Combined noninvasive brain stimulation and acupuncture for post-stroke motor recovery: a systematic review and network meta-analysis.

Abstract

Objective Stroke is highly prevalent among older adults, and age-related reductions in neuroplastic reserve may limit motor recovery. This systematic review and network meta-analysis aimed to compare and rank the effects of noninvasive brain stimulation combined with acupuncture on post-stroke motor recovery, spasticity, balance, and activities of daily living (ADL). Methods PubMed, Embase, the Cochrane Library, Web of Science, Scopus, CNKI, SinoMed, Wanfang, and CQVIP were searched from inception to July 1, 2026. Randomized controlled trials evaluating noninvasive brain stimulation, including TMS-based NIBS or transcranial direct current stimulation, combined with acupuncture or electroacupuncture were included. Pairwise and frequentist random-effects network meta-analyses were performed. Risk of bias was assessed using the Cochrane tool, and confidence in network estimates was evaluated using CINeMA. Results Forty-six randomized controlled trials involving 4,080 participants were included. Combined interventions generally showed greater effects than single-modality therapies or conventional rehabilitation, although heterogeneity was substantial. In the network meta-analysis, both TMS-based NIBS plus acupuncture and tDCS plus acupuncture showed favorable ranking probabilities across several outcomes. tDCS plus acupuncture ranked highly for FMA total, FMA-UE, and ADL, whereas TMS-based NIBS plus acupuncture ranked favorably for FMA-LE, spasticity, and balance. Differences between the two combined regimens were generally not statistically significant. CINeMA indicated moderate, low, or very low confidence across network estimates, with no high-confidence evidence. Conclusion Combined noninvasive brain stimulation and acupuncture may provide additional benefits for post-stroke motor and functional recovery. However, current findings should be interpreted cautiously because of substantial heterogeneity, sparse evidence for some intervention nodes, risk-of-bias concerns, and limited confidence in several network estimates. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251051398, Identifier: CRD420251051398.