Acupuncture combined with repetitive transcranial magnetic stimulation vs repetitive transcranial magnetic stimulation alone for recovery of hemiparesis after ischemic stroke: A systematic review and meta-analysis.

OBJECTIVE: To compare the efficacy and safety of acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) versus rTMS alone for recovery of limb motor function in patients with post-ischemic stroke hemiparesis. METHODS: Eight databases were searched up to September 25, 2025, for randomised controlled trials comparing the combination therapy with rTMS alone. The primary outcome was recovery of motor function, assessed by the Fugl-Meyer Assessment (FMA) total, upper-extremity, and lower-extremity scores. Secondary outcomes included activities of daily living, assessed by the Barthel Index. A random‑effects model was used for meta‑analyses. This review was prospectively registered with PROSPERO (CRD420251155831). RESULTS: Thirty trials (3,261 patients) were included. Combination therapy significantly improved FMA total score (7 trials, n = 673; mean difference [MD] 7.11, 95% CI 5.51-8.70; I2 = 48.3%), FMA upper-extremity score (14 trials, n = 1,358; MD 8.21, 7.68-8.75; I2 = 0%), FMA lower-extremity score (14 trials, n = 1,489; MD 5.06, 4.42-5.71; I2 = 71.3%), and Barthel Index (13 trials, n = 1,203; MD 8.54, 7.61-9.47; I2 = 38.6%). Sensitivity analyses confirmed robustness. In the small number of trials that reported adverse events, these were mild and infrequent. CONCLUSION: Acupuncture combined with rTMS produced clinically meaningful improvements in upper-extremity motor function and activities of daily living, with lower-extremity gains that exceeded measurement error but require further validation. No obvious safety risk signals were identified. These findings provide moderate-certainty evidence to support its consideration as an adjunctive therapy in post-stroke rehabilitation.