Wang 2004b.

Study characteristics
Methods	Study design: RCT Method of randomisation: not stated
Participants	Number of participants: n = 50 Inclusion criteria: "Satisfied the 1995 Fourth National Conference on Cerebral Vascular Disease classification guidelines, confirmed by CT or MRI scan, first ever stroke, within 4 months since stroke onset, spastic hemiplegic limbs and between 1‐3 for Ashworth assessment" Exclusion criteria: "Impairment in consciousness, psychology, cognition, agnosia, apraxia, Parkinson’s disease, epilepsy, electrolyte imbalance, cardiac pacemaker, severe malnutrition, severe cardiorespiratory disease and participants with poor adherence"
Interventions	(1) Treatment group (n = 25) "Both groups were given routine drug treatment and basic rehabilitative training, looking over brain circulation, anti‐coagulation, nutrition and rest, electrolyte balance, prevention of various secondary complications; maintaining optimal limb positioning, passive and active joint range of motion, tissue massage etc. Patients in the treatment group had additional neural facilitation combined with the use of the muscular spasm machine, following the characteristics of the stages of spasticity. Prior to neural facilitation, patients had to undergo relaxation. Neural facilitation training included prone positioning, slow traction to relax tensed muscles; striking spastic muscles including both agonists and antagonists to restore the appropriate muscular balance; traction to muscles and gentle striking to the muscle belly, guiding the affected limbs to exercise, so as to stimulate a balancing reaction, overcoming over activated muscles and compensatory movements; using co‐contraction principles, allowing resistive forces exerted during flexion and extension of the non‐affected upper limb to illicit flexion and extension of the affected upper limb, and assisting or encouraging the patient to actively flex and extend the limb; making use of asymmetric tonic neck reflex mechanisms, reducing the tone in both upper and lower limbs and stimulating limb movement by rotating the patient’s neck, holding on to the lower limbs while moving them with momentum, or through reverse action by moving the non‐affected shoulder and elbow joints rhythmically so as to reduce muscle tension; making use of body weight to optimise ankle joint integrity; stretching the thumb and externally rotating the forearm to reduce tension in the wrist joint and finger flexors; using cold and hot sensations etc to stimulate and activate contraction of relevant muscles, suppress spasticity etc, compressing the joint to reduce tension, reducing spasticity etc. Low‐frequency pulse current treatment: using a Beijing manufactured KX‐3A model for spasticity treatment" The individual components delivered are listed in Table 6. Based on the individual components, this intervention is categorised as comprising modality, musculoskeletal intervention (passive) and musculoskeletal (active) and neurophysiological intervention Length of intervention period: four weeks Number of sessions and length of individual sessions: 30 to 45 minutes/session, one session/d, five/wk Intervention provider: doctor, nurse (2) Control group (n = 25) "Both groups were given routine drug treatment and basic rehabilitative training, looking over brain circulation, anti‐coagulation, nutrition and rest, electrolyte balance, prevention of various secondary complications; maintaining optimal limb positioning, passive and active joint range of motion, tissue massage etc" The individual components delivered are listed in Table 6. Based on the individual components, this intervention is categorised as usual care (musculoskeletal intervention (passive)) Length of intervention period: not stated Number of sessions and length of individual sessions: not stated Intervention provider: not stated This study was classified as intervention (musculoskeletal (active), musculoskeletal (passive), neurophysiological) versus usual care (musculoskeletal (passive)) (Table 8). The intervention group also received modality
Outcomes	Measures of motor function: Fugl‐Meyer Assessment Measures of tone or spasticity: Ashworth Scale Time points when outcomes were assessed: at enrolment and after four weeks of intervention
Notes	Original study translated from Chinese to English
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information provided
Allocation concealment (selection bias)	High risk	Study implementation by authors
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcome assessment by authors
Incomplete outcome data (attrition bias) All outcomes	Low risk	No dropouts
Free of systematic differences in baseline characteristics of groups compared?	Low risk	No significant baseline differences
Did authors adjust for baseline differences in their analyses?	Low risk	No information provided
Other bias	Unclear risk	No information provided