Transcutaneous Auricular Vagus Nerve Stimulation Paired With Exercise Training for Upper Limb Motor Function and Activities of Daily Living After Stroke: A Systematic Review and Meta-analysis

Objective: To evaluate the safety and efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) paired with exercise training on upper limb motor function, Activities of Daily Living (ADL) and adverse events, and to assess the impact of device parameters on rehabilitation outcomes, in patients with stroke through a meta-analysis. Data Sources: A systematic literature search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, China National Knowledge Infrastructure, and Wanfang Database from inception to November 2025. Study Selection: Randomized controlled trials were included to evaluate the effects of taVNS paired with exercise training in patients with stroke. Data Extraction: Two researchers independently extracted relevant data (sociodemographic characteristics, study characteristics, stimulus parameters, and outcome indicators). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias 2.0 tool. Any discrepancies were resolved through discussion or consultation with a third researcher. Data Synthesis: Sixteen original studies involving a total of 708 patients with stroke were included. The results showed that patients receiving taVNS paired with exercise training had significant improvements in upper limb motor function, as assessed by the Fugl-Meyer Assessment Upper Extremity (standardized mean difference [SMD]=1.27; 95% confidence interval [CI], 0.89-1.66; P<.01), Wolf Motor Function Test (SMD=1.46; 95% CI, 0.74-2.17; P<.01), and Action Research Arm Test (SMD=4.51; 95% CI, 2.73-6.29; P<.01). TaVNS paired with exercise also exhibited beneficial effects on ADL (SMD=1.42; 95% CI, 0.70-2.14; P<.01). Subgroup analysis indicated that an intervention frequency of ≥4 sessions/wk had a significant effect on upper limb motor function (SMD=1.36; 95% CI, 0.90-1.82; P<.01). Conclusions: TaVNS paired with exercise training can effectively improve upper limb motor function and ADL, with a significant effect when the intervention frequency is ≥4 sessions/wk. Further research is needed to determine the optimal stimulation parameters and exercise protocols. © 2026 The Authors