support routine use of a specific protocol or replacement of standard multidisciplinary stroke care. Future trials should prospectively define anxiety, standardize stimulation and sham procedures, and assess sustained benefit and safety.