Strategies for rehabilitation of poststroke hand edema: A scoping review

Hand edema is common complication following stroke that can significantly impair quality of life. Despite its prevalence, there is no established consensus on optimal management.

The objective of this review is to identify and evaluate the range of interventions studied for poststroke hand edema, synthesize their reported effects on edema reduction, and examine their accessibility and application across diverse stroke populations.

Scoping review METHODS: A systematic search was conducted in five databases following methodology criteria outlined by the Joanna Briggs Institute for scoping reviews. Two independent reviewers screened titles, abstracts, and full texts for inclusion, and performed data extraction with a third reviewer resolving conflicts.

In total, 19 studies with 653 patients were included. Three groupings of interventions were created based on mechanism of action: physical and mechanical modalities, neuromodulatory therapies, and pharmacologic or alternative therapies. Most interventions showed some degree of hand edema reduction. Among these, physical and mechanical modalities, particularly compressive wrapping, wrist hand orthoses (WHO), and fluidotherapy, demonstrated positive results in multiple studies. Neuromodulatory and pharmacologic/alternative therapies showed inconsistent or limited evidence with interventions often assessed in single studies. Methodological heterogeneity, small sample sizes, and short follow-ups limited the ability to compare and draw conclusions. Accessibility of interventions also varied, but compressive wrapping and WHOs stood out as offering potential for home use and reduced clinic visits.

The included studies were heterogeneous and lacked strong evidence for any specific intervention. Treatment should be individualized and emphasize accessible approaches that may improve adherence. Further research should focus on larger sample sizes, longer follow-up, standardized outcome measures, and clearly defined stroke chronicity to inform clinical practice.