Abstract

Background

Sensory impairments significantly limit the ability to use the upper limb after stroke. However, little is known about the effects of interventions used to address such impairments.

Objectives

To determine the effects of interventions that target upper limb sensory impairment after stroke.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched 8 October 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to January 2009), EMBASE (1980 to January 2009), and six further electronic databases to January 2009. We also handsearched relevant journals, contacted authors in the field, searched doctoral dissertation databases, checked reference lists, and completed citation tracking.

Selection criteria

Randomized controlled trials and controlled trials comparing interventions for sensory impairment after stroke with no treatment, conventional treatment, attention placebo or with other interventions for sensory impairment.

Data collection and analysis

Two review authors selected studies, assessed quality and extracted data. We analyzed study data using mean differences and odds ratios as appropriate. The primary outcome we considered was sensory function and secondary outcomes examined included upper limb function, activities of daily living, impact of stroke and quality of life as well as adverse events.

Main results

We included 13 studies, with a total 467 participants, testing a range of different interventions. Outcome measures included 36 measures of sensory impairment and 13 measures of upper limb function. All but two studies had unclear or high risk of bias. While there is insufficient evidence to reach conclusions about the effects of interventions included in this review, three studies provided preliminary evidence for the effects of some specific interventions, including mirror therapy for improving detection of light touch, pressure and temperature pain; a thermal stimulation intervention for improving rate of recovery of sensation; and intermittent pneumatic compression intervention for improving tactile and kinesthetic sensation. We could not perform meta‐analysis due to a high degree of clinical heterogeneity in both interventions and outcomes.

Authors' conclusions

Multiple interventions for upper limb sensory impairment after stroke are described but there is insufficient evidence to support or refute their effectiveness in improving sensory impairment, upper limb function, or participants' functional status and participation. There is a need for more well‐designed, better reported studies of sensory rehabilitation.

Author(s)

Susan Doyle, Sally Bennett, Susan E Fasoli, Kryss T McKenna

Abstract

Plain language summary

Interventions for sensory impairment in the upper limb after stroke

Up to 80% of people who have a stroke experience sensory loss in their affected arm. This sensory loss puts the arm at risk for injury and impacts functional use of the arm and the survivors' level of independence during daily activities. We found 13 studies involving 467 participants that tested different treatments for sensory loss. There is limited evidence that these treatments may be effective. No more than one study examined each particular intervention, frequently the studies were of poor quality and lacked sufficient information. Further research is needed before clear recommendations can be made.

Author(s)

Susan Doyle, Sally Bennett, Susan E Fasoli, Kryss T McKenna

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

There are a large number of techniques that show promise for addressing sensory impairments in the upper limb after stroke but we do not at this stage have adequate high quality trials to be able to make recommendations that support or refute the use of specific interventions. Since few studies mentioned adverse effects, the clinician should be conscious of monitoring adverse affects when using any interventions for sensory impairment.

Implications for research 

This review was based on a small number of trials, generally only one, for each of the types of interventions. Most of the trials included a small number of participants and had high to unclear levels of bias. Addressing these issues should be priorities in research design in the stroke rehabilitation area. Some interventions identified in this review have potential to prove beneficial to those with sensory impairment of the upper limb after stroke but need further high quality studies to assess their effectiveness. When searching for studies for this review it was evident there are also many non‐randomized studies that addressed these and other interventions that could be investigated with randomized controlled trials to ascertain the value of these treatment techniques in this field.

The large number of outcome measures used was another significant factor that contributed to the clinical diversity of this review. Diagnostic test accuracy reviews to look at the effectiveness of these outcome measures for measuring sensory impairments, upper limb function and functional performance and participation after stroke would also be a priority.

Improved reporting of trials of rehabilitation interventions would assist with the ability to determine risk of bias and contributions of these trials. Compliance with the CONSORT guidelines is recommended. Researchers should include outcome measures that address participants’ functional performance and quality of life and any possible adverse reactions should be actively screened for in both experimental and control groups. Improved descriptions of the intervention would assist with reviewing the study and with replicating the study.

There was inadequate descriptions of the settings in which the interventions occurred and no studies addressed cost effectiveness of the different delivery options, dosages available, or the timing of the intervention after stroke. Further, no studies addressed the effectiveness of any of these interventions against usual care. These would be factors to address in further studies.

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