The Effects of Repetitive Transcranial Magnetic Stimulation on Standing Balance and Walking in Older Adults with Age-related Neurological Disorders: A Systematic Review and Meta-analysis

Abstract

Abstract Background Considerable evidence showed that repetitive transcranial magnetic stimulation (rTMS) can improve standing balance and walking performance in older adults with age-related neurological disorders. We here thus completed a systematic review and meta-analysis to quantitatively examine such benefits of rTMS. Methods A search strategy based on the PICOS principle was used to obtain the literature in 4 databases. The screening and assessments of quality and risk of bias in the included studies were independently completed by 2 researchers. Outcomes included scales related to standing balance, Timed Up and Go (TUG) time, and walking speed/time/distance. Results Twenty-three studies consisting of 532 participants were included, and the meta-analysis was completed on 21 of these studies. The study quality was good. Compared to control, rTMS induced both short-term (≤3 days after last intervention session) and long-term (≥1 month following last intervention session) significant improvements in balance scales (eg, Berg Balance Scale), TUG time, and walking speed/time/distance (short-term: standardized mean difference [SMD] = 0.26–0.34, 95% confidence interval [CI] = 0.05–0.62; long-term: SMD = 0.40–0.47, 95% CI = 0.04–0.79) for both PD and stroke cohorts. Subgroup analyses suggested that greater than 9 sessions of high-frequency rTMS targeting primary motor cortex with greater than 3 000 pulses/wk can maximize such benefits. Only a few mild-to-moderate adverse events/side effects were reported, which were similar between rTMS and control group. Conclusion The results suggest that rTMS holds promise to improve balance and walking performance in older adults with age-related neurological disorders. Future studies with more rigorous design are needed to confirm the observations in this work.