Incidence of upper limb oedema in patients with acute hemiparetic stroke

Reliability of Jeweler Rings and a Revised Figure-of-Eight Circumference Protocol for the Assessment of Finger and Hand Circumferences

Background: Assessing the circumference of the hand and fingers can be challenging. Therefore, we studied the reliability of jeweler rings and a revised figure-of-eight (figure-8) protocol for the clinical assessment of finger and hand circumference. Methods and Results: Thirteen patients residing in a rehabilitation center were recruited. Inter- and intrarater reliability of the jeweler rings as well as the revised figure-8 protocol were assessed. Jewelers rings were used to assess the circumferences of the middle and ring finger of both hands. The figure-8 method was used to assess the circumference of both hands. Reliability analyses were performed in Statistical Package for the Social Sciences 26 and demonstrated an excellent reliability for the jeweler rings as well as the revised figure-8 protocol, represented by single random measure intraclass correlation coefficient_(2,1) values of at least 0.973 and Cronbach alpha of at least 0.99. Conclusions: Circumference measurements are valid to use; however, reliability issues do exist in clinical practice. Assessing the circumference of fingers with our new jeweler rings protocol and the circumference of the hand by means of a revised figure-8 protocol is highly reliable in a clinical setting.

Handgrip exercise by the non-affected hand increases venous return in the contralateral axillary vein in patients with stroke: a pilot study

Objective

Treatment of hand edema is important for maintaining upper limb function in patients with stroke, although the effects of many such treatments have been limited. This study aimed to examine, using ultrasound, the effect of handgrip exercise by the non-affected hand of stroke patients on venous return in the affected upper limb.

Results

Seven men participated, within 6 months of a unilateral first-ever stroke. With the patient supine, examinations were performed on the axillary vein of the affected side. The diameter and flow velocity of the axillary vein on the affected side were measured during two regimens: at rest or during rhythmic resistance exercise (30% of maximum grip strength for 20 s) performed by the non-affected hand. The venous flow volume in the axillary vein was then calculated using the data obtained. During resistance exercise by the non-affected hand, there were significant increases in both venous flow velocity (p = 0.01, d = − 0.80) and volume (p = 0.01, d = − 0.74) on the affected side, compared with baseline. The present preliminary study found that rhythmic resistance exercise with the non-affected hand increased venous flow velocity and volume in the affected upper limb of patients with stroke.

Rehabilitation Interventions for Poststroke Hand Oedema: A Systematic Review

Objective/Background

To review the evidence of rehabilitation interventions for the management of poststroke hand oedema.

Methods

We conducted a systematic review of research articles in electronic databases published in English between 1999 and 2015. Two investigators working independently retrieved articles from the Cochrane Central Register of Controlled Trials, SCOPUS, Taylor & Francis Online, Wiley Online Library, CINAHL, Springer (MetaPress), ScienceDirect, PubMed, SAGE Journals Online, EBSCO, and Web of Science. Only controlled trials with outcome measures and interventions for poststroke hand oedema were included. Three investigators critically appraised the selected studies using the Physiotherapy Evidence Database Scale.

Results

Of the 189 articles identified, nine (5 randomized controlled trials, 3 nonrandomized controlled trials, and 1 crossover controlled trial) were selected. These studies are heterogeneous in terms of design and types of intervention for poststroke hand oedema. The interventions reducing hand oedema are Lycra pressure garments with glove splints, bilateral passive motion upper-limb exercises, laser therapy, and acupressure. However, due to these studies’ short intervention periods and the fact that hand oedema is not their primary outcome measure, it is not possible to draw a firm conclusion on their clinical significance for managing poststroke hand oedema.

Conclusion

Further study needs to focus solely on interventions for poststroke hand oedema and their long-term effects. No conclusion can be made on the most effective management of poststroke hand oedema until much more evidence is available.

Single-Case-Design Study of Finger-to-Axilla Compression Bandaging for Edema of the Hemiplegic Upper Limb

OBJECTIVE

This single-case study investigated the effectiveness of compression bandaging from the finger to the axilla in reducing poststroke edema in the upper limb.

METHOD

Repeated circumferential measurements were recorded at five points along the participants' hand and forearm. Analysis of the data included the generation of graphs, celeration lines, and visual analysis.

RESULTS

Five participants with edema (mean 38 days poststroke) were recruited to the study. Fluctuations in edema were observed in all three study phases, with an increasing to decreasing trend in edema between the baseline and intervention phases. There was no clear trend from the intervention to second baseline phase.

CONCLUSION

Bandaging from the fingers to the axilla appears to be effective in reducing edema in the hand and forearm. However, return of edema after removal of the bandaging suggest that a greater understanding of underlying mechanisms and the appropriate intervention protocols is warranted.

Light Retrograde Massage for the Treatment of Post-Stroke Upper Limb Oedema: Clinical Consensus Using the Delphi Technique

Background:

Oedema of the hemiplegic upper limb is a common complication following stroke and can restrict mobility and function. Limited evidence is available regarding the assessment and treatment of post-stroke upper limb oedema by occupational therapists.

Objective:

To determine consensus amongst occupational therapists with regard to the use of light retrograde massage for the treatment of post-stroke upper limb oedema.

Method:

A Delphi technique was used to gather opinion from a national sample of stroke occupational therapists. Two rounds of questionnaires were undertaken. Data were analysed from the 31 respondents to round two, using the chi-square goodness of fit to determine consensus in relation to statements about the use of light retrograde massage.

Results:

Of the 85 therapists who volunteered for the study, 58 returned round one questionnaires and 56 were eligible to participate. Most of the therapists who responded to round one (41/56, 73%) used light retrograde massage to reduce post-stroke upper limb oedema. Agreement regarding the definition and application of light retrograde massage was identified in round two.

Conclusion:

Despite a lack of evidence for the efficacy of light retrograde massage in stroke patients, this study found that it is often used in clinical practice and that consensus exists about many components of the treatment method. Further research is recommended to investigate the efficacy of light retrograde massage for reducing post-stroke upper limb oedema.