Effect of low-frequency repetitive transcranial magnetic stimulation combined with abdominal acupuncture on lower limb motor function and balance in post-stroke hemiplegia: a randomized controlled trial.

BACKGROUND: Post-stroke hemiplegia frequently results in lower limb motor dysfunction and impaired balance, leading to reduced independence in activities of daily living. Repetitive transcranial magnetic stimulation (rTMS) and abdominal acupuncture (AA) are both used in rehabilitation, but evidence on their combined effect remains limited. This study evaluated the efficacy and safety of low-frequency rTMS combined with AA in patients with post-stroke hemiplegia. METHODS: In this assessor-blind randomized controlled trial, 108 patients with post-stroke hemiplegia and lower limb dysfunction were randomly assigned (1:1:1) to a control group (conventional rehabilitation), an AA group (rehabilitation plus abdominal acupuncture), or a combined group (rehabilitation plus AA and low-frequency rTMS). All interventions were administered for 8 weeks. Outcomes were assessed at baseline, 4 weeks, and 8 weeks. The primary outcomes included lower limb motor function measured by the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), balance assessed by the Berg Balance Scale (BBS), and activities of daily living evaluated using the Modified Barthel Index (MBI). Adverse events were recorded to assess safety. RESULTS: All groups showed significant improvement in FMA-LE, BBS, and MBI scores at 4 and 8 weeks compared with baseline (all p < 0.05). The combined group demonstrated significantly greater improvements than both the AA and control groups at each post-treatment time point (p < 0.05), while the AA group also showed superior outcomes compared with the control group (p < 0.05). At 8 weeks, the combined group achieved the highest scores across all outcomes. No serious adverse events were recorded during the trial, while several mild transient adverse events were observed in a small proportion of participants. And the incidence of mild adverse events did not differ significantly among groups (p > 0.05). CONCLUSION: Low-frequency rTMS combined with abdominal acupuncture significantly improves lower limb motor function, balance, and activities of daily living in patients with post-stroke hemiplegia, with a favorable safety profile. This combined approach may offer an effective strategy for enhancing rehabilitation outcomes. CLINICAL TRIAL REGISTRATION: https://itmctr.ccebtcm.org.cn, identifer ITMCTR2026001195.