Comparative effects of different magnetic stimulation modalities on upper limb motor function and activities of daily living in patients with stroke: a systematic review and network meta-analysis

Objective To systematically evaluate the effects of different magnetic stimulation (MS) modalities on upper limb motor function and activities of daily living (ADL) in patients with stroke through a network meta-analysis. Methods Embase, Web of Science, PubMed, Wanfang, VIP, and CNKI were searched from inception to January 2026 for randomized controlled trials evaluating MS interventions for upper limb motor function and activities of daily living (ADL) in patients with stroke. A frequentist network meta-analysis was performed using standardized mean difference (SMD) with 95% confidence interval (CI). The surface under the cumulative ranking curve (SUCRA) was used to estimate the relative ranking probabilities of interventions. Risk of bias was assessed using RoB 2, and the certainty of evidence was evaluated using GRADE. Results A total of 48 randomized controlled trials were included. For upper limb motor function, rPMS (SMD = 0.65, 95% CI: 0.19 to 1.12), rTMS (SMD = 0.96, 95% CI: 0.68 to 1.24), and combined MS (SMD = 1.01, 95% CI: 0.47 to 1.55) were all superior to conventional rehabilitation. SUCRA rankings suggested that combined MS ranked highest, followed by rTMS. However, pairwise comparisons among active magnetic stimulation interventions did not reach statistical significance. For ADL, rPMS (SMD = 0.60, 95% CI: 0.26 to 0.95), rTMS (SMD = 0.76, 95% CI: 0.56 to 0.97), and combined MS (SMD = 1.27, 95% CI: 0.94 to 1.59) significantly improved ADL compared with conventional rehabilitation. Combined MS was also superior to rPMS and rTMS alone. Sensitivity analysis excluding studies that reported only the Barthel Index showed broadly consistent results. No clear evidence of publication bias or small-study effects was detected. The certainty of evidence was rated as low. Conclusion MS interventions may improve upper limb motor function and ADL in patients with stroke. Combined MS and rTMS showed relatively high ranking probabilities for upper limb motor recovery, whereas combined MS showed the highest ranking probability for ADL improvement. Given the heterogeneity among included studies, non-significant differences in some direct comparisons, and low certainty of evidence, these findings should be interpreted cautiously and confirmed by high-quality head-to-head trials. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261302905 , Identifier: CRD420261302905.