Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?
Maurits H J Hoonhorst, Rinske H M Nijland, Peter J S van den Berg and 3 others
PMID 29972088WHAT IT FOUND
Adding TMS to the SAFE clinical test did not improve 6-month upper-limb prediction.
At 11 days, SAFE plus TMS was better than TMS alone, but not better than SAFE alone.
Key findings
01Within 48 hours, the SAFE model and the SAFE plus TMS model were not significantly different in predicting upper-limb recovery.
02At 11 days, the SAFE plus TMS model was significantly better than the TMS model alone.
03At 11 days, the SAFE plus TMS model was not significantly better than the SAFE model alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 51 patients were recruited, and one was lost to follow-up. The study included only first-ever ischemic hemispheric stroke with severe arm weakness, so it does not apply to brainstem, hemorrhagic, or recurrent strokes. The second assessment was at 11 days, chosen pragmatically because of length of hospital stay. The TMS target muscle, the abductor digiti minimi, was chosen partly for practical reasons, and the authors say this choice was arbitrary compared with other intrinsic hand muscles. All patients received usual Dutch rehabilitation, including early mobilization and daily physical therapy for upper-limb training, gait, and mobility. The contribution of any single rehabilitation component cannot be separated.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the significant difference between the combined model and TMS alone at 11 days as evidence that TMS improves the SAFE clinical prediction. The combined model was not significantly better than SAFE alone, and the study had only 51 patients.