The Effectiveness of Thermal Stimulation Plus Conventional Therapy for Functional Recovery After Stroke: A Systematic Review and Meta-Analysis.

Abstract

<b>Background:</b> Motor impairments limit the functional abilities of patients after stroke; it is important to identify low-cost rehabilitation avenues. The aim of this study is to determine the effectiveness of thermal stimulation in addition to conventional therapy for functional recovery in post-stroke patients. <b>Methods:</b> An electronic search was performed in the MEDLINE, Scopus, Web of Science, EMBASE, CINAHL, SPORTDiscus, Epistemonikos, LILACS, and PEDro databases. The eligibility criterion was randomized clinical trials that analyzed the clinical effects of thermal stimulation plus conventional therapy. Two authors independently performed the search, study selection, data extraction, and risk of bias assessment. <b>Results:</b> Eight studies met the eligibility criteria, and six studies were included in the quantitative synthesis. For thermal stimulation plus conventional therapy versus conventional therapy alone, the mean difference (MD) for function was 6.92 points (95% CI = 4.36-9.48; <i>p</i> < 0.01), for motor function was 6.31 points (95% CI = 5.18-7.44; <i>p</i> < 0.01), for balance was 4.41 points (95% CI = -2.59-11.4; <i>p</i> = 0.22), and for walking was 1.01 points (95% CI = 0.33-1.69; <i>p</i> < 0.01). For noxious thermal stimulation versus innocuous thermal stimulation, the MD for activities of daily living was 1.19 points (95% CI = -0.46-2.84; <i>p</i> = 0.16). <b>Conclusions:</b> In the short term, adding thermal stimulation to conventional therapy showed statistically significant differences in functional recovery in post-stroke patients. The quality of evidence was high to very low according to GRADE rating. The studies included varied in the frequency and dosage of thermal stimulation, which may affect the consistency and generalizability of the results. A larger quantity and a better quality of clinical studies are needed to confirm our findings. PROSPERO registration: CRD42023423207.