Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

Abstract Background Virtual reality and arm cycling have been reported as effective treatments for improving upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, has increasingly used However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated virtual reality-based training (VCT) function Methods randomized controlled trial, 23 stroke were recruited. Each patient received either 15 sessions or sham addition to VCT same day. Outcome measures assessed before after intervention. Primary outcome improvement spasticity Fugl-Meyer Assessment-Upper Extremity (FMA-UE) Modified Ashworth Scale Upper-Extremity (MAS-UE). Secondary activity participation Action Research Arm Test (ARAT), Nine Hole Peg (NHPT), Box Block (BBT) Motor Activity Log (MAL), Stroke Impact (SIS). Wilcoxon signed-rank tests performed evaluate effectiveness intervention Mann–Whitney U conducted compare therapeutic effects between two groups. Results At post-treatment, both groups showed significant FMA-UE ARAT, while only + group demonstrated MAS-UE, BBT, NHPT, MAL SIS. The revealed that presented greater than significantly MAL-AOU there no differences changes FMA-UE, NHPT MAL-QOM Conclusions TBS efficacy reducing spasticity, increasing actual use affected limb, daily life patients. This study provided an integrated innovative intervention, which may be a promising therapy improve rehabilitation. small sample size, thus further larger-scale is warranted confirm treatment efficacy. Trial registration trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, November 22, 2017