Therapeutic Potential of Transcranial Magnetic Stimulation (TMS) in Long COVID: Protocol for a Systematic Review and Meta-Analysis

Objective To synthesise quantitative evidence on the effectiveness of Transcranial Magnetic Stimulation (TMS) as an intervention for individuals with long COVID/post-COVID syndrome. Introduction An estimated 65 million people worldwide meet the WHO’s criteria for post-COVID-19 condition, a multisystem disorder with persistent symptoms following SARS-CoV-2 infection. Despite its global impact, effective treatments are limited. A recent review highlighted early but promising results from non-invasive brain stimulation techniques, including transcranial magnetic stimulation (TMS), though the underlying mechanisms remain unclear. Given the expanding use of TMS in long COVID, a follow-up meta-analysis is needed to reflect recent developments. This review aims to evaluate the efficacy of TMS in treating post-COVID-19 symptoms. Inclusion criteria This review will include studies that investigate interventions involving TMSin individuals diagnosed with long COVID or post-COVID syndrome, limited to those published in the English language. Studies will be excluded if they do not involve rTMS as a therapeutic intervention, do not involve TMS at all, focus on populations other than those with long COVID or post-COVID condition, are review articles or case studies, or are not published in English. Methods A comprehensive search will be conducted in CINAHL Ultimate, MEDLINE, ScienceDirect, and Scopus using a strategy developed with the research team. Retrieved citations will be managed in Rayyan. Two independent reviewers will screen titles and abstracts, followed by full-text screening and data extraction by two other independent reviewers. All stages will follow predefined, pilot-tested inclusion and exclusion criteria. Discrepancies will be resolved by a third reviewer or team discussion. Intra-rater reliability at both screening stages will be assessed using Cohen’s Kappa. Study characteristics and findings will be presented using both narrative synthesis and tabular formats. Review registration https://doi.org/10.17605/OSF.IO/RE235