Background: Large scale clinical trials demonstrating the efficacy of repetitive transcranial magnetic stimulation (rTMS) for post-stroke functional motor recovery are lacking. Missing consensus regarding the optimal protocol for rTMS in stroke has been a challenge for trial design. 
Objective: To develop consensus recommendations for the use of rTMS as an adjunct intervention for upper extremity motor recovery in stroke rehabilitation trials.
Methods: The multidisciplinary Consensus Working Group of clinicians and researchers from across Canada identified four consensus themes: 1) patient population; 2) stimulation parameters; 3) rehabilitation interventions; and 4) outcome measures. Comprehensive evidence reviews for each theme were conducted and a weighted dot-voting procedure was used to achieve consensus. 
Results: The following consensus recommendations were reached: 1) recruit cortical and subcortical stroke patients between 2 and 12 weeks after stroke who have been identified to need upper extremity rehabilitation 2) randomization to receive 1800 pulses of 1Hz rTMS over contralesional M1 at 120% of RMT or sham stimulation 3)  followed by 60 minutes of a controlled treatment with known effects (GRASP), for a total of 15 sessions. 4) use of a suite of validated core primary outcome measures of impairment, function and ability as well as subjective patient-centered and real-world actigraphy secondary outcomes and MR imaging biomarkers and MEP parameters as exploratory outcomes.   
Conclusions: Establishing the CanStim platform and developing these consensus recommendations for an rTMS protocol for clinical trials is a first step toward the translation of non-invasive brain stimulation technologies into the clinic to enhance stroke recovery.

CANADIAN PLATFORM FOR TRIALS IN NON-INVASIVE BRAIN STIMULATION (CANSTIM) CONSENSUS RECOMMENDATIONS FOR REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN UPPER EXTREMITY MOTOR STROKE REHABILITATION TRIALS