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. 2016 Mar 21;2016(3):CD009645. doi: 10.1002/14651858.CD009645.pub3

Au‐Yeung 2014.

Methods Study design: randomised controlled cross‐over trial
Number of dropouts: none
Number of adverse effects: not described
Deaths: none
ITT: yes
Participants Country: China
Sample size: 10 participants; mean age (SD) 63 (6) years; mean UE‐FM (SD) 58 (8)
Inclusion criteria: not explicitly stated; participants were recruited from a convenience sample from two patient self help groups for stroke; participants were < 80 years of age; had a single stroke more than a year prior to enrolment and had weakness in the affected upper limb and could perform a pincer grip with the index finger
Exclusion criteria: not explicitly stated, but people excluded were either illiterate in Chinese, had a history of other neurologic disorders, metal in the head, musculoskeletal pathologies affecting movements in the upper limbs, had aphasia or < 18 points on the MMSE
Interventions Each participant underwent all of the following conditions:
  1. A‐tDCS over M1 of the affected hemisphere (1 mA for 20 minutes) plus sham tDCS over M1 of the unaffected hemisphere (1 mA for 10 seconds) once

  2. C‐tDCS over M1 of the unaffected hemisphere (1 mA for 20 minutes) plus sham tDCS over M1 of the affected hemisphere (1 mA for 10 seconds) once

  3. Sham tDCS over M1 of the unaffected hemisphere plus sham tDCS over M1 of the affected hemisphere (1 mA for 10 seconds) once

Outcomes Outcomes were measured at baseline and at the end of intervention period
Primary outcome measures:
  1. Purdue pegboard test (hand dexterity)

  2. Color‐word Stroop test (selective attention)


Secondary outcome measures:
  1. Pinch grip strength (handheld digital dynamometer)

  2. Fatigue (NRS)

Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote: "The sequence was determined in advance for each subject by drawing lots from an envelope"
Allocation concealment (selection bias) Unclear risk Quote: "The sequence was determined in advance for each subject by drawing lots from an envelope"
Blinding of participants and personnel (performance bias) 
 Subjective outcome measures Unclear risk Participants were blinded, but personnel were not. Quote: "It was the third investigator (C.Y.) who set the tDCS parameters for both channels and operated the machine behind the subject throughout the experimental procedure"
Blinding of participants and personnel (performance bias) 
 Objective outcome measures Low risk Participants were blinded, but personnel were not. Quote: "It was the third investigator (C.Y.) who set the tDCS parameters for both channels and operated the machine behind the subject throughout the experimental procedure"
Blinding of outcome assessment (detection bias) 
 Subjective outcome measures Low risk Outcome assessors were blinded. Quote: "Two other investigators (J.W. and E.C.) who were blinded to the allocated tDCS conditions then
 assessed the baseline motor status of the subjects’ paretic upper limb"
Blinding of outcome assessment (detection bias) 
 Objective outcome measures Low risk Outcome assessors were blinded. Quote: "Two other investigators (J.W. and E.C.) who were blinded to the allocated tDCS conditions then
 assessed the baseline motor status of the subjects’ paretic upper limb"
Incomplete outcome data (attrition bias) 
 Subjective outcome measures Unclear risk All participants apparently completed the study. No treatment withdrawals, no losses to follow‐up, no trial group changes and no major adverse events were stated
Incomplete outcome data (attrition bias) 
 Objective outcome measures Unclear risk All participants apparently completed the study. No treatment withdrawals, no losses to follow‐up, no trial group changes and no major adverse events were stated
Selective reporting (reporting bias) Unclear risk All outcomes reported in the methods section reported