Repetitive peripheral magnetic stimulation for activities of daily living and functional ability in people after stroke

Ryo Momosaki; Naoki Yamada; Erika Ota; Masahiro Abo

doi:10.1002/14651858.CD011968.pub2

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Figure 1

Study flow diagram.

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Figure 2

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

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Figure 3

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

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Analysis 1.1

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 2.3

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

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Analysis 2.4

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

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Analysis 2.5

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

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Analysis 2.6

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

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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
Outcomes	Risk with any type of control intervention	Risk with rPMS	Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
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)	⊕⊕⊝⊝ LOW^a
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)	⊕⊕⊝⊝ LOW^a
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)	⊕⊕⊝⊝ LOW^a
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)	⊕⊕⊝⊝ LOW^a
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)	⊕⊕⊝⊝ LOW^a
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

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

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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]

Comparison 1. rPMS versus sham

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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]

Comparison 2. rPMS plus rehabilitation versus rehabilitation only

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