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

Wang 2014.

Methods Study design: RCT
Number of dropouts: not stated
Number of adverse effects: 3 (mild tingling)
Deaths: none
ITT: unclear
Participants Country: USA
Sample size: 9 participants
Inclusion criteria: aged between 18 and 90 years; first time clinical ischaemic or haemorrhagic stroke, radiologically confirmed; > 20° wrist extension and > 10° finger extension (all fingers); time since stroke more than 1 month prior to study enrolment
Exclusion criteria: significant prestroke disability; advanced or terminal disease; substantial decrease in alertness, language reception or attention interfering with understanding instructions; contraindications to TMS; history of alcohol/drug abuse; participation in another study targeting stroke recovery; use of neuropsychotropic drugs (monoamine oxidase‐inhibitors); epilepsy; marked agitation/anxiety; having already received MP or tDCS treatment; pregnancy
Interventions 3 arms
  1. Real tDCS plus placebo MP: A‐tDCS with the anode placed over M1 of the affected hemisphere (1 mA for 20 minutes) and the cathode placed over contralateral M1 plus placebo MP 1 hour prior to stimulation once

  2. Sham tDCS plus MP: sham tDCS with the anode placed over M1 of the affected hemisphere (1 mA for 10 seconds) and the cathode placed over contralateral M1 plus 20 mg of MP 1 hour prior to stimulation once

  3. Real tDCS plus MP: A‐tDCS with the anode placed over M1 of the affected hemisphere (1 mA for 20 minutes) and the cathode placed over contralateral M1 plus 0 mg of MP 1 hour prior to stimulation once

Outcomes Outcomes were measured at baseline, immediately after the intervention and 30 minutes after the end of intervention
  1. TMS (cortical excitability)

  2. PPT (hand function)

Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote: "Subjects were randomly assigned to 1 of 3 groups"
Allocation concealment (selection bias) Unclear risk Not described by the authors
Blinding of participants and personnel (performance bias) 
 Subjective outcome measures Low risk There were no subjective outcome measures
Blinding of participants and personnel (performance bias) 
 Objective outcome measures Low risk Participants were blinded; blinding of personnel not described, however the review authors judge that the outcome measurement is not likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias) 
 Subjective outcome measures Low risk There were no subjective outcome measures
Blinding of outcome assessment (detection bias) 
 Objective outcome measures Low risk Quote: "A blinded rater measured safety, hand function, and cortical excitability before and after treatment"
Incomplete outcome data (attrition bias) 
 Subjective outcome measures Low risk There were no subjective outcome measures
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 listed in the methods section reported