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뇌졸중 환자의 일상생활 및 기능적 활동에 대한 반복적인 말초신경 자극

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Appendices

Appendix 1. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

#1 [mh ^"cerebrovascular disorders"] or [mh "basal ganglia cerebrovascular disease"] or [mh "brain ischemia"] or [mh "carotid artery diseases"] or [mh "intracranial arterial diseases"] or [mh "intracranial arteriovenous malformations"] or [mh "intracranial embolism and thrombosis"] or [mh "intracranial hemorrhages"] or [mh ^stroke] or [mh "brain infarction"] or [mh ^"stroke, lacunar"] or [mh ^"vasospasm, intracranial"] or [mh ^"vertebral artery dissection"] or [mh ^"brain injuries"] or [mh ^"brain injury, chronic"]

#2 (stroke or poststroke or post‐stroke or cerebrovasc* or brain next vasc* or cerebral next vasc* or cva* or apoplex* or SAH):ti,ab,kw (Word variations have been searched)

#3 ((brain or cerebr* or cerebell* or vertebrobasil* or hemispher* or intracran* or intracerebral or infratentorial or supratentorial or middle cerebral artery or MCA* or anterior circulation or posterior circulation or basilar artery or vertebral artery or space‐occupying) near/5 (isch?emi* or infarct* or thrombo* or emboli* or occlus* or hypoxi*)):ti,ab,kw (Word variations have been searched)

#4 ((brain* or cerebr* or cerebell* or intracerebral or intracran* or parenchymal or intraparenchymal or intraventricular or infratentorial or supratentorial or basal gangli* or putaminal or putamen or posterior fossa or hemispher* or subarachnoid) near/5 (h?emorrhag* or h?ematoma$ or bleed*)):ti,ab,kw (Word variations have been searched)

#5 [mh ^hemiplegia] or [mh paresis]

#6 (hempar* or hemipleg* or paresis or paraparesis or paretic):ti,ab,kw (Word variations have been searched)

#7 {or #1‐#6}

#8 [mh ^"magnetic field therapy"]

#9 [mh ^magnetics]

#10 [mh ^"electromagnetic fields"] or [mh ^"electromagnetic phenomena"] or [mh ^"magnetic fields"]

#11 ((magnet* or electromagnet* or electro‐magnet*) near/5 (field* or coil* or induction)):ti,ab,kw (Word variations have been searched)

#12 ((peripher* or nerv* or musc* or spine or spinal) near/5 (magnet* or electromagnet* or electro‐magnet*) near/5 (stimulat* or neurostimulat*)):ti,ab,kw (Word variations have been searched)

#13 (PMS or rPMS or PrMS):ti,ab,kw (Word variations have been searched)

#14 {or #8‐#13}

#15 #7 and #14

Appendix 2. MEDLINE (Ovid) search strategy

1. cerebrovascular disorders/ or exp basal ganglia cerebrovascular disease/ or exp brain ischemia/ or exp carotid artery diseases/ or exp cerebral small vessel diseases/ or exp intracranial arterial diseases/ or exp "intracranial embolism and thrombosis"/ or exp intracranial hemorrhages/ or stroke/ or exp brain infarction/ or stroke, lacunar/ or vasospasm, intracranial/ or vertebral artery dissection/

2. (stroke$ or poststroke or apoplex$ or cerebral vasc$ or brain vasc$ or cerebrovasc$ or cva$ or SAH).tw.

3. ((brain or cerebr$ or cerebell$ or vertebrobasil$ or hemispher$ or intracran$ or intracerebral or infratentorial or supratentorial or middle cerebral artery or MCA$ or anterior circulation or posterior circulation or basilar artery or vertebral artery or space‐occupying) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$ or hypoxi$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracran$ or parenchymal or intraparenchymal or intraventricular or infratentorial or supratentorial or basal gangli$ or putaminal or putamen or posterior fossa or hemispher$ or subarachnoid) adj5 (h?emorrhag$ or h?ematoma$ or bleed$)).tw.

5. hemiplegia/ or exp paresis/ or exp Gait Disorders, Neurologic/

6. (hemipleg$ or hemipar$ or paresis or paraparesis or paretic).tw.

7. or/1‐6

8. magnetic field therapy/

9. magnetics/

10. electromagnetic fields/ or electromagnetic phenomena/ or magnetic fields/

11. ((magnet$ or electromagnet$ or electro‐magnet$) adj5 (field$ or coil$ or induction)).tw.

12. ((peripher$ or nerv$ or musc$ or spine or spinal) adj5 (magnet$ or electromagnet$ or electro‐magnet$) adj5 (stimulat$ or neurostimulat$)).tw.

13. (PMS or rPMS or PrMS).tw.

14. 8 or 9 or 10 or 11 or 12 or 13

15. 7 and 14

16. Randomized Controlled Trials as Topic/

17. random allocation/

18. Controlled Clinical Trials as Topic/

19. control groups/

20. clinical trials as topic/ or clinical trials, phase i as topic/ or clinical trials, phase ii as topic/ or clinical trials, phase iii as topic/ or clinical trials, phase iv as topic/

21. double‐blind method/

22. single‐blind method/

23. Placebos/

24. placebo effect/

25. cross‐over studies/

26. randomized controlled trial.pt.

27. controlled clinical trial.pt.

28. (clinical trial or clinical trial phase i or clinical trial phase ii or clinical trial phase iii or clinical trial phase iv).pt.

29. (random$ or RCT or RCTs).tw.

30. (controlled adj5 (trial$ or stud$)).tw.

31. (clinical$ adj5 trial$).tw.

32. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.

33. (quasi‐random$ or quasi random$ or pseudo‐random$ or pseudo random$).tw.

34. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

35. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

36. (cross‐over or cross over or crossover).tw.

37. (placebo$ or sham).tw.

38. trial.ti.

39. (assign$ or allocat$).tw.

40. controls.tw.

41. or/16‐40

42. 15 and 41

43. exp animals/ not humans.sh.

44. 42 not 43

Appendix 3. Embase (Ovid) search strategy

1. cerebrovascular disease/ or brain disease/ or exp basal ganglion hemorrhage/ or exp brain hemangioma/ or exp brain hematoma/ or exp brain hemorrhage/ or exp brain infarction/ or exp brain ischemia/ or exp carotid artery disease/ or exp cerebral artery disease/ or exp cerebrovascular accident/ or exp cerebrovascular malformation/ or exp intracranial aneurysm/ or exp occlusive cerebrovascular disease/ or exp vertebrobasilar insufficiency/

2. (stroke$ or poststroke or apoplex$ or cerebral vasc$ or brain vasc$ or cerebrovasc$ or cva$ or SAH).tw.

3. ((brain or cerebr$ or cerebell$ or vertebrobasil$ or hemispher$ or intracran$ or intracerebral or infratentorial or supratentorial or middle cerebral artery or MCA$ or anterior circulation or posterior circulation or basilar artery or vertebral artery or space‐occupying) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$ or hypoxi$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracran$ or parenchymal or intraparenchymal or intraventricular or infratentorial or supratentorial or basal gangli$ or putaminal or putamen or posterior fossa or hemispher$ or subarachnoid) adj5 (h?emorrhag$ or h?ematoma$ or bleed$)).tw.

5. exp hemiplegia/ or exp paresis/

6. (hemipleg$ or hemipar$ or paresis or paraparesis or paretic).tw.

7. or/1‐6

8. magnetotherapy/

9. exp magnetic field/ or exp magnetism/

10. ((magnet$ or electromagnet$ or electro‐magnet$) adj5 (field$ or coil$ or induction)).tw.

11. ((peripher$ or nerv$ or musc$ or spine or spinal) adj5 (magnet$ or electromagnet$ or electro‐magnet$) adj5 (stimulat$ or neurostimulat$)).tw.

12. (PMS or rPMS or PrMS).tw.

13. or/8‐12

14. Randomized Controlled Trial/ or "randomized controlled trial (topic)"/

15. Randomization/

16. Controlled clinical trial/ or "controlled clinical trial (topic)"/

17. control group/ or controlled study/

18. clinical trial/ or "clinical trial (topic)"/ or phase 1 clinical trial/ or phase 2 clinical trial/ or phase 3 clinical trial/ or phase 4 clinical trial/

19. Crossover Procedure/

20. Double Blind Procedure/

21. Single Blind Procedure/ or triple blind procedure/

22. placebo/ or placebo effect/

23. (random$ or RCT or RCTs).tw.

24. (controlled adj5 (trial$ or stud$)).tw.

25. (clinical$ adj5 trial$).tw.

26. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw

27. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

28. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

29. (cross‐over or cross over or crossover).tw.

30. (placebo$ or sham).tw.

31. trial.ti.

32. (assign$ or allocat$).tw.

33. controls.tw.

34. or/14‐33

35. 7 and 13 and 34

36. (exp animals/ or exp invertebrate/ or animal experiment/ or animal model/ or animal tissue/ or animal cell/ or nonhuman/) not (human/ or normal human/ or human cell/)

37. 35 not 36

Appendix 4. CINAHL (EBSCO) search strategy

S1 (MH "Cerebrovascular Disorders") OR (MH "Basal Ganglia Cerebrovascular Disease+") OR (MH "Carotid Artery Diseases+") OR (MH "Cerebral Ischemia+") OR (MH "Cerebral Vasospasm") OR (MH "Intracranial Arterial Diseases+") OR ( (MH "Intracranial Embolism and Thrombosis") ) OR (MH "Intracranial Hemorrhage+") OR (MH "Stroke") OR (MH "Vertebral Artery Dissections") OR (MH "Stroke Patients") OR (MH "Stroke Units")

S2 TI ( stroke or poststroke or post‐stroke or cerebrovasc* or brain vasc* or cerebral vasc or cva or apoplex or SAH ) or AB ( stroke or poststroke or post‐stroke or cerebrovasc* or brain vasc* or cerebral vasc or cva or apoplex or SAH)

S3 TI ( brain* or cerebr* or cerebell* or intracran* or intracerebral ) or AB ( brain* or cerebr* or cerebell* or intracran* or intracerebral)

S4 TI ( ischemi* or ischaemi* or infarct* or thrombo* or emboli* or occlus* ) or AB ( ischemi* or ischaemi* or infarct* or thrombo* or emboli* or occlus*)

S5 S3 AND S4

S6 TI ( brain* or cerebr* or cerebell* or intracerebral or intracranial or subarachnoid ) or AB ( brain* or cerebr* or cerebell* or intracerebral or intracranial or subarachnoid)

S7 TI ( haemorrhage* or hemorrhage* or haematoma* or hematoma* or bleed* ) or AB ( haemorrhage* or hemorrhage* or haematoma* or hematoma* or bleed*)

S8 S6 AND S7

S9 S1 OR S2 OR S5 OR S8

S10 (MH "Magnetics+") OR (MH "Magnet Therapy+") OR (MH "Magnets")

S11 TI ((magnet* or electromagnet* or electro‐magnet*) N5 (field* or coil* or induction)) OR AB ((magnet* or electromagnet* or electro‐magnet*) N5 (field* or coil* or induction))

S12 TI ((peripher* or nerv* or musc* or spine or spinal) N5 (magnet* or electromagnet* or electro‐magnet*) N5 (stimulat* or neurostimulat*)) or AB ((peripher* or nerv* or musc* or spine or spinal) N5 (magnet* or electromagnet* or electro‐magnet*) N5 (stimulat* or neurostimulat*))

S13 TI (PMS or rPMS or PrMS) or AB ( PMS or rPMS or PrMS)

S14 S10 OR S11 OR S12 OR S13

S15 (MH "Randomized Controlled Trials") or (MH "Random Assignment") or (MH "Random Sample+")

S16 (MH "Clinical Trials") or (MH "Intervention Trials") or (MH "Therapeutic Trials")

S17 (MH "Double‐Blind Studies") or (MH "Single‐Blind Studies") or (MH "Triple‐Blind Studies")

S18 (MH "Control (Research)") or (MH "Control Group") or (MH "Placebos") or (MH "Placebo Effect")

S19 (MH "Crossover Design") OR (MH "Quasi‐Experimental Studies")

S20 PT (clinical trial or randomized controlled trial)

S21 TI (random* or RCT or RCTs) or AB (random* or RCT or RCTs)

S22 TI (controlled N5 (trial* or stud*)) or AB (controlled N5 (trial* or stud*))

S23 TI (clinical* N5 trial*) or AB (clinical* N5 trial*)

S24 TI ((control or treatment or experiment* or intervention) N5 (group* or subject* or patient*)) or AB ((control or treatment or experiment* or intervention) N5 (group* or subject* or patient*))

S25 ((control or experiment* or conservative) N5 (treatment or therapy or procedure or manage*)) or AB ((control or experiment* or conservative) N5 (treatment or therapy or procedure or manage*))

S26 TI ((singl* or doubl* or tripl* or trebl*) N5 (blind* or mask*)) or AB ((singl* or doubl* or tripl* or trebl*) N5 (blind* or mask*))

S27 TI (cross‐over or cross over or crossover) or AB (cross‐over or cross over or crossover)

S28 TI (placebo* or sham) or AB (placebo* or sham)

S29 TI trial

S30 TI (assign* or allocat*) or AB (assign* or allocat*)

S31 TI controls or AB controls

S32 S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31

S34 S9 AND S14 AND S32

Appendix 5. PsycINFO (Ovid) search strategy

1. cerebrovascular disorders/ or cerebral hemorrhage/ or exp cerebral ischemia/ or cerebral small vessel disease/ or cerebrovascular accidents/ or subarachnoid hemorrhage/

2. (stroke$ or poststroke or apoplex$ or cerebral vasc$ or brain vasc$ or cerebrovasc$ or cva$ or SAH).tw.

3. ((brain or cerebr$ or cerebell$ or vertebrobasil$ or hemispher$ or intracran$ or intracerebral or infratentorial or supratentorial or middle cerebral artery or MCA$ or anterior circulation or posterior circulation or basilar artery or vertebral artery or space‐occupying) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$ or hypoxi$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracran$ or parenchymal or intraparenchymal or intraventricular or infratentorial or supratentorial or basal gangli$ or putaminal or putamen or posterior fossa or hemispher$ or subarachnoid) adj5 (h?emorrhag$ or h?ematoma$ or bleed$)).tw.

5. hemiparesis/ or hemiplegia/

6. (hemipleg$ or hemipar$ or paresis or paretic).tw.

7. or/1‐6

8. exp magnetism/

9. ((magnet$ or electromagnet$ or electro‐magnet$) adj5 (field$ or coil$ or induction)).tw.

10. ((peripher$ or nerv$ or musc$ or spine or spinal) adj5 (magnet$ or electromagnet$ or electro‐magnet$) adj5 (stimulat$ or neurostimulat$)).tw.

11. (PMS or rPMS or PrMS).tw.

12. or/8‐11

13. clinical trials/ or treatment effectiveness evaluation/ or placebo/

14. (random$ or RCT or RCTs).tw.

15. (controlled adj5 (trial$ or stud$)).tw.

16. (clinical$ adj5 trial$).tw.

17. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw

18. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

19. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

20. (cross‐over or cross over or crossover).tw.

21. (placebo$ or sham).tw.

22. trial.ti.

23. (assign$ or allocat$).tw.

24. controls.tw.

25. or/13‐24

26. 7 and 12 and 25

Appendix 6. AMED (Ovid) search strategy

1. cerebrovascular disorders/ or cerebral hemorrhage/ or cerebral infarction/ or cerebral ischemia/ or cerebrovascular accident/ or stroke/ or brain injuries/

2. (stroke$ or poststroke or apoplex$ or cerebral vasc$ or brain vasc$ or cerebrovasc$ or cva$ or SAH).tw.

3. ((brain or cerebr$ or cerebell$ or vertebrobasil$ or hemispher$ or intracran$ or intracerebral or infratentorial or supratentorial or middle cerebral artery or MCA$ or anterior circulation or posterior circulation or basilar artery or vertebral artery or space‐occupying) adj5 (isch?emi$ or infarct$ or thrombo$ or emboli$ or occlus$ or hypoxi$)).tw.

4. ((brain$ or cerebr$ or cerebell$ or intracerebral or intracran$ or parenchymal or intraparenchymal or intraventricular or infratentorial or supratentorial or basal gangli$ or putaminal or putamen or posterior fossa or hemispher$ or subarachnoid) adj5 (h?emorrhag$ or h?ematoma$ or bleed$)).tw.

5. hemiplegia/

6. (hemipleg$ or hemipar$ or paresis or paretic or brain injur$).tw.

7. or/1‐6

8. exp magnetics/

9. exp electromagnetics/ or exp electromagnetic fields/

10. ((magnet$ or electromagnet$ or electro‐magnet$) adj5 (field$ or coil$ or induction)).tw.

11. ((peripher$ or nerv$ or musc$ or spine or spinal) adj5 (magnet$ or electromagnet$ or electro‐magnet$) adj5 (stimulat$ or neurostimulat$)).tw.

12. (PMS or rPMS or PrMS).tw.

13. or/8‐12

14. clinical trials/ or randomized controlled trials/ or random allocation/

15. research design/ or comparative study/

16. double blind method/ or single blind method/

17. placebos/

18. (random$ or RCT or RCTs).tw.

19. (controlled adj5 (trial$ or stud$)).tw.

20. (clinical$ adj5 trial$).tw.

21. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.

22. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

23. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

24. (cross‐over or cross over or crossover).tw.

25. (placebo$ or sham).tw.

26. trial.ti.

27. (assign$ or allocat$).tw.

28. controls.tw.

29. or/14‐28

30. 7 and 13 and 29

Appendix 7. OTseeker (Occupational Therapy Systematic Evaluation of Evidence) search strategy

[Any Field] like 'stroke* or poststroke or apoplex* or cerebral vasc* or brain vasc* or cerebrovasc* or cva* or SAH' AND [Any Field] like 'magnet* or electromagnet* or electro‐magnet*' AND [Method] like 'Randomised controlled trial'

Appendix 8. PEDro (physiotherapy evidence database) search strategy

<electrotherapies, heat, cold> in “Therapy” field, <muscle weakness> in “Problem” field. <neurology> in "Subdiscipline" field, and <clinical trial> in "Method" field

Appendix 9. Ichushi‐Web (Japanese medical database) search strategy

(脳卒中/AL or 脳梗塞/AL or 脳出血/AL or クモ膜下出血/AL or 脳血管障害/AL) and (磁気/AL) and (臨床試験/AL or 比較試験/AL or ランダム化比較試験/AL or 準ランダム化比較試験/AL or 第I相試験/AL or 第II相試験/AL or 第III相試験/AL or 第IV相試験/AL or 盲検/AL or ランダム/AL or プラセボ/AL or 対照群/AL or コントロール群/AL)

(We used Japanese characters in the search.)

Appendix 10. US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov

(stroke* OR poststroke OR apoplex* OR "cerebral vascular" OR "brain vascular*" OR cerebrovascular* OR "transient ischemic" OR tia OR cva* OR SAH) AND (magnetic OR electromagnetic OR electro‐magnetic OR PMS OR rPMS OR PrMS) | Interventional Studies

Appendix 11. ISRCTN Registry

(cerebrovascular OR stroke OR TIA OR SAH OR "transient ischemic attack" OR (cerebral AND (ischemia OR ischemia OR embolism OR infarction OR haematoma OR hematoma OR haemorrhage OR hemorrhage))) AND magnet*

Appendix 12. Stroke Trials Registry

Intervention ; Clinical Trials:“Magnetic”

Appendix 13. World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP)

stroke* or poststroke or apoplex* or cerebral vasc* or brain vasc* or cerebrovasc* or transient isch?emic or tia or cva* or SAH – Title AND magnetic OR electromagnetic OR electro‐magnetic OR PMS OR rPMS OR PrMS ‐ Intervention

Appendix 14. Japanese UMIN Clinical Trials Registry (UMIN‐CTR)

Study type: Intervention:“Magnetic”

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 rPMS versus sham, Outcome 1 Muscle strength at the end of treatment.
Figuras y tablas -
Analysis 1.1

Comparison 1 rPMS versus sham, Outcome 1 Muscle strength at the end of treatment.

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 1 Activities of daily living at the end of treatment.
Figuras y tablas -
Analysis 2.1

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 1 Activities of daily living at the end of treatment.

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 2 Activities of daily living at the end of follow‐up.
Figuras y tablas -
Analysis 2.2

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 2 Activities of daily living at the end of follow‐up.

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 3 Upper limb function at the end of treatment.
Figuras y tablas -
Analysis 2.3

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 3 Upper limb function at the end of treatment.

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 4 Upper limb function at the end of follow‐up.
Figuras y tablas -
Analysis 2.4

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 4 Upper limb function at the end of follow‐up.

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 5 Spasticity at the end of treatment.
Figuras y tablas -
Analysis 2.5

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 5 Spasticity at the end of treatment.

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 6 Spasticity at the end of follow‐up.
Figuras y tablas -
Analysis 2.6

Comparison 2 rPMS plus rehabilitation versus rehabilitation only, Outcome 6 Spasticity at the end of follow‐up.

Summary of findings for the main comparison. rPMS compared with any type of control intervention in stroke

rPMS compared with any type of control intervention in stroke

Patient or population: people with stroke
Intervention: rPMS
Comparison: any type of control intervention

Setting: Germany and Canada

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

No. of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with any type of control intervention

Risk with rPMS

Activities of daily living (ADLs)
assessed with Barthel Index
Scale, from 0 to 100

Mean activities of daily living score was 50

MD 3 lower
(16.35 lower to 10.35 higher)

63
(1 RCT)

⊕⊕⊝⊝
LOWa

Upper limb function
assessed with Fugl‐Meyer Assessment
Scale, from 0 to 66

Mean upper limb function score was 13

MD 2 higher
(4.91 lower to 8.91 higher)

63
(1 RCT)

⊕⊕⊝⊝
LOWa

Lower limb function ‐ not measured

See comments

No trials measured this outcome

Spasticity (elbow)
assessed with Modified Tardieu Scale
Scale, from 0 to 5

Mean spasticity (elbow) score was 1.41

MD 0.41 lower
(0.89 lower to 0.07 higher)

63
(1 RCT)

⊕⊕⊝⊝
LOWa

Spasticity (wrist)
assessed with Modified Tardieu Scale
Scale, from 0 to 5

Mean spasticity (wrist) score was 2.13

MD 0.2 lower
(0.76 lower to 0.36 higher)

63
(1 RCT)

⊕⊕⊝⊝
LOWa

Muscle strength
assessed with dorsiflexion strength

Mean muscle strength was 10.44 kg

MD 3 kg higher
(2.44 lower to 8.44 higher)

18
(1 RCT)

⊕⊕⊝⊝
LOWa

Death ‐ not reported

See comments

No trials reported this outcome

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; OR: odds ratio; RR: risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aOne study with small sample size; 95% CI overlaps zero

Figuras y tablas -
Summary of findings for the main comparison. rPMS compared with any type of control intervention in stroke
Comparison 1. rPMS versus sham

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Muscle strength at the end of treatment Show forest plot

1

18

Mean Difference (IV, Fixed, 95% CI)

3.0 [‐2.44, 8.44]

Figuras y tablas -
Comparison 1. rPMS versus sham
Comparison 2. rPMS plus rehabilitation versus rehabilitation only

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Activities of daily living at the end of treatment Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

‐3.00 [‐16.35, 10.35]

2 Activities of daily living at the end of follow‐up Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐14.86, 10.86]

3 Upper limb function at the end of treatment Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

2.0 [‐4.91, 8.91]

4 Upper limb function at the end of follow‐up Show forest plot

1

63

Mean Difference (IV, Fixed, 95% CI)

4.0 [‐2.92, 10.92]

5 Spasticity at the end of treatment Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 Spasticity at the end of treatment (elbow)

1

63

Mean Difference (IV, Fixed, 95% CI)

‐0.41 [‐0.89, 0.07]

5.2 Spasticity at the end of treatment (wrist)

1

63

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.76, 0.36]

6 Spasticity at the end of follow‐up Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 Spasticity at the end of follow‐up (elbow)

1

63

Mean Difference (IV, Fixed, 95% CI)

‐0.48 [‐0.93, ‐0.03]

6.2 Spasticity at the end of follow‐up (wrist)

1

63

Mean Difference (IV, Fixed, 95% CI)

‐0.13 [‐0.67, 0.41]

Figuras y tablas -
Comparison 2. rPMS plus rehabilitation versus rehabilitation only