title: Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo-controlled trial in chronic stroke patients.
abstract: BACKGROUND
  Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke. However, its clinical value, including anticipated size and duration of the treatment effects, remains largely unknown.
  
  
  OBJECTIVE
  The authors designed a small semi-randomized clinical trial to explore whether long-lasting clinically important gains can be achieved by adding theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS), to a rehabilitation program for the hand.
  
  
  METHODS
  A total of 41 chronic stroke patients received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers; each active group was compared with a group receiving sham TBS. TBS was followed by physical therapy for 10 working days. Patients and therapists were blinded to the type of TBS. Primary outcome measures (9-hole Peg Test [9HPT], Jebsen Taylor Test [JTT], and grip and pinch-grip dynamometry) were assessed 4, 30, and 90 days post treatment. The clinically important difference was defined as 10% of the maximum score.
  
  
  RESULTS
  There were no differences between the active treatment and sham groups in any of the outcome measures. All patients achieved small sustainable improvements--9HPT, 5% of maximum (confidence interval [CI] = 3%-7%); JTT, 5.7% (CI = 3%-8%); and grip strength, 6% (CI = 2%-10%)--all below the defined clinically important level.
  
  
  CONCLUSIONS
  Cortical stimulation did not augment the gains from a late rehabilitation program. The effect size anticipated by the authors was overestimated. These results can improve the design of future work on therapeutic uses of TMS.
authors.affiliation: Sobell Department, UCL Institute of Neurology, London WC1N 3BG, UK. p.talelli@ion.ucl.ac.uk
authors.forename: Penelope
authors.initials: P
authors.lastname: Talelli
authors.forename: Amanda
authors.initials: A
authors.lastname: Wallace
authors.forename: Michelle
authors.initials: M
authors.lastname: Dileone
authors.forename: Damon
authors.initials: D
authors.lastname: Hoad
authors.forename: Binith
authors.initials: B
authors.lastname: Cheeran
authors.forename: Rupert
authors.initials: R
authors.lastname: Oliver
authors.forename: Mehdi
authors.initials: M
authors.lastname: VandenBos
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hammerbeck
authors.forename: Karen
authors.initials: K
authors.lastname: Barratt
authors.forename: Cecilia
authors.initials: C
authors.lastname: Gillini
authors.forename: Gabriella
authors.initials: G
authors.lastname: Musumeci
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Boudrias
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Cloud
authors.forename: Joanna
authors.initials: J
authors.lastname: Ball
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Marsden
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Ward
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Lazzaro
authors.forename: Richard G
authors.initials: RG
authors.lastname: Greenwood
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D010147:Pain Measurement; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*