Non-invasive brain stimulation shows favorable tolerability and 94.9% completion rate for post-stroke upper limb rehabilitationBrain Stimulation Shows Good Safety for Post-Stroke Arm Recovery

Frontiers in Medicine Published September 10, 2026 DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Note that NIBS for post-stroke upper limb rehabilitation is well-tolerated with a 94.9% completion rate.

This systematic review and network meta-analysis evaluated the safety and completion rates of various non-invasive brain stimulation (NIBS) modalities, including rTMS, tDCS, iTBS, BL-rTMS, and Dual-tDCS, for patients with upper limb dysfunction after stroke. The analysis included 2,640 participants to assess treatment adherence and tolerability.

The study found a pooled intervention group completion rate of 94.9% (95% CI: 93.3-96.4%). While specific modalities showed varying SUCRA rankings for completion rates—iTBS (71.1%), BL-rTMS (60.9%), and Dual-tDCS (58.1%)—there were no statistically significant differences in completion rates between NIBS and sham/control groups. Safety data indicated a 16.4% adverse event rate (95% CI: 8.5-26.2%), consisting primarily of mild headache and skin tingling, with a low 1.1% rate of adverse event-related dropouts.

Limitations noted by the authors include the fact that four interventions were informed by only a single study and that absolute differences in completion rates were minimal. Furthermore, the authors state that SUCRA rankings should be considered hypothesis-generating rather than definitive. Clinically, NIBS demonstrates favorable tolerability and safety for upper limb rehabilitation, though it does not show statistically superior completion rates over sham controls.

How this fits prior evidence

This finding addresses a gap in the safety and tolerability profile of non-invasive brain stimulation (NIBS) for stroke recovery. While robotics-based interventions show stronger evidence for improving upper-limb motor function, this meta-analysis confirms that NIBS is a well-tolerated option with a 94.9% completion rate and a 16.4% adverse event rate. It provides specific safety data for NIBS modalities that complement the existing evidence for other stroke rehabilitation modalities like robotics and light therapy.

Researchers looked at how patients with upper limb issues after a stroke responded to various types of non-invasive brain stimulation (NIBS). This included methods like rTMS, tDCS, and iTBS. The study included a large group of 2,640 participants to see how well these treatments were tolerated over time.

The results showed that about 95% of patients completed the treatment programs. While some specific methods showed slightly different rankings in the data, there was no significant difference in completion rates between the active treatments and the sham (placebo) groups. This suggests that the procedures are generally well-tolerated by patients.

Safety was also a key focus. About 16.4% of participants reported side effects, but these were mostly mild, such as skin tingling or headaches. Only 1.1% of people had to stop treatment due to these issues. Because the evidence for some specific methods comes from only one study, these findings are currently used to help guide future research rather than making definitive claims about one specific method over another.

What this means for you:

Brain stimulation is generally safe and well-tolerated by patients recovering arm movement after a stroke.

Common questions

Is brain stimulation safe for stroke recovery?

Yes, the study found that these treatments have favorable tolerability. While 16.4% of participants reported side effects, these were mostly mild issues like skin tingling or headaches. Only 1.1% of patients had to stop their treatment because of these side effects.

What kind of side effects are common with these treatments?

The most common side effects reported in the study were mild headaches and skin tingling. These occurred in about 16.4% of the participants. The overall safety profile was considered favorable for patients with upper limb dysfunction after a stroke.

Are some types of brain stimulation better than others?

The study did not find a statistically significant difference in completion rates between the different types of brain stimulation and the sham groups. While some rankings were calculated, they are currently considered hypothesis-generating rather than definitive proof of one method being superior.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedSep 2026

View Original Abstract ↓

Non-invasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has been widely used as an adjunctive intervention for upper limb motor recovery after stroke; however, the treatment completion rates and comparative safety profiles across different NIBS modalities have not been systematically evaluated. This systematic review and network meta-analysis aimed to assess and compare the treatment completion rates of various NIBS interventions for post-stroke upper limb rehabilitation. We systematically searched six databases and trial registries (PubMed, Embase, Cochrane CENTRAL, CINAHL, WHO ICTRP, and ClinicalTrials.gov) for randomized controlled trials (RCTs) published up to January 20, 2025, with an updated search conducted to April 15, 2026. Random-effects single-arm meta-analyses using the Freeman-Tukey double arcsine transformation were performed to pool completion rates, and a Bayesian random-effects network meta-analysis estimated relative risks (RRs) with 95% credible intervals (CrIs); treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. The protocol was registered with PROSPERO (CRD420261309536). Fifty-five RCTs comprising 68 comparisons and 2,640 participants were included. The pooled intervention group completion rate was 94.9% (95% CI: 93.3–96.4%; I2 = 46.8%). The network meta-analysis showed no statistically significant differences in completion rate between any NIBS intervention and sham/control (all 95% CrIs included 1.00). SUCRA rankings indicated that intermittent theta burst stimulation (iTBS; 71.1%), bilateral rTMS (BL-rTMS; 60.9%), and dual transcranial direct current stimulation (Dual-tDCS; 58.1%) ranked highest. The overall adverse event (AE) rate was 16.4% (95% CI: 8.5–26.2%) in intervention groups, predominantly mild headache and skin tingling, with an AE-related dropout rate of only 1.1%. Subgroup analyses showed higher completion rates for tDCS (96.8%) than rTMS (93.9%), with the chronic phase highest (97.1%) and the mixed phase lowest (89.1%). The LFK index was 0.04, indicating no publication bias. In conclusion, NIBS for post-stroke upper limb rehabilitation demonstrates favorable tolerability and safety, with an overall completion rate of approximately 95%. Exploratory SUCRA rankings placed iTBS, BL-rTMS, and Dual-tDCS in the top three positions; however, these rankings should be considered hypothesis-generating rather than definitive, as four interventions were informed by only a single study, absolute differences in completion rates were minimal, and all pairwise credible intervals included 1.00. These observed phase-specific differences suggest that stroke phase may be an important factor to consider when designing adherence strategies, although prospective evaluation of tailored interventions is needed.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261309536, PROSPERO (Registration ID: CRD420261309536).

Non-invasive brain stimulation shows favorable tolerability and 94.9% completion rate for post-stroke upper limb rehabilitationBrain Stimulation Shows Good Safety for Post-Stroke Arm Recovery

How this fits prior evidence

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Non-invasive brain stimulation shows favorable tolerability and 94.9% completion rate for post-stroke upper limb rehabilitationBrain Stimulation Shows Good Safety for Post-Stroke Arm Recovery

How this fits prior evidence

Common questions

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