Upper-Limb Recovery After Stroke: A Randomized Controlled Trial Comparing EMG-Triggered, Cyclic, and Sensory Electrical Stimulation.

The study did not reach its planned sample size because of slow recruitment, so it may have missed a real difference. At the extremes of the confidence intervals, FMA differences could exceed the lower estimate of the minimum clinically important difference. The minimum clinically important differences for the wrist and hand FMA subscale and the mAMAT were not established. Sensory stimulation was not a true placebo, because sensory stimulation alone can reduce motor impairment. Participants and treatment therapists were not blinded, although the outcome assessor was blinded. Concurrent physical and occupational therapy, and other treatments such as botulinum toxin, baclofen, shoulder injections, sling, or splint, were not limited. The improvements seen in all groups cannot be clearly attributed to the assigned stimulation rather than spontaneous recovery or concomitant therapy. Adherence to prescribed stimulation was lower in the EMG-triggered NMES group. One participant delayed the 1, 3, and 6 month follow-up assessments to 9 months, and these data were included.

The supplied article text does not include a conflicts-of-interest or funding declaration. The supplied publication types list Research Support, N.I.H., Extramural.

Do not read the significant score increases as proof that EMG-triggered or cyclic NMES works. All groups improved, including sensory stimulation, and the primary outcome showed no significant difference among the groups.