Raghavan 2017.
| Study characteristics | ||
| Methods | RCT Setting: UK, community hospital | |
| Participants | Inclusion criteria: (1) spatial and/or object neglect as identified by asymmetry scores on the Hearts Cancellation test of the Oxford Cognitive Screen (OCS); (2) neglect diagnosis confirmed by multi‐disciplinary team (MDT); (3) between 1 week and within 6 months of the stroke event; (4) medically fit; (5) able to comprehend instructions and provide informed consent as per the opinion of the MDT; (6) ability to concentrate for 20 to 30 minutes as judged by the MDT; (7) no co‐morbid psychological or neurological disorders (e.g. depression, dementia) as judged by the MDT; (8) no contraindications for rTMS administration upon administration of a screening questionnaire Age, years, mean: intervention = 75. 2, SD = 8.5; control = 80.08, SD = 7.1 Sex: intervention 3 women, control 1 woman Time post stroke, days: screening was done on average 19 days (SD = 9 days) after stroke for Intervention group, and 27 days (SD = 21 days) after stroke for control group | |
| Interventions | Magstim Super Rapid magnetic stimulator (Magstim Company, Whitland, Wales, UK) connected to a figure of 8 coil was used to deliver rTMS. The resting motor threshold was defined as lowest intensity of stimulation required to elicit 5 visible motor twitches in the relaxed right hand's first dorsal interosseous muscle, in response to 10 consecutive stimuli. To identify this threshold, the optimal "hotspot‟ in each patient's motor cortex was identified and stimulated (Rossini et al, 2015). rTMS was then provided at 90% of this identified resting motor threshold. Intervention group received 20 minutes of rTMS at 1 Hz (1200 pulses) to the left inferior parietal lobe (P3) of the intact hemisphere Control group received sham stimulation |
|
| Outcomes |
Follow‐up testing on the same cognitive test battery as at baseline was conducted both in the short term, i.e. less than 1 month post rTMS, and in the long term, i.e. at 6 or more months post rTMS |
|
| Notes | Data are from Chapter 5 of thesis | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "Based on computerized randomization" only detail |
| Allocation concealment (selection bias) | Unclear risk | No details |
| Blinding of participants | Unclear risk | No details |
| Blinding of personnel | High risk | Different placement of probe suggests not possible |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No details |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | 2 dropped out of intervention group, 1 from control group |
| Selective reporting (reporting bias) | Low risk | Outcomes reported equally |
| Other bias | Low risk | Nothing obvious. Multiple testing adjustments made |