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Non-targeted and suspect screening analysis using liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) holds great promise to comprehensively characterize complex chemical mixtures. Data preprocessing is a crucial part of the process, however, some limitations are observed: (i) peak-picking and feature extraction might be incomplete, especially for low abundant compounds, and (ii) limited reproducibility has been observed between laboratories and software for detected features and their relative quantification. We first conducted a critical review of existing solutions that could improve the reproducibility of preprocessing for LC-HRMS. Solutions include providing repositories and reporting guidelines, open and modular processing workflows, public benchmark datasets, tools to optimize the data preprocessing and to filter out false positive detections. We then propose harmonized quality assurance/quality control guidelines that would allow to assess the sensitivity of feature detection, reproducibility, integration accuracy, precision, accuracy, and consistency of data preprocessing for human biomonitoring, food and environmental communities.

Contains fulltext : 218689.pdf (Publisher’s version ) (Closed access)

Contains fulltext : 218689.pdf (Publisher’s version ) (Closed access)

Contains fulltext : 218689.pdf (Publisher’s version ) (Closed access)

This special issue – Protecting and sustainably using the world’s plants and fungi – features the research that underpins Kew’s State of the World’s Plants and Fungi 2020 report. This special issue, and the associated report, are global efforts representing work from 210 authors, in 97 institutions, across 42 countries and six continents. We anticipate that this landmark special issue will inform and inspire researchers, policymakers, practitioners and many others to value and appreciate the world’s plant and fungal diversity and its largely untapped potential to help address the global challenges faced by humanity.

This special issue – Protecting and sustainably using the world’s plants and fungi – features the research that underpins Kew’s State of the World’s Plants and Fungi 2020 report. This special issue, and the associated report, are global efforts representing work from 210 authors, in 97 institutions, across 42 countries and six continents. We anticipate that this landmark special issue will inform and inspire researchers, policymakers, practitioners and many others to value and appreciate the world’s plant and fungal diversity and its largely untapped potential to help address the global challenges faced by humanity.

© 2017 Elsevier B.V. Background Impaired balance is common in neurological disorders. Cervical dystonia is a neurological movement disorder affecting the neck. The effect of this aberrant head posture on physical function is unknown. Objectives To compare balance, mobility, gait and stepping reactions between ten people with cervical dystonia and ten control adults. Methods Spatiotemporal gait parameters and walking speed were assessed using a computerised walkway. Step length and time, time in double support and gait variability were calculated, then normalised to gait speed. Centre of pressure path length was assessed with eyes open and eyes closed to calculate a Romberg Quotient. Simple and choice reaction times were measured using customised apparatus while mobility was assessed by the timed up and go. Cervical spine range of motion was measured using a head mounted goniometer. Self-reported scales included Falls Self Efficacy Scale and Dystonia Discomfort Scale. Results There was a difference between groups for most outcome measures. The timed up-and-go and walking speed was slower (both P < 0.005) and the Romberg Quotient lower (P = 0.046) in cervical dystonia. People with cervical dystonia had lower falls self-efficacy (P = 0.0002). Reduced cervical range of motion was correlated with balance, stepping reaction time and mobility (all P < 0.05). Timed up and go was positively associated with stepping reaction time (P < 0.01). Dystonia discomfort did not impact function. Conclusions People with cervical dystonia displayed deficits in balance, gait and stepping reactions, and expressed higher fear of falling. Studies to further elucidate functional limitations and their impact on activity and participation in daily life are required.

© 2017 Elsevier B.V. Background Impaired balance is common in neurological disorders. Cervical dystonia is a neurological movement disorder affecting the neck. The effect of this aberrant head posture on physical function is unknown. Objectives To compare balance, mobility, gait and stepping reactions between ten people with cervical dystonia and ten control adults. Methods Spatiotemporal gait parameters and walking speed were assessed using a computerised walkway. Step length and time, time in double support and gait variability were calculated, then normalised to gait speed. Centre of pressure path length was assessed with eyes open and eyes closed to calculate a Romberg Quotient. Simple and choice reaction times were measured using customised apparatus while mobility was assessed by the timed up and go. Cervical spine range of motion was measured using a head mounted goniometer. Self-reported scales included Falls Self Efficacy Scale and Dystonia Discomfort Scale. Results There was a difference between groups for most outcome measures. The timed up-and-go and walking speed was slower (both P < 0.005) and the Romberg Quotient lower (P = 0.046) in cervical dystonia. People with cervical dystonia had lower falls self-efficacy (P = 0.0002). Reduced cervical range of motion was correlated with balance, stepping reaction time and mobility (all P < 0.05). Timed up and go was positively associated with stepping reaction time (P < 0.01). Dystonia discomfort did not impact function. Conclusions People with cervical dystonia displayed deficits in balance, gait and stepping reactions, and expressed higher fear of falling. Studies to further elucidate functional limitations and their impact on activity and participation in daily life are required.

Objective: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. Design(s): Retrospective observational analysis. Setting(s): 56 acute stroke hospitals in eight countries. Participant(s): 1074 trial physiotherapists, nurses, and other clinicians. Outcome measures: Number of babies born during trial recruitment per trial participant recruited. Result(s): With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. Conclusion(s): The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group.

Introduction: Generalizability of the results of randomized controlled trials (RCTs) could be compromised when recruitment is poor. We aimed to examine potential threats to generalizability of a multicenter RCT using data from A Very Early Rehabilitation Trial (AVERT). Method(s): AVERT is a prospective, parallel group, assessor-blinded, randomized, clinical trial. The trial setting is acute stroke units at 44 hospitals in 8 countries. Among the first 20,000 patients screened for AVERT, 1158 were recruited and randomized. We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalizability. As well as comparing the recruited patients to the target population, we performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment. Result(s): The demographics and stroke characteristics of the included patients in the trial were broadly similar to population based norms, with the exception that men featured more often in those recruited (63%) than not recruited (53%, p<0.001). The most common reason for non-recruitment was late arrival to hospital (i.e. >24 hours). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95%CI: 9.27-11.65). Conclusion(s): A model which explores person, place and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials.

Objective: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. Design(s): Retrospective observational analysis. Setting(s): 56 acute stroke hospitals in eight countries. Participant(s): 1074 trial physiotherapists, nurses, and other clinicians. Outcome measures: Number of babies born during trial recruitment per trial participant recruited. Result(s): With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. Conclusion(s): The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group.

Introduction: Generalizability of the results of randomized controlled trials (RCTs) could be compromised when recruitment is poor. We aimed to examine potential threats to generalizability of a multicenter RCT using data from A Very Early Rehabilitation Trial (AVERT). Method(s): AVERT is a prospective, parallel group, assessor-blinded, randomized, clinical trial. The trial setting is acute stroke units at 44 hospitals in 8 countries. Among the first 20,000 patients screened for AVERT, 1158 were recruited and randomized. We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalizability. As well as comparing the recruited patients to the target population, we performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment. Result(s): The demographics and stroke characteristics of the included patients in the trial were broadly similar to population based norms, with the exception that men featured more often in those recruited (63%) than not recruited (53%, p<0.001). The most common reason for non-recruitment was late arrival to hospital (i.e. >24 hours). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95%CI: 9.27-11.65). Conclusion(s): A model which explores person, place and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials.

© 2016 Bentham Science Publishers. Background: Stroke is a major contributor to the reduced ability to carry out activities of daily living (ADL) post cerebral infarct. There has been a major focus on understanding and improving rehabilitation interventions in order to target cortical neural plasticity to support recovery of upper limb function. Conventional therapies delivered by therapists have been combined with the application of mechanical and robotic devices to provide controlled and assisted movement of the paretic upper limb. The ability to provide greater levels of intensity and reproducible repetitive task practice through the application of intervention devices are key mechanisms to support rehabilitation efficacy. Results: This review of literature published in the last decade identified 141 robotic or mechanical devices. These devices have been characterised and assessed by their individual characteristics to provide a review of current trends in rehabilitation device interventions. Correlation of factors identified to promote positive targeted neural plasticity has raised questions over the benefits of expensive robotic devices over simple mechanical ones. Conclusion: A mechanical device with appropriate functionality to support the promotion of neural plasticity after stroke may provide an effective solution for both patient recovery and to stimulate further research into the use of medical devices in stroke rehabilitation. These findings indicate that a focus on simple, cost effective and efficacious intervention solutions may improve rehabilitation outcomes.

© 2015 International Federation of Clinical Neurophysiology. Objective: To characterise short afferent inhibition (SAI) and the cortical silent period (CSP) in the primary motor cortex representations of the infraspinatus muscle in healthy adults and people experiencing chronic shoulder pain, to determine the impact of a suprascapular nerve block (SSNB). Methods: Neurophysiological measures were obtained in 18 controls and 8 patients with chronic shoulder pain, pre and post SSNB and 1 week later. Pain intensity was assessed by a visual analogue scale. Results: SAI was apparent in controls (all P < 0.03) and a CSP was observed which reduced in the presence of SAI (all P < 0.0001). Compared to controls, shoulder pain patients demonstrated higher active motor threshold (P = 0.046), less SAI (P = 0.044), a longer CSP (P = 0.048) and less modulation of the CSP by SAI (P = 0.045). Higher motor thresholds were related to higher pain scores (P = 0.009). The SSNB immediately restored SAI (P = 0.013), with a positive relationship between increased SAI and reduced pain (P = 0.031). The SSNB further reduced modulation of CSP by SAI at 1 week post injection (P = 0.006). Conclusions: SAI and the CSP were present and demonstrated robust interaction in controls, which was aberrant in patients. The SSNB transiently restored SAI but had no effect on the CSP; however CSP modulation by SAI was further attenuated 1 week post injection. Significance: The current findings improve understanding of the neurophysiology of the shoulder motor cortex and its modulation by chronic pain. The effect of SSNB in shoulder pain patients should be interpreted with caution until proven in a larger population. Interventions that target intracortical inhibition might increase efficacy in people with chronic shoulder pain.

© 2016 Bentham Science Publishers. Background: Stroke is a major contributor to the reduced ability to carry out activities of daily living (ADL) post cerebral infarct. There has been a major focus on understanding and improving rehabilitation interventions in order to target cortical neural plasticity to support recovery of upper limb function. Conventional therapies delivered by therapists have been combined with the application of mechanical and robotic devices to provide controlled and assisted movement of the paretic upper limb. The ability to provide greater levels of intensity and reproducible repetitive task practice through the application of intervention devices are key mechanisms to support rehabilitation efficacy. Results: This review of literature published in the last decade identified 141 robotic or mechanical devices. These devices have been characterised and assessed by their individual characteristics to provide a review of current trends in rehabilitation device interventions. Correlation of factors identified to promote positive targeted neural plasticity has raised questions over the benefits of expensive robotic devices over simple mechanical ones. Conclusion: A mechanical device with appropriate functionality to support the promotion of neural plasticity after stroke may provide an effective solution for both patient recovery and to stimulate further research into the use of medical devices in stroke rehabilitation. These findings indicate that a focus on simple, cost effective and efficacious intervention solutions may improve rehabilitation outcomes.

© 2015 International Federation of Clinical Neurophysiology. Objective: To characterise short afferent inhibition (SAI) and the cortical silent period (CSP) in the primary motor cortex representations of the infraspinatus muscle in healthy adults and people experiencing chronic shoulder pain, to determine the impact of a suprascapular nerve block (SSNB). Methods: Neurophysiological measures were obtained in 18 controls and 8 patients with chronic shoulder pain, pre and post SSNB and 1 week later. Pain intensity was assessed by a visual analogue scale. Results: SAI was apparent in controls (all P < 0.03) and a CSP was observed which reduced in the presence of SAI (all P < 0.0001). Compared to controls, shoulder pain patients demonstrated higher active motor threshold (P = 0.046), less SAI (P = 0.044), a longer CSP (P = 0.048) and less modulation of the CSP by SAI (P = 0.045). Higher motor thresholds were related to higher pain scores (P = 0.009). The SSNB immediately restored SAI (P = 0.013), with a positive relationship between increased SAI and reduced pain (P = 0.031). The SSNB further reduced modulation of CSP by SAI at 1 week post injection (P = 0.006). Conclusions: SAI and the CSP were present and demonstrated robust interaction in controls, which was aberrant in patients. The SSNB transiently restored SAI but had no effect on the CSP; however CSP modulation by SAI was further attenuated 1 week post injection. Significance: The current findings improve understanding of the neurophysiology of the shoulder motor cortex and its modulation by chronic pain. The effect of SSNB in shoulder pain patients should be interpreted with caution until proven in a larger population. Interventions that target intracortical inhibition might increase efficacy in people with chronic shoulder pain.

Objective: The purpose of this paper is to examine potential threats to generalisability of the results of a multicentre randomised controlled trial using data from A Very Early Rehabilitation Trial (AVERT). Design(s): AVERT is a prospective, parallel group, assessor-blinded randomised clinical trial. This paper presents data assessing the generalisability of AVERT. Setting(s): Acute stroke units at 44 hospitals in 8 countries. Participant(s): The first 20 000 patients screened for AVERT, of whom 1158 were recruited and randomised. Model: We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalisability. As well as comparing the recruited patients with the target population, we also performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment. Result(s): The demographics and stroke characteristics of the included patients in the trial were broadly similar to population-based norms, with the exception that AVERT had a greater proportion of men. The most common reason for non-recruitment was late arrival to hospital (ie, >24 h). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95% CI 9.27 to 11.65). Conclusion(s): A model which explores person, place, and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials.

OBJECTIVE: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. DESIGN: Retrospective observational analysis. SETTING: 56 acute stroke hospitals in eight countries. PARTICIPANTS: 1074 trial physiotherapists, nurses, and other clinicians. OUTCOME MEASURES: Number of babies born during trial recruitment per trial participant recruited. RESULTS: With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. CONCLUSION: The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators' meetings and helped maintain a cohesive collaborative group. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry no 12606000185561. DISCLAIMER: Participation in a rehabilitation trial does not guarantee successful reproductive activity.

OBJECTIVE: The purpose of this paper is to examine potential threats to generalisability of the results of a multicentre randomised controlled trial using data from A Very Early Rehabilitation Trial (AVERT). DESIGN: AVERT is a prospective, parallel group, assessor-blinded randomised clinical trial. This paper presents data assessing the generalisability of AVERT. SETTING: Acute stroke units at 44 hospitals in 8 countries. PARTICIPANTS: The first 20,000 patients screened for AVERT, of whom 1158 were recruited and randomised. MODEL: We use the Proximal Similarity Model, which considers the person, place, and setting and practice, as a framework for considering generalisability. As well as comparing the recruited patients with the target population, we also performed an exploratory analysis of the demographic, clinical, site and process factors associated with recruitment. RESULTS: The demographics and stroke characteristics of the included patients in the trial were broadly similar to population-based norms, with the exception that AVERT had a greater proportion of men. The most common reason for non-recruitment was late arrival to hospital (ie, >24 h). Overall, being older and female reduced the odds of recruitment to the trial. More women than men were excluded for most of the reasons, including refusal. The odds of exclusion due to early deterioration were particularly high for those with severe stroke (OR=10.4, p<0.001, 95% CI 9.27 to 11.65). CONCLUSIONS: A model which explores person, place, and setting and practice factors can provide important information about the external validity of a trial, and could be applied to other clinical trials. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12606000185561) and Clinicaltrials.gov (NCT01846247).

Contains fulltext : 118677.pdf (publisher's version ) (Open Access), BACKGROUND: Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. OBJECTIVES: To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors. SELECTION CRITERIA: Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. MAIN RESULTS: We included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants).For number of fallers, one study exam

Contains fulltext : 118677.pdf (publisher's version ) (Open Access), BACKGROUND: Falls are one of the most common medical complications after stroke with a reported incidence of 7% in the first week after stroke onset. Studies investigating falls in the later phase after stroke report an incidence of up to 73% in the first year post-stroke. OBJECTIVES: To evaluate the effectiveness of interventions aimed at preventing falls in people after stroke. SEARCH METHODS: We searched the trials registers of the Cochrane Stroke Group (November 2012) and the Cochrane Bone, Joint and Muscle Trauma Group (May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library 2012, Issue 5, MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), CINAHL (1982 to May 2012), PsycINFO (1806 to May 2012), AMED (1985 to May 2012) and PEDro (May 2012). We also searched trials registers, checked reference lists and contacted authors. SELECTION CRITERIA: Randomised controlled trials of interventions where the primary or secondary aim was to prevent falls in people after stroke. DATA COLLECTION AND ANALYSIS: Review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We used a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per person year) between intervention and control groups. For risk of falling we used a risk ratio and 95% CI based on the number of people falling (fallers) in each group. We pooled results where appropriate. MAIN RESULTS: We included 10 studies with a total of 1004 participants. One study evaluated the effect of exercises in the acute and subacute phase after stroke but found no significant difference in rate of falls (rate ratio 0.92, 95% CI 0.45 to 1.90, 95 participants). The pooled result of four studies investigating the effect of exercises on preventing falls in the chronic phase also found no significant difference for rate of falls (rate ratio 0.75, 95% CI 0.41 to 1.38, 412 participants).For number of fallers, one study exam

Contains fulltext : 81271.pdf (publisher's version ) (Open Access), BACKGROUND AND PURPOSE: In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation. Method- A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches. RESULTS: The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness. CONCLUSIONS: This system

Contains fulltext : 81271.pdf (publisher's version ) (Open Access), BACKGROUND AND PURPOSE: In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation. Method- A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches. RESULTS: The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness. CONCLUSIONS: This system