Electrical Stimulation and Mental Practice for Function of the Upper Limb after Stroke

A systematic review 1 including 5 studies with a total of 229 subjects was abstracted in DARE. A small but statistically significant effect of electrical stimulation was found on overall functional recovery of upper limbs in stroke patients (d=0.21, 95% CI: 0.04 to 0.38). The individual study effect sizes ranged from 0.32 to 1.53.

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by inconsistency (heterogeneity in participants, interventions and outcomes).

A Cochrane review 2[Abstract] included 6 studies with a total of 119 stroke patients. Four studies included participants more than 6 months post stroke.Studies that evaluated mental practice (MP) in addition to another treatment were compared with other treatment alone. Treatment intensity varied across studies. MP in combination with other treatment appears more effective in improving upper extremity function than other treatment alone (standardised mean difference (SMD) 1.37; 95%CI 0.60 to 2.15; 5 trials, n=112). In subgroup analyses, based on time since stroke and dosage of MP, numbers in each group were small.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, lack of blinding), imprecise results (few patients) and indirectness (differences in patients)

References

• Handy J, Salinas S, Blanchard SA, Aitken MJ. Meta-analysis examining the effectiveness of electrical stimulation in improving functional use of the upper limb in stroke patients. Phys Occup Ther Ger 2004;21:67-78. [DARE]
• Barclay-Goddard RE, Stevenson TJ, Poluha W et al. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database Syst Rev 2011;(5):CD005950. [PubMed]