The clinical effect of manual therapy including Tuina (or Chuna) on post-stroke shoulder hand syndrome–a literature review

Background: Post-stroke SHS is a common sequela of stroke, presenting with pain, hypersensitivity, allodynia, and edema in the upper extremities. These symptoms can significantly hinder functional recovery and reduce quality of life. Manual therapy, including Tuina (or Chuna) has been increasingly applied in integrative rehabilitation; however, its clinical role has not been systematically evaluated. Methods: We conducted a comprehensive search across 13 databases, including PubMed, Cochrane Library, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), KoreaMed, Korean Medical Database (KMBase), Korean Studies Information Service System (KISS), ScienceON, KoreaScience, DBPia, Research Information Sharing Service (RISS), and Oriental Medicine Advanced Searching Integrated System (OASIS). Studies were selected according to predefined criteria. We extracted and analyzed the characteristics of the selected studies to evaluate their clinical efficacy and safety. Results: All 13 selected studies were randomized controlled trials (RCTs) that applied Tuina manual therapy. These interventions were additionally interpreted within the framework of Chuna manual therapy. Among these, 1 study employed lymphatic drainage massage as the manual therapy, while the remaining 12 studies targeted specific body areas or acupuncture points. Based on the treatment approaches, we classified the studies into 4 categories: monotherapy (1 study), add-on therapy with traditional Chinese medicine (2 studies), add-on therapy with conventional treatment (7 studies) or combination therapy (3 studies). All studies reported significant effects across various outcome measures, while only 2 evaluated the occurrence of adverse events. Conclusion: This research suggests the potential clinical value of manual therapy including Tuina (or Chuna) into SHS. However, there was variability in the duration of therapies, techniques, acupuncture points, and outcome measures, which made it difficult to generalize the results. To develop standardized guidelines for manual therapy in SHS, further large-scale, multinational studies are needed.