The effects of repetitive peripheral magnetic stimulation combined with repetitive transcranial magnetic stimulation on lower limb motor function and balance in patients with chronic stroke: A pilot randomized controlled trial

Abstract Background In the chronic phase of stroke, repetitive transcranial magnetic stimulation (rTMS) exhibits limited effectiveness in improving motor recovery due to reduced brain plasticity. Patients with chronic stroke also typically present with lower limb motor dysfunction and disability. Recent studies suggest that repetitive peripheral magnetic stimulation (rPMS) can promote brain plasticity and potentially offer additional improvement in patients with chronic stroke. Objective To investigate whether combining a designed rPMS program with rTMS could further improve lower limb motor function, mobility, and balance function in patients with chronic stroke. Design Two‐arm randomized controlled trial. Setting Inpatient clinic. Participants 20 patients with chronic stroke with lower limb hemiparesis were recruited. Interventions One group received ipsilateral rTMS, and the other received rTMS and rPMS designed based on the lower limb myofascial chain and neural pathways. Main Outcome Measures The primary outcome measure was the lower extremity motor section of the Fugl‐Meyer Assessment (FMA‐LE), evaluating lower limb motor function. Secondary outcomes included the timed up and go test (TUG), the 10‐meter walking test (10MWT), the 6‐minute walking test (6MWT), Berg balance scale (BBS), and parameters measured by the balance training and evaluation system (Rx, mediolateral sway; Ry, anteroposterior sway; and RecArea, total sway area). All outcome assessments were conducted at baseline, 2 weeks post intervention, and 4 weeks post intervention. Two‐way repeated measures analysis of variance (ANOVA) was then performed to analyze any group differences over time. Results Two‐way ANOVA revealed a significant interaction effect between time and group for FMA‐LE ( p = .001), 6MWT ( p < .001), TUG ( p = .015), BBS ( p = .046), Rx ( p = .008), Ry ( p = .009), and RecArea ( p < .001). Effect size (the value of partial ɳ 2 ) of FMA‐LE was 0.40. Conclusions This study provides evidence that combining rTMS with rPMS may be a more practical approach for improving lower limb motor function, ambulation, and balance in patients with chronic stroke compared to rTMS alone.