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

Fusco 2013a.

Methods Study design: double‐blinded, sham‐controlled, randomised cross‐over study
Dropouts: none
Adverse effects: none
Deaths: none
ITT: yes
Participants Country: Italy
Number of participants: 9
Age (mean ± SD): 53.5 ± 20.7 years
Gender: 4 (57%) female
Type of stroke: 8 (89%) ischaemic, 1 (11%) haemorrhagic
Time poststroke (mean ± SD): 28.3 ± 10.4 days
Severity (mean ± SD): grip strength 17.83 ± 7.45 kg
Inclusion criteria: cortical or subcortical first‐ever stroke (radiologically confirmed), possibility to perform pinch/grip test
Exclusion criteria: history of chronic disabling pathologies of the upper limb; spasticity; presence of pacemaker or severe cardiovascular conditions; a history of tumour, prior neurosurgical brain intervention, severe cardiovascular conditions (including the presence of a pacemaker), a diagnosis of epilepsy or major psychiatric disorders
Interventions Each participant underwent 1 of the following different stimulation conditions in 2 consecutive sessions on 2 consecutive days in random order (sham tDCS was obligatory)

  1. A‐tDCS for 15 minutes at 1.5 mA over M1 of the lesioned hemisphere

  2. C‐tDCS for 15 minutes at 1.5 mA over M1 of the non‐lesioned hemisphere

  3. Dual‐tDCS for 15 minutes at 1.5 mA, with the anode over M1 of the lesioned hemisphere and the cathode over M1 of the non‐lesioned hemisphere

  4. Sham tDCS (dosage and application not clearly stated, probably as in the other groups)
Outcomes Outcomes were measured at baseline and at the end of intervention period

  1. Nine‐Hole Peg Test‐index (quote: "9HPT‐index=velocity LS/velocity HS∗100")

  2. Maximum pinch and grasp force in kg (measured by specific dynamometers according to the Jamar method, with a higher value indicating greater pinch and grasp force)

  3. Patient satisfaction as measured by the Quebec User Evaluation of Satisfaction with Assistive Technology
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "For the random sequence generation, we used the RAND function in Matlab"
Allocation concealment (selection bias) Low risk Quote: "Specifically, patients were asked to take a sealed envelope from a box, containing a piece of paper with the assignment, which was concealed until the envelope was opened"
Blinding of participants and personnel (performance bias) 
 Subjective outcome measures Unclear risk Quote: "Patients were blinded while physicians and assessors knew the treatment (real or sham)"
Blinding of participants and personnel (performance bias) 
 Objective outcome measures Low risk Quote: "Patients were blinded while physicians and assessors knew the treatment (real or sham)"
Blinding of outcome assessment (detection bias) 
 Subjective outcome measures High risk Quote: "Patients were blinded while physicians and assessors knew the treatment (real or sham)"
Blinding of outcome assessment (detection bias) 
 Objective outcome measures Unclear risk Quote: "Patients were blinded while physicians and assessors knew the treatment (real or sham)"
Incomplete outcome data (attrition bias) 
 Subjective outcome measures Low 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 Low 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