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Effects of noxious versus innocuous thermal stimulation on lower extremity motor recovery 3 months after stroke
Hsu H-W, Lee C-L, Hsu M-J, Wu H-C, Lin R, Hsieh C-L, Lin J-H
Archives of Physical Medicine and Rehabilitation 2013 Apr;94(4):633-641
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To examine the effects of thermal stimulation (TS) on the lower extremity (LE) movement and function in patients with stroke. DESIGN: A double-blinded randomized controlled trial. SETTING: A university hospital. PARTICIPANTS: Thirty-four patients at least 3 months after stroke were randomly assigned into the experimental and the control groups. INTERVENTIONS: In addition to regular rehabilitation, the experimental group received a 30-minute noxious TS protocol (heat-pain 46 to 47 degrees C, cold-pain 2 to 3 degrees C) 3 days per week for 8 weeks, and the control group received a 30-minute innocuous TS protocol (heat 40 to 41 degrees C, cold 23 to 24 degrees C) 3 days per week for 8 weeks. MAIN OUTCOME MEASURES: The Low Extremity subscale of the Stroke Rehabilitation Assessment of Movement (LE-STREAM), the Mobility subscale of the STREAM (Mob-STREAM), the Functional Ambulation Category (FAC), the Barthel Index (BI), the Postural Assessment Scale for Stroke Patients (PASS), and the Modified Ashworth Scale (MAS) were administered by a blinded rater at baseline, post-treatment (8 weeks), and follow-up (12 weeks). RESULTS: Twenty-three participants completed the study protocol and all outcome measurements. No pre-existing group differences between the experimental group (n = 11) and the control group (n = 12) were found on demographic and clinical variables. Compared to baseline, the experimental group showed significant improvements at post-treatment and follow-up on the LE-STREAM, Mob-STREAM, FAC, and BI (p < 0.05), while the control group showed no significant improvements for all outcome measures. As for the between-group comparison, significant differences were seen at follow-up (12 weeks) on the LE-STREAM, Mob-STREAM, BI, and MAS. CONCLUSIONS: Our findings indicate that an 8-week program of noxious TS combined with a traditional stroke rehabilitation program can improve the LE-related movement and function in patients with stroke for more than 3 months.

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