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

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. 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. 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 (≤3days after last intervention session) and long-term (≥1month 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 3000 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. 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.