1. What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis
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Marc B. Rietberg, Erik J.M. Hendriks, Roland P. S. Van Peppen, Philip J. van der Wees, Janne M. Veerbeek, Erwin van Wegen, Gert Kwakkel, Rehabilitation medicine, MOVE Research Institute, VU University medical center, Epidemiologie, RS: CAPHRI School for Public Health and Primary Care, RS: CAPHRI - Epidemiology of musculoskeletal Disorders, and Research Institute MOVE
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Activities of daily living ,medicine.medical_treatment ,Alternative medicine ,lcsh:Medicine ,Cardiovascular ,CONSTRAINT-INDUCED MOVEMENT ,law.invention ,Randomized controlled trial ,law ,BODY-WEIGHT SUPPORT ,Medicine ,lcsh:Science ,Stroke ,Randomized Controlled Trials as Topic ,Multidisciplinary ,Rehabilitation ,ELECTROMECHANICAL GAIT TRAINER ,Stroke Rehabilitation ,RANDOMIZED CONTROLLED-TRIAL ,Neurology ,Meta-analysis ,EXTREMITY MOTOR RECOVERY ,Research Article ,FUNCTIONAL ELECTRICAL-STIMULATION ,medicine.medical_specialty ,Systematic Reviews ,Clinical Research Design ,Cerebrovascular Diseases ,MEDLINE ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,UPPER-LIMB FUNCTION ,SDG 3 - Good Health and Well-being ,Neurorehabilitation and Trauma ,Humans ,SUBACUTE STROKE PATIENTS ,Muscle Strength ,cardiovascular diseases ,Physical Therapy Modalities ,Ischemic Stroke ,business.industry ,lcsh:R ,ROBOT-ASSISTED THERAPY ,medicine.disease ,Geriatrics ,TRIGGERED NEUROMUSCULAR STIMULATION ,Physical therapy ,lcsh:Q ,Physiotherapy and Rehabilitation ,Meta-Analyses ,business ,Rehabilitation interventions - Abstract
Contains fulltext : 137204.pdf (Publisher’s version ) (Open Access) BACKGROUND: Physical 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 FINDINGS: Randomized 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; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 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; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 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. CONCLUSIONS: There 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. 33 p.
- Published
- 2014
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