9. Overview of reviews: Rehabilitation.
| Intervention and comparison | Contributing reviews | Relative effect | Number of participants (trials) | GRADE certainty of evidence | Comments |
| Sensory‐motor training strategies | |||||
| Graded motor imagery (GMI) | |||||
| GMI vs standard care | Smart 2022 (Cochrane) |
Pain intensity 0 to 100 VAS: post‐intervention MD ‐14.45, 95% CI ‐23.02 to ‐5.87, P = 0.001; I2 = 29%; two trials, n = 49; medium‐term MD ‐21.00, 95% CI ‐31.17 to ‐10.83; 1 trial, n = 37 (both in favour of GMI) No between‐group difference short‐term (1 trial) Disability 0 to 10 patient specific functional scale: post‐intervention MD 1.87, 95% CI 1.03 to 2.71, P < 0.001; I² = 41%; 2 trials, n = 49; medium‐term MD 2.30, 95% CI 1.12 to 3.48, P < 0.001; 1 trial, n = 37 |
68 (3) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| GMI vs waiting‐list control | Smart 2022 (Cochrane) |
Pain intensity 0 to 10 VAS: MD –0.58, 95% CI –1.94 to 0.78 Adverse events Increased swelling of the affected limb in 2 participants; increased pain in 12 participants (both occurring in GMI group) |
22 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Mirror therapy | |||||
| Mirror therapy vs placebo | Smart 2022 (Cochrane) |
Pain intensity 0‐ to 100 VAS: 7/8 participants experienced reduced pain with mirror therapy vs 1/8 with placebo |
24 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Mirror therapy + stroke rehabilitation vs placebo mirror therapy + stroke rehabilitation | Smart 2022 (Cochrane) |
Pain intensity 0 to 10 VAS: post‐intervention MD ‐2.9, 95% CI ‐4.23 to ‐1.57, P < 0.001; medium‐term MD ‐3.4, 95% CI ‐4.71 to ‐2.09; P < 0.001 (both in favour of mirror therapy) Disability 0 to 5 Wolf Motor Function: post‐intervention 0‐5 scale, MD ‐1.9, 95% CI ‐2.36 to ‐1.44; P < 0.001; medium‐term MD ‐2.3, 95% CI ‐2.88 to ‐1.72; P < 0.001 |
48 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Mirror therapy vs mental imagery | Smart 2022 (Cochrane) |
Pain intensity 0 to 100 VAS: 7/8 participants experienced reduced pain with mirror therapy vs 2/8 with placebo |
24 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Mirror therapy + stroke rehabilitation vs stroke rehabilitation alone | Smart 2022 (Cochrane) |
Pain intensity 0 to 10 NRS: MD ‐1.40, 95% CI ‐2.26 to ‐0.54, P < 0.001; 1 trial (in favour of mirror therapy) 0 to 10 VAS: median within group change 0‐10 VAS, 3 vs 1; 1 trial (in favour of mirror therapy) Disability 18 to 126 FIM: MD 21.95, 95% CI 9.71 to 34.19; P < 0.001; 1 study (in favour of mirror therapy) 0 to 14 Fugl‐Meyer Assessment: median within‐group change 3 vs 0; 1 study (in favour of mirror therapy) |
68 (2) | Very low | Downgraded twice for serious study limitations, and once for imprecision. |
| Mirror visual feedback + medical management vs contrast baths + medical management | Smart 2022 (Cochrane) |
Pain intensity 11‐point NRS: MD ‐2.65, 95% CI ‐3.14 to ‐2.16; P < 0.001 (in favour of mirror visual feedback) |
30 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Mirror visual feedback + medical management vs contrast baths and exercise + medical management | Smart 2022 (Cochrane) |
Pain intensity 11‐point NRS: MD ‐2.60, 95% CI ‐3.08 to ‐2.12; P < 0.001 (in favour of mirror visual feedback) |
30 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Virtual reality | |||||
| Virtual body swapping with mental rehearsal vs 'watching movement only' | Smart 2022 (Cochrane) |
Pain intensity 11‐point pain scale: no between‐group difference |
39 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Virtual body swapping with mental rehearsal vs mental rehearsal only | Smart 2022 (Cochrane) |
Pain intensity 11‐point pain scale: no between‐group difference |
39 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Virtual body swapping with mental rehearsal vs virtual body swapping alone | Smart 2022 (Cochrane) |
Pain intensity No between‐group difference |
10 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Virtual reality vs sham virtual reality | Smart 2022 (Cochrane) |
Pain intensity 11‐point NRS: MD 1.2; SMD 0.7 (measures of variance NR) |
45 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Tactile discrimination | |||||
| Four tactile discrimination training protocols compared with each other | Smart 2022 (Cochrane) |
Pain intensity 100 mm VAS: no between‐group differences Adverse events Increased pain during training |
10 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Prism adaptation | |||||
| Prism adaptation treatment vs placebo | Smart 2022 (Cochrane) |
Pain intensity 11‐point NRS: no between‐group differences post‐intervention and medium‐term |
49 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision. |
| Electrophysical agents | |||||
| Stellate ganglion ultrasound vs placebo | Smart 2022 (Cochrane) |
Pain intensity 10 cm VAS: no between‐group difference Disability DASH: no between‐group difference |
45 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Stellate ganglion ultrasound vs TENS | Smart 2022 (Cochrane) |
Pain intensity 0‐10 VAS: MD 2.13, 95% CI 1.47 to 2.79; P < 0.001 (in favour of TENS) |
30 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Electromagnetic field therapy vs placebo | Smart 2022 (Cochrane) |
Pain intensity 10 cm VAS: MD ‐2.2, 95% CI ‐1.99 to ‐2.41; P < 0.001; 1 trial; MD 1.6, 95% CI 0.83 to 2.37, P < 0.001; 1 trial (both in favour of electromagnetic field therapy); no between‐group difference in 1 trial Disability 0 to 100 Maryland Foot Score: MD 14.4, 95% CI 11.36 to 17.44; P < 0.001; one study, n = 18 (in favour of electromagnetic field therapy) 0 to 100 DASH: MD ‐14.0 95% CI ‐4.41 to ‐23.59; P < 0.004; 1 study, n = 12 (in favour of electromagnetic field therapy) 0 to 100 Quick‐DASH: 0‐100, MD 2, 95% CI ‐3.91 to 7.91; one study Adverse events No between‐group difference (1 study) |
112 (3) | Very low | Downgraded once for serious study limitations, once for inconsistency |
| TENS vs placebo | Smart 2022 (Cochrane) |
Pain intensity 10 cm VAS: MD ‐9, 95% CI ‐18.5 to 0.5; P = 0.074 (in favour of TENS) Disability Duruöz Hand Index: MD ‐3.6, 95% CI ‐13.38 to 6.18; P = 0.48 |
30 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Laser therapy vs interferential therapy | Smart 2022 (Cochrane) |
Pain intensity 0 to 100 VAS: MD ‐8.6, 95% CI ‐16.27 to ‐0.93; P = 0.03 (in favour of laser therapy) Adverse events No between‐group difference |
50 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| CO2 bath therapy and exercise vs exercise alone | Smart 2022 (Cochrane) |
Pain intensity Between‐group difference in favour of CO2 bath therapy |
40 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Whirlpool baths vs neuromuscular electrical stimulation | Smart 2022 (Cochrane) |
Pain intensity 10 cm VAS: MD ‐0.65, 95% CI ‐1.03 to ‐0.27 ; P < 0.001 (in favour of whirlpool bath) Adverse events No between‐group difference |
60 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Fluidotherapy + stroke rehabilitation vs stroke rehabilitation alone | Smart 2022 (Cochrane) |
Pain intensity 10 cm VAS: no between‐group difference Disability FIM: no between‐group difference |
32 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Exposure‐based interventions | |||||
| Pain exposure physical therapy vs usual physiotherapy | Smart 2022 (Cochrane) |
Pain intensity 1‐10 VAS: MD 0.61, 95% CI ‐0.70 to 1.92 at long‐term Disability 0 to 100 DASH: MD 6.47, 95% CI ‐5.97 to 18.90 at long‐term 0 to 40 Lower Limb Tasks Questionnaire: MD 5.11, 95% CI ‐0.45 to 10.68 at long‐term |
56 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Exposure in vivo vs usual physiotherapy | Smart 2022 (Cochrane) |
Pain intensity 0 to 10 NPS: MD ‐2.04 95% CI ‐3.01 to ‐1.07; P = 0.001 post‐intervention; MD ‐2.82, 95% CI ‐4.18 to ‐1.46; P = 0.001 at medium‐term (both in favour of exposure in vivo) Disability 0 to 5 Radboud Skills Questionnaire: MD ‐1.08, 95% CI ‐1.60 to ‐0.56; P = 0.001 post‐intervention; MD ‐1.30, 95% CI ‐0.92 to ‐1.69; P = 0.001 medium‐term (both in favour of exposure in vivo) 0 to 10 Walking Ability Questionnaire: no between‐group difference post‐intervention; MD ‐3.62, 95% CI ‐6.78 to ‐0.47; P = 0.02 at medium‐term (in favour of exposure in vivo) |
46 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Multimodal physiotherapy | |||||
| Physiotherapy vs minimal care | Smart 2022 (Cochrane) |
Pain intensity Between‐group difference post‐intervention; no between‐group difference at long‐term Disability 5 to 50 Impairment Level Sum Score: MD ‐3.7, 95% CI ‐7.13 to ‐0.27, P = 0.03; long‐term follow‐up (in favour of physiotherapy) Radboud Skills Questionnaire: no between‐group difference at long‐term Modified Greentest: no between‐group difference at long‐term Radboud Dexterity Test: no between‐group difference at long‐term |
135 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Physiotherapy vs occupational therapy | Smart 2022 (Cochrane) |
Pain intensity No between‐group difference at long‐term Disability Impairment Level Sum Score: no between‐group difference at long‐term Radboud Skills Questionnaire: no between‐group difference at long‐term Modified Greentest: no between‐group difference at long‐term Radboud Dexterity Test: no between‐group difference at long‐term |
135 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Upper limb aerobic exercise + physiotherapy vs physiotherapy alone | Smart 2022 (Cochrane) |
Pain intensity 10 cm VAS: MD ‐1.9, 95% CI ‐3.23 to ‐0.57; P < 0.005 |
40 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Other physiotherapy‐based interventions | |||||
| Manual lymphatic drainage therapy vs conventional care | Smart 2022 (Cochrane) |
Pain intensity No between‐group difference |
74 (2) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
| Electro‐acupuncture and massage vs rehabilitation | Smart 2022 (Cochrane) |
Pain intensity Pain on movement NRS: MD ‐1.70, 95% CI ‐2.09 to ‐1.31; P = 0.01 post‐intervention; MD ‐1.40, 95% CI ‐1.78 to ‐1.02; P < 0.001 at short‐term (both in favour of electro‐acupuncture and massage) Disability Fugl‐Meyer hand: no between‐group difference post‐intervention Fugl‐Meyer upper limb no between‐group difference at short‐term Adverse events No between‐group difference |
120 (1) | Very low | Downgraded once for serious study limitations, once for inconsistency, and once for imprecision |
Unless specifically stated, comparisons refer to outcomes measured at the end of the intervention period.
CO2 = carbon dioxide DASH = Disabilities of the Arm, Shoulder and Hand questionnaire FIM = Functional Independence Measure GMI = graded motor imagery MD = mean difference NR = not reported NPS = neuropathic pain scale NRS = numeric rating scale TENS = transcutaneous electrical nerve stimulation VAS = visual analogue scale