Manual mobilization of the wrist: a pilot study in rehabilitation of patients with a chronic hemiplegic hand post-stroke.
STUDY DESIGN
Prospective pilot cohort study, quasi-experimental design.


INTRODUCTION
Restricted hand mobility, limitation in activities and participation, due to relative immobilization of the hemiplegic hand are frequently reported after stroke.


PURPOSE OF THE STUDY
To establish whether manual mobilization of the wrist has an additional value in the treatment of the hemiplegic hand.


METHODS
Eighteen patients received treatment twice a week for a period of 6 weeks. Both treatment groups received therapy based upon the Dutch guidelines for stroke. In the intervention group, a 10-min manual mobilization of the wrist was integrated. The primary outcomes were active and passive wrist mobility and activity limitation. The secondary outcomes were spasticity, grip strength, and pain. Data were collected at 0, 6 and 10 weeks. Statistical analysis was performed using the Friedman's test, related t-test, Wilcoxon test, independent t-test, and Mann-Whitney U-test.


RESULTS
Statistically significant differences were found in the intervention group; between T0 and T2 measurements in active wrist extension (+18°; p < 0.001), in passive wrist extension (+15°; p < 0.001), and in the Frenchay Arm Test (+2 points, 18%; p = 0.038). This significant improvement was not found in the control group. Statistically significant differences were found between the two groups in active and passive wrist extension (p < 0.001; p = 0.002), as well as a change in Frenchay Arm Test (p = 0.01).


CONCLUSION
This study suggests that manual mobilization of the wrist has a positive influence on the recovery of the hemiplegic hand. Replication of the results is needed in a large scale randomized controlled trial.


LEVEL OF EVIDENCE
4.