Comparative efficacy of motor imagery augmented with central non-invasive brain stimulation versus peripheral electrical stimulation for upper extremity rehabilitation post-stroke: a systematic review and network meta-analysis.

The network included 13 trials and 9 intervention modalities, and the authors state that the number of participants and studies is relatively small. Most studies were single-blind, and 12 trials were rated as having some concerns and 2 trials were rated high risk. Only 5 studies reported follow-up outcomes or adverse events, and follow-up beyond 6 months was absent. The primary FMA network had high heterogeneity (I² = 85.3%), and the ARAT and MBI networks also had high heterogeneity. The included studies came mostly from China, so generalization to other settings is uncertain. Different motor imagery types were merged into one node, so the analysis cannot separate possible differences between kinesthetic and visual motor imagery. The network did not include high-frequency rTMS combined with motor imagery, so the review cannot compare that protocol with the tested low-frequency rTMS combination.

Funding was provided by multiple Chinese institutional programs, including Rehabilitation Clinical Medical Centre of Yunnan Province, Jiajie Expert Workstation of Yunnan Province, National Key Research and Development Program of China, and National Natural Science Foundation of China. No conflict-of-interest declaration is included in the supplied text.

Do not conclude that motor imagery plus low-frequency rTMS is the best upper limb treatment after stroke. It was an add-on to conventional rehabilitation, and the study cannot separate the contribution of motor imagery from low-frequency rTMS. Most other tested combinations did not show a significant difference.