Physiotherapy treatment approaches following stroke: major update of Cochrane systematic review of evidence

Abstract

Introduction: Physiotherapists traditionally base stroke rehabilitation practice on global ‘approaches’ (e.g. Bobath and Motor Learning approaches). A 2007 Cochrane systematic review explored the effect of different physiotherapy approaches for stroke, but failed to include all foreign-language (particularly Chinese) trials. We aim to update this Cochrane review, restructuring to incorporate all current international evidence relating to effectiveness of physiotherapy treatment approaches. Method: Our Cochrane review update is based on searches of electronic databases (including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED) from 2005-December 2012. Foreign-language abstracts have been translated. Two independent reviewers applied selection criteria with disagreements resolved by a third reviewer. Two review authors will independently categorise the interventions within identified trials, document methodological quality, and extract data. Cochrane risk of bias tool will be used to assess methodological quality. Data from included studies will be pooled within meta-analyses, calculating standardised mean differences and 95% confidence intervals, using a random-effects model, for disability, motor impairment and participation outcomes. Results: (June 2013) We considered 11,576 titles, screened 592 abstracts and included 75 new RCTs (n = 896, plus 13 awaiting assessment). 49/75 RCTs were completed in China. 38/75 RCTs compare a physical rehabilitation approach with no rehabilitation. Our updated review synthesises evidence from 95 trials (n = 10,048). Data extraction is ongoing and meta-analyses will be completed by October 2013. Conclusion: This major Cochrane review update substantially increases the volume of evidence, with trials including over 10,000 participants, providing the most comprehensive, up-to-date synthesis of international evidence relating to the effect of physiotherapy treatment approaches after stroke.