Clinical Efficacy and Preliminary Cost-Utility of Low-Frequency Repetitive Transcranial Magnetic Stimulation Versus Sham Stimulation for Neurogenic Overactive Bladder in Stroke Survivors: A Randomized Controlled Trial.

Single-site study of 60 stroke survivors, so generalizability to other settings is uncertain. Follow-up was only 8 weeks, so long-term durability for chronic neurogenic overactive bladder is unknown. The trial compared active rTMS with sham, not with standard care, so it cannot establish that rTMS is better than usual bladder management. The between-group bladder symptom score difference was 1.66 and 1.81 points, below the 3-point minimal clinically important difference, even though the active group improved 4.31 points from baseline. No formal blinding assessment was done, so participants may have guessed their group and influenced subjective outcomes. Qualitative interviews included only active-group participants, so the themes describe their experience and do not compare them with sham participants. Randomization was not stratified by sex, and the groups had different sex distributions, so sex effects are unclear. Three participants were lost to follow-up at week 8 and their data were imputed.

The Hong Kong Polytechnic University funded the study through the Dean's Reserve, Faculty of Health and Social Sciences, Department of Rehabilitation Sciences. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication.

Do not conclude that the bladder symptom improvement versus sham met the clinical threshold. The between-group difference was 1.66 and 1.81 points, below the 3-point minimal clinically important difference, although the active group's own baseline-to-week 8 change was 4.31 points.