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

Kim 2010.

Methods Study design: double‐blind sham‐controlled multicentre randomised trial
Dropouts: 1 participant discontinued treatment because of dizziness and another because of headache (2 out of 20) during follow‐up
Adverse effects: none
Deaths: none
ITT: no
Participants Country: Republic of Korea
Number of participants: 20 participants from neurorehabilitation units at 2 tertiary university hospitals
Age: (mean ± SD) 57.27 ± 4.95
Gender: 7 female (35%)
Type of stroke: first‐ever cortical or subcortical ischaemic stroke
Time poststroke: (mean ± SD) A‐tDCS group: 34 ± 27.1 days; C‐tDCS: 19.4 ± 9.3 days; sham tDCS: 22.9 ± 7.5 days
Severity: mild to moderate motor deficits (MRC score ≥ 2)
Inclusion criteria: first‐ever ischaemic strokes in the cortical or subcortical area within the previous 2 months and mild to moderate motor deficits (MRC score ≥ 2)
Exclusion criteria: cerebellar or brainstem lesions; presence of a metallic foreign body implant, such as a pacemaker or an artificial cochlea; history of seizure or another unstable medical condition; severe language disturbance; neglect, depression or cognitive deficits (based on the MMSE, 10 of 30 points) that would limit participation; history of severe alcohol or drug abuse; previous stroke that resulted in residual disability; premorbid arm impairment; and hemiplegic shoulder pain; use Na+ or Ca2+channel blockers or NMDA receptor antagonists
Interventions Number of arms: 3
Each participant received 10 sessions (5 times per week for 2 weeks during conventional occupational therapy aiming at improving the co‐ordination and strength of the paretic hand) of 1 of the following interventions:
  1. A‐tDCS over the primary motor cortex (M1) of the contralateral FDI muscle of the lesioned hemisphere (2 mA for 20 minutes)

  2. C‐tDCS over the M1 of the ipsilateral FDI of the non‐lesioned hemisphere (2 mA for 20 minutes)

  3. Sham tDCS over the M1 of the contralateral FDI (for 20 minutes)

Outcomes Outcomes used: FMA 0 to 66 (with higher scores indicating better function) for assessing upper limb motor function and MBI 0 to 100 (with higher scores indicating better global function)
Time point of measurement: at baseline, 1 day and 6 months after intervention
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "Patients were randomly assigned to one of the three groups (atDCS, ctDCS or Sham treatment) using a stratified randomisation procedure with permuted block size of 3 and an algorithm that balanced Brunnstrom stages"
Allocation concealment (selection bias) Low risk Quote: "Sealed opaque envelopes were used for randomisation"
Blinding of participants and personnel (performance bias) 
 Subjective outcome measures Low risk Participants and personnel were blinded
Blinding of participants and personnel (performance bias) 
 Objective outcome measures Low risk Participants and personnel were blinded
Blinding of outcome assessment (detection bias) 
 Subjective outcome measures Low risk Quote: "Two independent raters blinded to the type of intervention performed outcome measurements"
Blinding of outcome assessment (detection bias) 
 Objective outcome measures Low risk Quote: "Two independent raters blinded to the type of intervention performed outcome measurements"
Incomplete outcome data (attrition bias) 
 Subjective outcome measures Unclear risk 1 participant of each interventional arm (14% each) discontinued intervention; we excluded these participants from analysis
Incomplete outcome data (attrition bias) 
 Objective outcome measures Unclear risk 1 participant of each interventional arm (14% each) discontinued intervention; we excluded these participants from analysis
Selective reporting (reporting bias) Unclear risk All outcomes reported in the methods section reported