Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis

Abstract

Introduction People with ulnar, radial or median nerve injuries can present significant impairment of their sensory and motor functions. The prescribed treatment for these conditions often includes electrophysical therapies, whose effectiveness in improving symptoms and function is a source of debate. Therefore, this systematic review aims to provide an integrative overview of the efficacy of these modalities in sensorimotor rehabilitation compared to placebo, manual therapy, or between them. Methods We conducted a systematic review according to PRISMA guidelines. We perform a literature review in the following databases: Biomed Central, Ebscohost, Lilacs, Ovid, PEDro, Sage, Scopus, Science Direct, Semantic Scholar, Taylor & Francis, and Web of Science, for the period 1980–2020. We include studies that discussed the sensorimotor rehabilitation of people with non-degenerative ulnar, radial, or median nerve injury. We assessed the quality of the included studies using the Risk of Bias Tool described in the Cochrane Handbook of Systematic Reviews of Interventions and the risk of bias across studies with the GRADE approach described in the GRADE Handbook. Results Thirty-eight studies were included in the systematic review and 34 in the meta-analysis. The overall quality of evidence was rated as low or very low according to GRADE criteria. Low-level laser therapy and ultrasound showed favourable results in improving symptom severity and functional status compared to manual therapy. In addition, the low level laser showed improvements in pinch strength compared to placebo and pain (VAS) compared to manual therapy. Splints showed superior results to electrophysical modalities. The clinical significance of the results was assessed by effect size estimation and comparison with the minimum clinically important difference (MCID). Conclusions We found favourable results in pain relief, improvement of symptoms, functional status, and neurophysiological parameters for some electrophysical modalities, mainly when applied with a splint. Our results coincide with those obtained in some meta-analyses. However, none of these can be considered clinically significant. Trial registration PROSPERO registration number CRD42020168792; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=168792.

Treatment, Diagnostic Criteria and Variability of Terminology for Lateral Elbow Pain: Findings from an Overview of Systematic Reviews

“…If positive, proceed with two further tests: the Rule-of-Nines test and the Tinel test; in case of positivity to at least one of the two, the clinical picture will be considered a neural prevalence of lateral elbow disorder (N-LED) with the related sub-declinations. Thus, the treatment will include a manual therapy approach composed of neurodynamic and myofascial techniques associated with dynamic thermoplastic splints, ESWT, neurodynamic sliding or tensioning techniques, and dynamic stretching, with a prognostic perspective of (4) 8–12 weeks [ 72 ]. In case of failure of the conservative approach (NPRS <2 points, DASH <10 points, PRTEE <10 points), we consider it useful to refer patients to the orthopaedist.…”

Early Intensive Neurorehabilitation in Traumatic Peripheral Nerve Injury—State of the Art

“…In human medicine, this modality can be also associated with surgical techniques [ 146 , 185 ]. For improving plantar spasticity, it was described a 5-day/week protocol [ 186 ] for 3–4 weeks, although longer treatments of 6–12 weeks could be necessary with pulse frequencies of 30–50 Hz and a pulse duration of 300 microseconds [ 186 , 187 , 188 , 189 , 190 , 191 ]. Treatment time has to consider potential fatigue, but usually ranges from 20 to 30 min per session [ 188 , 189 , 190 ].…”

Early Intensive Neurorehabilitation in Traumatic Peripheral Nerve Injury – State of the Art

“…In human medicine, this modality can be also associated with surgical techniques [146,185]. For improving plantar spasticity, it was described a 5-day/week protocol [186] for 3-4 weeks, although longer treatments of 6-12 weeks could be necessary with pulse frequencies of 30-50 Hz and a pulse duration of 300 microseconds [186][187][188][189][190][191].…”