Abstract Number: Esoc2026a1075 Repetitive Transcranial Magnetic Stimulation-Enhanced Upper Limb Recovery After Stroke Improves Mood and Perceived Recovery: Secondary Outcomes of the B-Stars Trial

Abstract Background and aims We showed that contralesional continuous theta-burst stimulation (cTBS), a form of repetitive transcranial magnetic stimulation, enhances upper-limb motor recovery after stroke in the randomized controlled trial B-STARS (Vink et al., 2023, Stroke), but indirect effects on psychological well-being and perceived recovery are unknown. Methods Adults with first-ever stroke and upper-limb paresis were randomized to receive ten sessions of active or sham contralesional cTBS over two weeks, in addition to standard inpatient rehabilitation. Psychological well-being and self-reported recovery were assessed using the Hospital Anxiety and Depression Scale (HADS) and Stroke Impact Scale, respectively, at baseline, one month post-treatment, and three and six months post-stroke. Statistical analysis was performed using mixed models for repeated measures. Results Sixty patients were randomized to active (n = 29) or sham treatment (n = 31). Patients who received active cTBS showed a clinically relevant improvement in HADS score one month post-treatment compared to sham (mean difference (MD) = –2.2; 95% confidence interval (95%CI) –4.2 to –0.2; P = 0.034; Figure 1A). This effect was specific for depressive symptoms (MD = –1.4; 95%CI –2.5 to –0.2; P = 0.024). No treatment effect was observed at the other timepoints. Upper limb recovery was associated with the HADS score one month post-stroke (beta = -0.12; P = 0.002), but not at 6 months post-stroke. Patient-reported recovery was higher in the active treatment group six months post-stroke (MD = 10.3%; 95%CI 0.9 to 19.7; P = 0.033; Figure 1B). Conclusions Contralesional cTBS-induced upper limb recovery leads to a temporary clinically relevant improvement in psychological well-being during inpatient rehabilitation and impacts patient’s sense of overall recovery chronically. Conflict of interest Bart van der Worp reports fees for consultancy for Boehringer Ingelheim, Bayer, and TargED, all paid to his institution. The other authors have no declarations of interest. Figure 1 - belongs to Results