Pan 2018.

Study characteristics
Methods	Study type: interventional (clinical trial) Primary purpose: treatment
Participants	170 participants Country: China Setting: inpatient At randomisation number allocated: 170, paroxetine (n = 85); usual care (n = 85) % male: paroxetine (71.8); usual care (unclear) Age: mean age paroxetine = 65.6 ± 7.56; placebo = unclear Subtype of stroke: not stated. Severity of stroke: NIHSS, Median (IQR): paroxetine 8 (6 – 10); usual care (unclear) Time since stroke onset: within 1 week Inclusion criteria Age between 50 and 80 years old Diagnostic criteria met (Fourth National Cerebrovascular Disease Conference) and confirmation by MRI Ability to participate in assessments within 1 week of stroke onset FMMS score of < 55 points MoCA score of < 26 points Exclusion criteria NIHSS score > 20 points Aphasia History of pre‐stroke depression and taken antidepressants or benzodiazepines HAMD score > 7 points Receipt of thrombolytic therapy Complications such as infection, bed sores, or heart failure that might affect rehabilitation Withdrawal criteria: not stated
Interventions	Experimental: orally administrated paroxetine at dosages of 10 mg/day during week 1 and 20 mg/day thereafter, for a total treatment duration of 3 months Comparator: usual care
Outcomes	Outcomes were collected at 15, 90 and 180 days Movement assessed using FMMS Cognitive impairment assessed using the MoCA Depression assessed using HAMD
Funding source	No grant funding from any grant funding agency, commercial or not‐for‐profit organisations
Notes	There is no study protocol/trial register reference Baseline sociodemographic and clinical characteristics are provided only for those who completed the study The authors state that one of the inclusion criteria is MOCA score of < 26 points. In the Results section they state that there were "72 cases of cognitive impairment" (i.e. a MoCA score of < 26 points) in the comparator group and 82 in the experimental group at days 15, 90 and 180. This suggests that either that the inclusion criteria were not strictly adhered to or if 100% of participants had a MoCA score of < 26 points at baseline then 10/82 participants in the comparator group and 3/85 in the experimental group have improved on the MoCA between days 0 and 15 Dates study conducted: participants recruited between January 2012 and June 2014 Declarations of interest: none reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "Random number table"
Allocation concealment (selection bias)	Unclear risk	Insufficient information to judge high or low
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Insufficient information to judge high or low
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "All scale evaluators were trained and tested by the main investigator and were blind to the group assignment."
Incomplete outcome data (attrition bias) All outcomes	Low risk	All data available for all participants in the experimental group (n = 85/85) and data available for (n = 82/85) participants in the comparison group for the Fugl–Meyer Motor Scale and the HAMD score For the MoCA (see 'Other bias' below) < 5% overall loss to follow‐up
Selective reporting (reporting bias)	Unclear risk	There is no study protocol/trial register reference, so insufficient information to judge high or low
Other bias	High risk	The authors state that one of the inclusion criteria is Montreal Cognitive Assessment (MoCA) score of < 26 points. In the Results section they state that there were "72 cases of cognitive impairment" (i.e., a MoCA score of < 26 points) in the comparator group and 82 in the experimental group at days 15, 90 and 180. This suggests that either that the inclusion criteria were not strictly adhered to or, if 100% of participants had a MoCA score of < 26 points at baseline then 10/82 participants in the comparator group and 3/85 in the experimental group have improved on the MoCA between days 0 and 15. The results 'Comparison of MoCA scores' and table 3 suggests otherwise