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

Abstract

ObjectiveTo assess the effectiveness of alternating hot-cold water immersion (AHCWI) in patients with acute stroke. DesignA single-blind pilot randomized controlled trial. SettingDepartment of Rehabilitation Medicine of a medical center. ParticipantsEarly stroke survivors (N=24) with moderate-to-severe arm paresis. InterventionsIn 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 MeasuresThe 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. ResultsCompared 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. ConclusionsAHCWI with stroke rehabilitation is feasible and may facilitate motor function recovery of the paretic UL after a stroke.