Strategies for Rehabilitation of Post-stroke Hand Edema: A Scoping Review

Objective: Post-stroke hand edema, affecting around one-third of patients, significantly impacts function and quality of life. Despite a growing body of research, there lacks consensus on the best treatment methods. The objective of this review is to evaluate the current literature on the treatment of post-stroke hand edema.

Data Sources: A systematic search was conducted in March 2024 utilizing MEDLINE, Embase, Web of Science, CINAHL, and Cochrane CENTRAL databases following the methodology criteria outlined by the Joanna Briggs Institute for scoping reviews.

Study Selection: Studies were included if they enrolled adult participants with stroke, utilized a rehabilitation intervention, and studied outcomes of hand edema. Randomized controlled trials, retrospective, and prospective studies published in English until March 2024 were included. Articles were reviewed by two independent reviewers with a third serving to resolve conflicts.

Data Extraction: Data was extracted by two independent extractors and evaluated for agreement. Participant details, treatment modality, methodology, and outcomes relevant to the review question were extracted.
Data Synthesis: A total of 19 studies with 653 patients were included. These studies are heterogeneous in study design, intervention, and outcome measurements. Three groupings of interventions were created: orthosis and wrapping, manual therapy, and device-assisted therapy. The orthosis and wrapping group demonstrated promise given its efficacy and increased accessibility. In the device-assisted group, fluidotherapy was effective with others indicating potential effect, though the accessibility is limited. Similarly, the manual therapy group showed promise in each intervention, though had limited evidence. Very few studies have been conducted for each intervention with each study utilizing various measurements of edema and many not using hand edema as the primary outcome.

Conclusions: The included studies were heterogeneous and lacked strong evidence for any specific intervention. There is a need for research focusing on post-stroke hand edema specifically using hand edema as the primary outcome and employing larger sample sizes with longer-term follow-up.