Abstract
BackgroundPhysical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.Methods and FindingsRandomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5–7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2 = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84–4.11; I2 = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2 = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41–0.82; I2 = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing.ConclusionsThere is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
Highlights
Prospective studies have estimated that about 795.000 people in the USA suffer a first or recurrent stroke each year [1]
Study Identification The search for relevant Randomized controlled trials (RCTs) is visualized in figure 1
Quality Appraisal The risk of bias in RCTs has decreased over time, as shown by the increase in PEDro scores from a median of 5 (IQR 4–6) points for RCTs published till 2004 [12] to 6 (IQR 5–7) for the RCTs published from 2004 to 2011
Summary
Prospective studies have estimated that about 795.000 people in the USA suffer a first or recurrent stroke each year [1]. The prevalence of chronic stroke in the USA is estimated at about 7 million [1], with about 80% of patients with stroke being over the age of 65. The prevalence of stroke is likely to increase in the future due to the aging population. 12% of the patients with stroke are independent in basic activities of daily living (ADL) at the end of the first week [4]. 25–74% of patients have to rely on human assistance for basic ADLs like feeding, self-care, and mobility [5]. Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation.
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