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. 2022 Aug 5;2022(8):CD011887. doi: 10.1002/14651858.CD011887.pub3

Celnik 2008.

Study characteristics
Methods Randomized cross‐over trial
Participants Methods of recruitment were not reported by authors
9 participants in a cross‐over design with 3 arms:
  1. 9 in physical training group;

  2. 9 in physical training and congruent AO group;

  3. 9 in physical training and incongruent AO group.


Inclusion criteria: stroke patients with single unilateral cortical or subcortical lesions
Exclusion criteria: there were no exclusion criteria described in the study
Mean (SD) age: not reported by authors
Stroke details: not reported by authors
Stroke phase: chronic
Interventions Physical training group: performed voluntary thumb movements
Physical training and congruent AO group: observed a video displaying thumb movements in the same direction to that physically practiced simultaneously
Physical training and incongruent AO group: observed a video displaying thumb movements in a direction opposite to that physically practiced simultaneously
Sessions were 30 minutes, 3 blocks of 10 minutes each separated by 2‐minute rest
Outcomes Outcomes recorded before and after intervention
  1. Corticomotor excitability: MEP of agonist and antagonist muscles

Notes The authors declared no potential conflicts of interest.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "The allocation was generated randomly using Excel creating a random session order for each of the subjects and conditions."
Allocation concealment (selection bias) Unclear risk The author did not make it clear whether there was allocation concealment.
Blinding of participants and personnel (performance bias)
All outcomes Low risk No blinding, but the outcome is not likely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias)
All outcomes Low risk Quote: "The outcome measures were analyzed by a blinded individual who did not participate in the data acquisition."
Incomplete outcome data (attrition bias)
All outcomes High risk One participant could not complete the protocol due to TMS‐related headache. The reasons were provided, but the exclusion of 1/9 participants in a cross‐over design, with 3 arms, may have affected the reliability of study results.
Selective reporting (reporting bias) Low risk There is no trial registration, but the outcomes are significant, and there is no selective reporting within the study.
Other bias Low risk No other potential risk of bias was found.