Study design <p>Systematic review and meta-analysis.</p> Objective <p>To determine the effectiveness of transcranial magnetic stimulation (TMS) in improving gait velocity and spasticity in people with spinal cord injury (SCI).</p> Setting <p>Studies included in the review were conducted in various countries; the review was carried out in Spain.</p> Methods <p>A systematic review with meta-analysis was conducted by searching for randomized controlled trials published up to November 2024 comparing the application of TMS with a sham group. Outcome variables were gait velocity and spasticity, measured with the 10 m walking test and the Modified Ashworth Scale (MAS) respectively. PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and PEDro databases were consulted.</p> Results <p>Fourteen studies were included in the qualitative analysis and twelve in the quantitative analysis, involving 235 participants with SCI. No significant differences were detected for the effect of TMS on gait velocity (SMD = −0.71; 95%CI: −1.62 to 0.20). However, TMS produced a significant decrease in MAS compared to the control group (MD = −0.56 points; 95%CI: −0.82 to −0.30). Although the subgroup analysis based on the number of pulses showed no significant differences between applications of &lt;1000 and ≥1000 pulses, the ≥1000 pulses subgroup showed significant differences (MD = −0.56 points; 95%CI: −0.83 to −0.30) favoring the experimental group, while the &lt;1000 pulses subgroup showed no significant differences (MD = −0.35 points; 95%CI: −2.03 to 1.34).</p> Conclusions <p>TMS is effective in improving spasticity in people with SCI with low certainty of evidence. However, TMS has not demonstrated a significant effect on gait velocity, with very low certainty of evidence. Further studies comparing the number of pulses and their effectiveness are warranted to elucidate the findings of this meta-analysis.</p>