Article

Thermal stimulation (TS) has been developed and incorporated into
stroke rehabilitation. However, whether noxious and innocuous TS induce the same
effects on motor function recovery after stroke is still unknown. A comparative
study of different temperature combination regimens is needed. OBJECTIVE: To
compare the short- and long-term effectiveness between noxious and innocuous TS
on motor recovery of upper extremity in patients with acute stroke. DESIGN:
Randomized, controlled trial with concealed allocation, intention-to-treat
analysis and blinded outcome assessors. SETTING: A university hospital
rehabilitation department in Taiwan. PARTICIPANTS: A total of 79 patients with
acute ischemic stroke were recruited. The majority had moderate to severe motor
impairment of the upper extremity (UE). INTERVENTION: In addition to traditional
rehabilitation, the experimental group (n = 39) underwent noxious TS (heat pain
46-47 degrees C/cold pain 7-8 degrees C), and the control group (n = 40) received
innocuous TS (heat 40-41 degrees C/cold 20-21 degrees C). TS intervention was
applied for 30 minutes once per day and for a total of 20-24 times during
hospital stay. A custom-made TS instrument, comprising 2 thermal stimulators and
their respective thermal pads constructed in a closed-loop system, was used.
OUTCOMES: The Fugl-Meyer upper extremity score (the primary outcome), Action
Research Arm Test, Motricity Index, Barthel Index, and modified Ashworth scale
(the secondary outcomes) were administered by a blinded assessor at baseline,
post-12th TS, post-intervention, 1-month, and 6-month follow-ups. RESULTS: No
significant differences between groups were found on the primary outcome at
postintervention and follow-up assessments. At 1-month follow-up, the innocuous
group showed a small effect (partial eta(2) = 0.02) that was greater than that of
the noxious group, but that effect was eliminated at 6 months. Both groups
presented significant within-group improvements over time (both P < .001).
CONCLUSIONS: Combining noxious TS with traditional rehabilitation did not yield
better short-term or long-term results than combining innocuous TS with
traditional rehabilitation on UE functional recovery for individuals with acute
stroke. LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS