According to the World Health Organization, stroke is a condition with no apparent cause other than vascular origin with symptoms lasting for more than 24 hours or leading to death with a rapidly developing clinical sign of focal or global disturbances of cerebral function [1]. Stroke is the most common serious neurological disorder, and in high-income countries, it is the fourth-leading cause of death, long-term disability, and reduced quality of life among adults [1,2]. According to the American Stroke Association, about 87% of the cases are ischemic, and the remaining 13% are hemorrhagic [1]. The most common symptoms include paralysis (in one or both sides), loss of balance, and spasticity, which commonly appear days or weeks after the occurrence of a stroke [3]. Hemiplegia is the primary motor manifestation of stroke, which is weakness of one half of the body contralateral to the site of a cerebral lesion [4].

Several manual therapy techniques were used in the management of patients with stroke including neurodynamic or neural mobilization (NM) techniques. NM is defined as manual techniques or exercise interventions aimed at affecting the neural structures or surrounding tissue (interface) directly or indirectly with the purpose of reducing pain, decreasing neural tension, and improving muscle flexibility and endurance [2,5]. Studies revealed that NM improves the elasticity of nervous and musculoskeletal tissues, increases the intraneural blood flow, improves intraneural fluid dispersion, reduces intraneural edema, reduces thermal and mechanical hyperalgesia, and reverses the increased immune responses following a nerve injury [2,3,5]. NMs restore the mechanical and neurophysiological function of the nerve and can be performed in different ways using active or passive movement, manual mobilization of the nerve or interface, and exercise [6,7].

A systematic review of the literature on the therapeutic efficacy of NM on various musculoskeletal conditions included 10 randomized controlled trials (RCTs) and revealed that there is limited evidence to support the use of NMs [8]. A systematic review of 13 clinical trials focused on carpal tunnel syndrome concluded that the efficacy of NM for carpal tunnel syndrome was unclear [9]. Another review of 20 clinically controlled trials assessed the effect of NM on chronic conditions and concluded that NM is not superior to other interventions [10]. A study conducted to examine the effect of rhythmic upper extremity neurodynamic for 18 patients with hemiplegia caused by stroke found that rhythmic neurodynamic was effective for improving the functions of upper extremities [11]. A blinded randomized clinical trial study on effectiveness of NMs performed in 12 volunteers, aged between 20 and 80 years, with a diagnosis of ischemic or hemorrhagic stroke showed positive effects in relation to flexibility, lower limb muscle strength, gait, and balance [2]. A study on 26 patients with stroke undertaken to compare the efficacy of instrument-assisted soft tissue mobilization and a neural dynamic technique on lower extremity muscle tone, stiffness, and static balance showed a significant improvement in the instrument-assisted soft tissue mobilization group in muscle tone and stiffness but no difference in static balance [3]. A quasi-experimental study to determine the effect of the neurodynamic sliding technique on 20 hemiplegic patients with hamstring tightness showed improved hip flexion assessed by the passive straight leg raise test [12]. A case report study on a combination therapy of botulinum toxin type A and NM for a patient with severe upper limb spasticity and pain after stroke showed an improved joint range of motion and decreased pain, anxiety, and depression [7]. A pretest and posttest experimental study on 20 patients with traumatic spinal cord injury (level C5-C8) and upper limb spasticity in the finger and wrist flexors suggest that neurodynamic mobilization of the median nerve may be effective for upper limb spasticity control and upper limb functional improvements [13].

A systematic review on neurodynamic techniques and mobilization in stroke rehabilitation finally included 12 studies (7 were RCTs, 3 quasi-experimental, 1 case report, and 1 systematic analysis) and concluded that there is limited evidence to support the use of NM techniques [4]. Another review on NM as a therapeutic option in the treatment of stroke included only 6 studies, and the results indicated beneficial effects of NM in the control of muscle tone, range of motion, and functionality of patients affected by stroke [14]. Previous studies on NM interventions on patients with stroke were limited to qualitative analysis, were not up to date, and had unclear or conflicting results [4,5,8,14]. Due to the limited evidence and varying methodological quality, conclusions may change over time [5], and new RCTs are available in the literature. For these reasons, we plan to perform this systematic review and meta-analysis to generate new evidence. The aim of this systematic review and meta-analysis is to systematically assess the types and techniques of different neurodynamic interventions used and their effectiveness on pain, disability, functional status, quality of life, and other variables on patients with stroke.

The search terms and databases have been identified. After selecting relevant studies and assessing the methodological quality, data extraction and statistical analyses will start. The data synthesis and presentation of the findings will be completed by the end of 2022. The final results will be published in a peer-reviewed journal and will be presented at relevant conferences and events.

This systematic review and meta-analysis will analyze the effects of different neurodynamic interventions on patients with stroke. We will explore their effect on pain, disability/functional status, quality of life, and other variables where data are available. We will also explore the types/techniques and durations of the interventions used. The final results will bring new and up-to-date evidence by investigating the pooled effect of neurodynamic interventions on patients with stroke in the literature. However, this study will have several potential limitations. First, a lack of RCTs with an adequate sample size might be the primary limitation. Second, there may be substantial heterogeneity due to the quality of different studies and due to different methods of neurodynamic interventions (eg, passive vs active approach, sliding vs tensioning techniques, and global vs local tissue mobilization). Finally, some RCTs may be of poor quality, and there may be a potential risk of bias. The final results of this systematic review and meta-analysis will be published in a peer-reviewed journal and presented at relevant conferences and events.