Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined with Physical Therapy in Post-Ischemic Stroke Rehabilitation: A Quasi-Experimental Study

Abstract

Background: Recovery after ischemic stroke requires a multimodal rehabilitation approach to restore neurological function. Repetitive transcranial magnetic stimulation (rTMS) and physical therapy (PT) have demonstrated effectiveness in enhancing neuroplasticity and improving functional outcomes. Nurses play a key role in coordinating care, monitoring patient progress, ensuring safe intervention delivery, and supporting patient education and adherence to rehabilitation programs.

Aim: This study aimed to evaluate the effectiveness of physical therapy alone compared with combined rTMS and physical therapy in improving neurological recovery among post-ischemic stroke patients using the National Institutes of Health Stroke Scale (NIHSS).

Methods: A quasi-experimental, multiple-group pre-post intervention study was conducted at Shar Hospital, Sulaimani, Iraq. Sixty patients with ischemic stroke were purposively allocated into two groups: PT alone and rTMS combined with PT. Interventions were implemented over six months duration, with the combined group receiving 20 rTMS sessions alongside routine physical therapy. Neurological outcomes were assessed at pre-, mid-, and post-intervention stages using the NIHSS.

Results: Mean NIHSS scores decreased significantly from 10.87 at baseline to 6.58 at mid-intervention and 4.17 post-intervention, reflecting a clinically meaningful reduction of 6.70 points (p < 0.001). Both groups showed improvement, with greater reductions observed in the combined therapy group.

Conclusion: Combined rTMS and physical therapy was associated with greater neurological improvement than physical therapy alone, suggesting that integrating neuromodulation may enhance post-stroke rehabilitation outcomes.