A Cochrane review [Abstract] 1 included 19 studies with a total of 588 subjects. The time between stroke and recruitment varied from 4 hours to 6 years. The trials compared repetitive transcranial magnetic stimulation (rTMS) therapy with sham therapy or no therapy. Two heterogenous trials (n=183) showed that rTMS treatment was not associated with a significant increase in the Barthel Index score (MD 15.92, 95% CI -2.11 to 33.95). Four trials (n= 73) did not find a statistically significant effect on motor function (SMD 0.51, 95% CI -0.99 to 2.01). Subgroup analyses of different stimulation frequencies or duration of illness also showed no significant difference. Few mild adverse events were observed in the rTMS groups, with the most common events being transient or mild headaches (2.4%, 8/327) and local discomfort at the site of the stimulation.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in patients and interventions).
Another Cochrane review [Abstract] 2 included 9 studies with a total of 396 patients. The studies compared transcranial direct current stimulation (tDCS) vs. sham tDCS or any other passive intervention, the primary outcome measure was activities of daily living (ADLs) after stroke. There was evidence of effect regarding ADL performance at the end of the intervention period (SMD 0.24, 95% CI 0.03 to 0.44; 9 studies, n=396). Six studies (n=269) assessed the effects of tDCS on ADLs at the end of follow-up, and found improved ADL performance (SMD 0.31, 95% CI 0.01 to 0.62; 6 studies, n=269). However, the results did not persist in a sensitivity analysis including only trials of good methodological quality.Twelve trials (n=431) measured upper extremity function at the end of the intervention period, revealing no evidence of an effect in favour of tDCS (SMD 0.01, 95% CI -0.48 to 0.50). There was no evidence of effects of tDCS on upper extremity function at the end of follow-up, either (SMD 0.01, 95% CI -0.48 to 0.50; 4 studies, n=187). Regarding muscle strength, there was no evidence of effect at the end of the intervention period (10 studies, n= 313) or at follow-up (3 studies, n=156).In 6 of 23 studies, dropouts and adverse events were reported, and their proportions were comparable between groups.
The third Cochrane review [Abstract] 3 included 21 trials with a total of 421 patients. Three studies (n=112) using transcranial direct current stimulation (tDCS) measured aphasia in a real-life communicative setting. There was no evidence of an effect (SMD 0.17, 95% CI −0.20 to 0.55). At follow-up, there also was no evidence of an effect (SMD 0.14, 95% CI −0.31 to 0.58; 2 studies, n=80). For the secondary outcome measure, accuracy in naming nouns at the end of intervention, there was evidence of an effect (SMD 0.42, 95% CI 0.19 to 0.66; 11 studies, n=298). There was an effect for the accuracy in naming nouns at follow-up (SMD 0.87, 95% CI 0.25 to 1.48; 2 studies, n=80). There was no evidence of an effect regarding accuracy in naming verbs post intervention (SMD 0.19, 95% CI −0.68 to 1.06; 3 studies, n=21).
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in patients, interventions and outcomes).
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