Objective: The aim of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on the post-stroke recovery of lower limb motor function. Data sources: We searched the databases of PubMed, Cochrane Library, and Embase. The randomized controlled trials were published by 25 January 2019. Review methods: We included randomized controlled trials that evaluated the effects of rTMS on lower limb motor recovery in patients with stroke. Two reviewers independently screened the searched records, extracted data, and assessed the risk of bias. The treatment effect sizes were pooled in a meta-analysis by using the RevMan 5.3 software. The internal validity was assessed using topics suggested by the Physiotherapy Evidence Database (PEDro). Results: Eight studies with 169 participants were included in the meta-analysis. Pooled estimates demonstrated that rTMS significantly improved the body function of the lower limbs (standardized mean difference (SMD) = 0.66; P < 0.01), lower limb activity (SMD = 0.66; P < 0.01), and motor-evoked potential (SMD = 1.13; P < 0.01). The subgroup analyses results also revealed that rTMS improved walking speed (SMD = 1.13) and lower limb scores on the Fugl-Meyer Assessment scale (SMD = 0.63). We found no significant differences between the groups in different mean post-stroke time or stimulation mode over lower limb motor recovery. Only one study reported mild adverse effects. Conclusion: rTMS may have short-term therapeutic effects on the lower limbs of patients with stroke. Furthermore, the application of rTMS is safe. However, this evidence is limited by a potential risk of bias.

Background Stroke can lead to movement disorders that affect interlimb coordination control of the bilateral upper extremities, especially the hands. However, few studies have investigated the influence of a stroke on bimanual force coordination control between the hands using a quantitative measurement tool, or the relationship of force coordination with paretic upper extremity motor and functional performance. We aimed to investigate these outcomes using a novel measurement device, and analyze the relationship of bimanual force coordination control deficits in both hands with motor and functional performances of the paretic upper extremity in stroke patients. Methods Sixteen healthy adults and 22 stroke patients were enrolled. A novel bilateral hand grip measurement device with two embedded dynamometers was used to evaluate the grip force during a bilateral hand grip-force coordination control task. The alternating time and force applied for coordination with the grip force of both hands were calculated to analyze control of bimanual grip force coordination. Motor and functional measurements included the upper-extremity portion of the Fugl-Meyer assessment (FMA-UE), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), and Barthel Index (BI). Results Compared with the healthy group, the alternating time from the non-paretic to the paretic hand was 27.6% shorter for stroke patients ( p < 0.001). The grip force generated for coordination in the healthy group was significantly greater (30–59%) than that of the stroke group ( p < 0.05), and the coefficients of variation of alternating time ( p = 0.001) and force applied ( p = 0.002) were significantly higher in the stroke group than the healthy group. The alternating time from the paretic to the non-paretic hand showed moderately significant correlations with the FMA-UE ( r = − 0.533; p = 0.011), the WMFT ( r = − 0.450; p = 0.036), and the BI ( r = − 0.497; p = 0.019). Conclusions Stroke results in a decline in bimanual grip force generation and increases the alternating time for coordinating the two hands. A shorter alternating time is moderately to highly associated with enhanced motor and functional performances.