Front Neurol. 2026 Sep 23;17:1932931. doi: 10.3389/fneur.2026.1932931. eCollection 2026.
ABSTRACT
BACKGROUND: To compare the effectiveness of non-invasive interventions for pain, upper-limb motor function, and activities of daily living in patients with stage I post-stroke shoulder-hand syndrome (SHS) using network meta-analysis.
METHODS: Randomized controlled trials evaluating non-invasive interventions for stage I SHS were systematically retrieved. Outcomes included visual analogue scale (VAS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), and Barthel Index (BI). Mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated, and surface under the cumulative ranking curve (SUCRA) values were calculated.
RESULTS: Thirty-six RCTs involving 2,769 participants were included. The VAS, FMA-UE, and BI networks included 24, 28, and 18 RCTs, respectively. Compared with conventional treatment (CT), VAS scores were significantly reduced by kinesiology taping (KT) (MD = -1.95, 95% CI - 2.85 to -1.05), air pressure therapy (AT) (MD = -2.30, -4.31 to -0.29), Traditional Chinese Medicine External Herbal Therapy (TCM-EHT) (MD = -1.36, -2.08 to -0.64), Traditional Chinese Medicine External Physical Stimulation (TCM-EPS) (MD = -1.43, -2.36 to -0.50), and moxibustion (MD = -1.52, -2.53 to -0.51). FMA-UE improved with TCM-EPS (SMD = 2.12, 0.03 to 4.21), TCM-EHT (SMD = 2.07, 0.62 to 3.52), and KT (SMD = 2.32, 0.04 to 4.61). BI improved with TCM-EHT (SMD = 3.64, 1.76 to 5.51), TCM-EPS (SMD = 2.55, 0.60 to 4.50), and KT (SMD = 1.98, 0.27 to 3.70). However, 95% prediction intervals for all statistically significant comparisons crossed the null. AT, KT, and TCM-EHT ranked highest for VAS, FMA-UE, and BI, respectively. No statistically significant global inconsistency was detected, although localized disagreement was identified for CT versus TCM-EHT in the VAS network.
CONCLUSION: Non-invasive interventions showed outcome-specific potential benefits, but no intervention demonstrated consistent superiority across all outcomes. Although AT and KT ranked favorably for pain and KT, TCM-EPS, and TCM-EHT for functional outcomes, wide prediction intervals indicated substantial uncertainty. Given methodological limitations and imprecision, findings should be interpreted cautiously and confirmed by adequately powered multicentre RCTs.
SYSTEMATIC REVIEW REGISTRATION: The publicly accessible registration record is available through the PROSPERO database: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251276361. The systematic review was registered in PROSPERO (registration number: CRD420251276361).
PMID:42845730 | PMC:PMC13642199 | DOI:10.3389/fneur.2026.1932931