Discussion
USN, stroke
STROKE
In this study, we observed that the main barriers to participation in a randomized clinical trial of noninvasive brain stimulation to treat USN in a developing country were clinical barriers, such as spontaneous USN recovery between the hospital discharge and start of the trial, clinical instability, significant cognitive changes, and limitations for tDCS applications. In addition, social barriers were identified, as a considerable proportion of patients had socioeconomic problems related to difficulty with transportation, lack of caregivers to accompany them to sessions, lack of telephone contact, low interest in participating in the research, or failure to attend scheduled evaluations.Difficulties in identifying the neurological recovery phase and standardization of terminology are frequently reported in clinical trials of rehabilitation in stroke patients (Ko et al. (Despite not being formal exclusion criteria, our study also demonstrated important socioeconomic barriers, such as difficulty with transportation and the absence of caregivers to accompany the patients to tDCS and physical therapy sessions. In the original protocol proposal (In addition, the failure to attend scheduled evaluations and lack of interest in trial participation and adherence to treatment negatively impacted the study protocol. Health in developing countries is not considered a priority, as the patient and caregiver often do not recognize the importance of rehabilitation due to the lack of an adequate support network for health information (We observed that both clinical and socioeconomic factors acting as barriers to rehabilitation trial participation in developing countries are modifiable by public health policies, constant training of health teams, and continuing health education for the population. This study is of great relevance, as these barriers must be considered during the methodological planning of a neurorehabilitation trial in developing countries. Based on our findings, patients with USN should be included in the first three months to take advantage of the learning window and brain plasticity, as this would increase the rate of included patients and reduce the effect of USN spontaneous recovery. In addition, researchers should consider using a different screening method than just using a BIT-C cutoff score because other types of USN may not be included in future clinical trials if using only one assessment tool (