Kim 2018.
Study characteristics | ||
Methods | RCT, 3‐group parallel Setting: Korea, 'patients receiving rehabilitation' | |
Participants | Patients with left hemi‐spatial neglect due to first stroke, right hemisphere stroke, no cognitive decline, muscle strength > 2, no visual defect, sitting balance to perform intervention Age, years: intervention 1 = 70.3 ± 9.6, intervention 2 = 66.6 ± 12.2, intervention 3 = 62.5 ± 16.5 Men/women: intervention 1 = 5/5, intervention 2 = 5/5, intervention 3 = 5/5 Time post stroke, days: intervention 1 = 19.2 ± 13.4, intervention 2 = 24.5 ± 22.4, intervention 3 = 15.3 ± 9.8 | |
Interventions | Intervention 1: rTMS therapy with a coil stimulator shaped like a figure 8 at diameter of 70 mm using MagPro (MagVenture Inc., Farum, Denmark). Session included 900 stimuli applied over contralesional posterior parietal cortex at an intensity of 95% motor thresholds and a frequency of 0.9 Hz Intervention 2: patients in the robot group received additional treatment for hemi‐spatial neglect using a rehabilitation robot (Neuro‐X; Apsun Inc., Seoul, Korea) for upper limbs. During robot therapy, patients sat on the right side of the robot with the robot’s monitor on their left side. Robot therapy programme was conducted through games that induced passive and active assistive range of motion of the wrist, elbow, and shoulder joints. These games consisted of 2 isometric exercises and 2 range of motion exercises. The 2 isometric exercises used wrist extension and wrist flexion, in which the default muscle strength for wrist extension and wrist flexion were measured quantitatively before the start of the game, so the game was continued only when a force exceeding a certain level of strength was applied Intervention 3: rTMS + upper limb robot |
|
Outcomes |
Measured before and after intervention |
|
Notes | ||
Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk | Computer‐generated randomisation table |
Allocation concealment (selection bias) | High risk | No mention of concealment, but blocks of size 3 highly predictable |
Blinding of participants | High risk | No sham for either intervention |
Blinding of personnel | High risk | No sham for either intervention |
Blinding of outcome assessment (detection bias) All outcomes | High risk | “Occupational therapist who did not directly participate in the treatment”, but patient clearly aware |
Incomplete outcome data (attrition bias) All outcomes | High risk | Early discharges excluded from analyses |
Selective reporting (reporting bias) | Low risk | Outcomes reported in equal detail |
Other bias | Low risk | Nothing obvious |