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. 2019 Nov 30;2019(11):CD011968. doi: 10.1002/14651858.CD011968.pub3

Zifko 2002.

Methods Study design: RCT
Study grouping: parallel groups
Participants 18 participants after stroke with spastic hemiparesis (mean age 60.8 years; 9 women, 9 men; 3 to 12 months after stroke)
Interventions Intervention characteristics
Active rPMS
  • Frequency: 20 Hz

  • Intensity: 40% of maximal stimulator output

  • Stimulation session: train duration of 20 second, and intertrain interval of 12 seconds

  • Duration of stimulation (per session): 240 seconds

  • Number of stimulations (per session): 4000 pulses

  • Number of sessions in treatment: 20 (1 time a day, 5 times a week, for 4 weeks)

  • Target of stimulation: extensors digitorum communis muscles

  • Co‐exercise: none


Sham rPMS
  • Frequency: 20 Hz

  • Intensity: 0% (used placebo coil that produced a similar noise without the magnetic field)

  • Stimulation session: train duration of 3 seconds, and intertrain interval of 3 seconds

  • Duration of stimulation (per session): 240 seconds

  • Number of stimulations (per session): 4000 pulses

  • Number of sessions in treatment: 20 (1 time a day, 5 times a week, for 4 weeks)

  • Target of stimulation: extensors digitorum communis muscles

  • Co‐exercise: none

Outcomes Upper limb function: angle of motion for hand extension and hand flexion (degree)
  • Outcome type: continuous

  • Direction: higher is better

  • Assessment time point: unclear


Upper limb function: Action Research Arm Test (scores range from 0 to 57 points)
  • Outcome type: continuous

  • Direction: higher is better

  • Assessment time point: unclear


Upper limb function: Bard and Hirschberg Score
  • Outcome type: continuous

  • Direction: higher is better

  • Assessment time point: unclear


Spasticity: Ashworth Score (scores range from 0 to 4)
  • Outcome type: ordinal

  • Direction: lower is better

  • Assessment time point: after intervention


Spasticity: Gerstenbrand Spasticity Rating Scale
  • Outcome type: continuous

  • Direction: lower is better

  • Assessment time point: unclear

Identification Sponsorship source: n/a
Country: Austria
Setting: n/a
Authors' names: Zifko UA, Morph M, Diem K, Havel PM, Struppler A
Institution: Rehabilitationsklinik Pirawarth, Bad Pirawarth, Austria
Email: n/a
Address: n/a
Notes
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk No information
Allocation concealment (selection bias) Unclear risk No information
Blinding of participants and personnel (performance bias) 
 All outcomes Unclear risk The abstract states "double‐blind study". However, there was no information on blinding for personnel
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk The abstract states "double‐blind study"
Incomplete outcome data (attrition bias) 
 All outcomes Unclear risk Loss to follow‐up 11%
Selective reporting (reporting bias) Unclear risk Protocol was not available
Other bias Low risk No other biases

CNS: central nervous system.
 CT: computed tomography.
 ITT: intention‐to‐treat.
 MRI: magnetic resonance imaging.
 RCT: randomised controlled trial.
 rPMS: repetitive peripheral magnetic stimulation.