Upper extremity pain after stroke: a systematic review and meta-analysis on primary prevention

Post-stroke upper extremity (UE) pain is a frequent and debilitating problem, with an incidence of 15 to 40% at 6 months. No clinical guidelines are available on the primary prevention of UE pain. The aim of this research was to identify and summarize the effectiveness of methods for the primary prevention of post-stroke UE pain.

This systematic review received no external funding and was conducted according to PRISMA guidelines (PROSPERO registration number: CRD42023445110). Two independent investigators searched PubMed, PEDro, EMBASE, Cochrane Library, SCOPUS and EBSCO (Cinahl Complete) until January 30^th, 2025, for eligible studies comparing adult stroke patients undergoing any type of prevention method to avoid the development of UE pain, with control patients. Meta-analysis, using a random-effects model, was performed per type of prevention method.

A systematic review of 29 eligible articles (total number of patients: N.=1436) identified 7 categories of prevention methods: orthotics, taping, exercise, positioning, neuromuscular stimulation, intramuscular drug injections and education. Meta-analysis showed with a very low level of certainty that orthotics (SMD=0.45; 95% CI=-0.24 to 1.14; P=0.2; I²=80.96%), taping (SMD=-0.15; 95% CI=-0.69 to 0.39; P=0.58; I²=68.4%) and exercise (SMD=-0.47; 95% CI=-1 to 0.06; P=0.08; I²=60.36%) are not more effective than standard care for the prevention of UE pain after stroke. Due to a small number of studies, meta-analysis was not performed for other categories of primary prevention methods.

This meta-analysis revealed, with a very low-certainty of evidence, that the effect of primary prevention methods on UE pain after stroke is uncertain. An increased number of studies is necessary in this area of clinical research. A combination of methods may increase the clinical relevance of preventive strategies.