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Placebo effect of rTMS on post-stroke motor rehabilitation: a meta-analysis

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Abstract

Previous studies have shown that placebo repetitive transcranial magnetic stimulation (rTMS) was effective on post-stroke motor rehabilitation. However, the placebo effect has not been systematically assessed. Therefore, this meta-analysis was conducted to resolve this issue and explore potential influencing factors further. PubMed, Embase, web of science and the Cochrane Library were searched for published randomised controlled trials (RCTs) with placebo rTMS treatment of stroke recovery until May 2019. The placebo effect size (Hedges’ g) was estimated using the motor outcome of pre- and post- placebo rTMS treatment. Meta-regression analysis was also performed to explore potential influencing factors for the placebo effect. Twenty-six placebo-controlled trials (including 381 patients in placebo group) were selected. Effect size results (Hedges’ g = 0.466, 95% CI 0.207–0.726; P < 0.05) showed a medium and significant placebo rTMS effect on improving post-stroke motor recovery. The mean ratio of the effect size of sham to real stimulation was 56%. Meta-regression analysis did not find significant result except for the treatment sessions, which was significantly correlated with the placebo effect size (r = 0.465, p = 0.031). In the follow-up observations (1, 2 and 3 months), the sham rTMS groups manifested gradually increased motor improvement, which was similar to the real group, but the amplitude was lower, which was sustained for at least 3 months. Placebo effect of rTMS on post-stroke motor recovery was medium but significant. Regarding different sham styles, the number of stimulation sessions had an impact on the effect.

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Funding

This work was supported by Sichuan Medical Association (Q17049) and Bureau of Science and Technology Nanchong (18SXHZ0306).

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  1. Yu Jin and Ting Pu are co-first authors.

Authors and Affiliations

  1. Department of Radiology and Institute of Rehabilitation and Imaging of Brain Function, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, 97 South Renmin Road, Shunqing District, Nanchong, 637000, Sichuan, China

    Yu Jin, Zhiwei Guo, Binghu Jiang & Qiwen Mu

  2. Department of Big Data Center, Sichuan Cancer Hospital and Institute, Chengdu, 610000, China

    Ting Pu

  3. Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China

    Qiwen Mu

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  1. Yu Jin
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Jin, Y., Pu, T., Guo, Z. et al. Placebo effect of rTMS on post-stroke motor rehabilitation: a meta-analysis. Acta Neurol Belg 121, 993–999 (2021). https://doi.org/10.1007/s13760-020-01460-w

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