Alternating Hot-Cold Water Immersion Facilitates Motor Function Recovery in the Paretic Upper Limb After Stroke: A Pilot Randomized Controlled Trial

Yu-Ting Chiu; Chung-Chao Liang; Hung- Yu Cheng; Chun-Hsiang Lin; Jia-Ching Chen

doi:10.1016/j.apmr.2024.05.008

Alternating Hot-Cold Water Immersion Facilitates Motor Function Recovery in the Paretic Upper Limb After Stroke: A Pilot Randomized Controlled Trial

Arch Phys Med Rehabil. 2024 May 10:S0003-9993(24)00996-1. doi: 10.1016/j.apmr.2024.05.008. Online ahead of print.

Authors

Yu-Ting Chiu¹, Chung-Chao Liang², Hung- Yu Cheng¹, Chun-Hsiang Lin³, Jia-Ching Chen⁴

Affiliations

¹ Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
² Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan.
³ Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien, Taiwan.
⁴ Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien, Taiwan. Electronic address: chenjiaching0608@gmail.com.

PMID: 38734047
DOI: 10.1016/j.apmr.2024.05.008

Abstract

Objective: To assess the effectiveness of alternating hot-cold water immersion (AHCWI) in patients with acute stroke.

Design: A single-blind pilot randomized controlled trial.

Setting: Department of Rehabilitation Medicine of a medical center.

Participants: Early stroke survivors (N=24) with moderate-to-severe arm paresis.

Interventions: In addition to conventional rehabilitation, eligible patients were randomly assigned to an AHCWI group (n=12, for AHCWI) or a control group (n=12, for upper limb [UL] cycling exercises) 5 times per week for 6 weeks.

Main outcome measures: The Fugl-Meyer Assessment motor-UL (FMA-UL) score, Motricity Index-UL (MI-UL) score, modified Motor Assessment Scale (MMAS; including its UL sections, MMAS-UL) score, Berg Balance Scale score, Barthel Index (BI), and modified Ashworth Scale score were assessed by the same uninvolved physical therapist at baseline and after 4 and 6 weeks of intervention.

Results: Compared with the control group, the AHCWI group performed better, with significant group effects (P<.05), and exhibited significant improvements in FMA-UL, MI-UL, and MMAS-UL scores at 4 and 6 weeks (P<.05). Although the remaining outcomes were not significantly different, they favored the AHCWI group. Notably, a significant difference was observed in the BI at 4 weeks (P=.032). Significant changes in the muscle tone or adverse effects were not observed in either group after the intervention.

Conclusions: AHCWI with stroke rehabilitation is feasible and may facilitate motor function recovery of the paretic UL after a stroke.

Keywords: Hot-cold water; Motor function; Rehabilitation; Stroke; Upper limb.