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. 2021 Jul 1;2021(7):CD003586. doi: 10.1002/14651858.CD003586.pub4

Nyfeller 2019.

Study characteristics
Methods RCT
Setting: Switzerland, neurorehabilitation centre
Participants 60 patients with a first, right hemispheric stroke participated in the study
Age, years: sham = 70.6 ± 11.44, 8cTBS = 67.8 ± 10.13, 16cTBS = 74.3 ± 10.23
Sex (men/women): sham = 7/3, 8cTBS = 5/5, 16cTBS = 6/4
Time post stroke, days: sham = 25.8 ± 11.26, 8cTBS = 26.8 ± 20.89, 16cTBS = 22.9 ± 10.34
Interventions In brief, the cTBS protocol comprised 801 pulses, delivered in a continuous train of 267 bursts. Each burst consisted of 3 pulses at 30 Hz, repeated at 6 Hz. Duration of 1 single cTBS train was therefore 44 seconds
In the 16cTBS group, the same daily protocol was repeated 4 times, i.e. 16 cTBS trains were applied over 4 days
In the 8cTBS group, 8 cTBS trains were applied over 2 days. Four cTBS trains were applied on Day 1 (2 cTBS trains with an interval of 15 minutes, third and fourth cTBS trains 60 and 75 minutes after the first one, respectively (Cazzoli et al, 2012), and 4 cTBS trains on Day 2 ‐ same time intervals as for Day 1, repeated after 24 hours)
Sham stimulation was applied with the same 8cTBS protocol as described above, except for use of a sham coil
Outcomes
  • CBS

  • Fluff test

  • Two‐Part‐Picture test

  • Bird cancellation task


Assessed pre‐intervention, post intervention, and 3 months post intervention
Notes We entered this study as Nyfeller 2019 8c TBS and Nyfeller 2019 16c TBS and spilt the control group across entries
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk The randomisation procedure was carried out by a blinded collaborator (TP), using a computerised block randomisation protocol to ensure equal group sizes (https://www.random.org/ integer‐sets)
Allocation concealment (selection bias) Low risk Treatment allocation was concealed from trained observers
Blinding of participants Low risk “Double‐blind”
Blinding of personnel Unclear risk Unclear
Blinding of outcome assessment (detection bias)
All outcomes Unclear risk CBS was completed by rehabilitation nurses taking care of patients on a daily basis, who were blind with respect to the experimental protocol, and who observed patients performing different ADL. Unknown whether blinding was successful
Incomplete outcome data (attrition bias)
All outcomes Unclear risk 3 dropped out at T2, unclear from which group though
Selective reporting (reporting bias) Low risk Outcomes reported equally
Other bias Low risk Nothing obvious