- Dawson, Jesse;
- Engineer, Navzer;
- Cramer, Steven;
- Wolf, Steven;
- Ali, Rushna;
- ODell, Michael;
- Pierce, David;
- Prudente, Cecília;
- Redgrave, Jessica;
- Feng, Wuwei;
- Liu, Charles;
- Francisco, Gerard;
- Brown, Benjamin;
- Dixit, Anand;
- Alexander, Jen;
- DeMark, Louis;
- Krishna, Vibor;
- Kautz, Steven;
- Majid, Arshad;
- Tarver, Brent;
- Turner, Duncan;
- Kimberley, Teresa
BACKGROUND: Vagus Nerve Stimulation (VNS) paired with rehabilitation improved upper extremity impairment and function in a recent pivotal, randomized, triple-blind, sham-controlled trial in people with chronic arm weakness after stroke. OBJECTIVE: We aimed to determine whether treatment effects varied across candidate subgroups, such as younger age or less injury. METHODS: Participants were randomized to receive rehabilitation paired with active VNS or rehabilitation paired with sham stimulation (Control). The primary outcome was the change in impairment measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score on the first day after completion of 6-weeks in-clinic therapy. We explored the effect of VNS treatment by sex, age (≥62 years), time from stroke (>2 years), severity (baseline FMA-UE score >34), paretic side of body, country of enrollment (USA vs UK) and presence of cortical involvement of the index infarction. We assessed whether there was any interaction with treatment. FINDINGS: The primary outcome increased by 5.0 points (SD 4.4) in the VNS group and by 2.4 points (SD 3.8) in the Control group (P = .001, between group difference 2.6, 95% CI 1.03-4.2). The between group difference was similar across all subgroups and there were no significant treatment interactions. There was no important difference in rates of adverse events across subgroups. CONCLUSION: The response was similar across subgroups examined. The findings suggest that the effects of paired VNS observed in the VNS-REHAB trial are likely to be consistent in wide range of stroke survivors with moderate to severe upper extremity impairment.