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Sensory re-education after nerve injury of the upper limb: a systematic review

Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, t.a.oud{at}amc.uva.nl

Anita Beelen

Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Elianne Eijffinger

Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Frans Nollet

Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Objective : To systematically review the available evidence for the effectiveness of sensory re-education to improve the sensibility of the hand in patients with a peripheral nerve injury of the upper limb.

Data sources : Studies were identified by an electronic search in the databases MEDLINE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), and the database of the Dutch National Institute of Allied Health Professions (Doconline) and by screening the reference lists of relevant articles.

Review methods : Two reviewers selected studies that met the following inclusion criteria: all designs except case reports, adults with impaired sensibility of the hand due to a peripheral nerve injury of the upper limb, and sensibility and functional sensibility as outcome measures. The methodological quality of the included studies was independently assessed by two reviewers. A best-evidence synthesis was performed, based on design, methodological quality and significant findings on outcome measures.

Results : Seven studies, with sample sizes ranging from 11 to 49, were included in the systematic review and appraised for content. Five of these studies were of poor methodological quality. One uncontrolled study (N = 1 3 ) was considered to be of sufficient methodological quality, and one randomized controlled trial ( N = 49) was of high methodological quality. Best-evidence synthesis showed that there is limited evidence for the effectiveness of sensory re-education, provided by a statistically significant improvement in sensibility found in one high-quality randomized controlled trial.

Conclusion : There is a need for further well-defined clinical trials to assess the effectiveness of sensory re-education of patients with impaired sensibility of the hand due to a peripheral nerve injury.

Clinical Rehabilitation, Vol. 21, No. 6, 483-494 (2007)
DOI: 10.1177/0269215507074395


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