Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis.
Adriana Bastos Conforto, Sarah Monteiro Dos Anjos, Wanderley Marques Bernardo and 4 others
PMID 30198383WHAT IT FOUND
Repetitive peripheral sensory stimulation, usually paired with motor training, was associated with upper limb motor gains in chronic stroke in small pooled trials, but participants likely knew they received active treatment.
The two-hour protocol may be hard to use.
Key findings
01Combining JTT, ARAT, FMA and hand force gave a statistically significant pooled standardized mean difference of 0.67, but the confidence interval was wide and heterogeneity was substantial.
02When the analysis was restricted to chronic-phase trials, the pooled standardized mean difference was 1.04 with no heterogeneity.
03The only trial that included subacute patients showed greater JTT benefit from sham than from active RPSS.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only five trials with 95 participants were analyzed, so the pooled result rests on a small evidence base. Active RPSS causes paresthesias, while control stimulation does not, so participants likely knew which treatment they received; risk of unblinding was high. The overall pooled effect was statistically significant but the confidence interval was wide and the studies varied substantially. The JTT and pinch force outcomes did not show significant benefit, and the only subacute trial favored sham. The two-hour stimulation period may be difficult to fit into routine therapy. Optimal dose, nerve target and timing after stroke remain uncertain.
Declared interests
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The easy way to misread this
Do not read this as proof that RPSS alone works for all stroke patients. The positive pooled result came from only 95 participants in five small trials, most paired with motor training, all at high risk of unblinding, and the one subacute trial favored sham.