Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke

Pollock, Alexandra S; Baer, Gillian; Pomeroy, V; Langhorne, Peter

doi:10.1016/s0031-9406(05)60025-9

Cited by 45 publications

(58 citation statements)

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“…Another meta-analysis of RCT41 reports that augmented exercise therapy time of at least 16 h within the first 6 months after stroke obtains a measurable improvement in ADL and, to a lesser degree, in instrumental ADL and gait speed. A Cochrane systematic review reports that, compared with no treatment or placebo, a mix of conventional rehabilitation approaches significantly improves the recovery of postural control and lower-limb function following stroke, thus enhancing independence 42. Finally, an RCT reports that older patients who had had a stroke benefit on a short-term basis from a higher intensity of community-based rehabilitation, especially in the domains of social participation and health-related quality of life 43…”

Section: Discussionmentioning

confidence: 99%

Efficacy of physiotherapy interventions late after stroke: a meta-analysis

Ferrarello

Baccini

Rinaldi

et al. 2010

Journal of Neurology, Neurosurgery & Psychiatry

109

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Objective. Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke. Methods. We searched published studies where participants were randomized to an active physiotherapy intervention, compared to placebo or no intervention, at least 6 months after stroke. Outcome was change in mobility and activities of daily living (ADL) independence. Quality of trials was evaluated using the PEDro scale. Findings were summarized across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% confidence interval (CI) in random effects models. Results. Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14-0.45). Efficacy of the intervention was particularly evident when short-and long-distance walking (SDW, LDW) were considered as separate outcomes, with WMD of 0.05 m/sec (95% CI 0.008-0.088) and 20 m (95% CI 3.6-36.0), respectively. Also ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found. Interpretation. A variety of physiotherapy interventions improve functional outcomes even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients that had experienced stroke and should be valued in planning community rehabilitation services.

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Section: Discussionmentioning

confidence: 99%

Efficacy of physiotherapy interventions late after stroke: a meta-analysis

Ferrarello

Baccini

Rinaldi

et al. 2010

Journal of Neurology, Neurosurgery & Psychiatry

109

View full text Add to dashboard Cite

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“…16 Finally, a recent Cochrane review concluded that there was insufficient evidence that any particular physiotherapy treatment approach was more effective than any other in promoting recovery of postural control or lower limb function after stroke. 17 In the current study we investigated the effects of the NDT approach in the treatment of hospital inpatients with stroke on the functional outcome and quality of life (QoL) one year after the stroke.…”

mentioning

confidence: 99%

Neurodevelopmental treatment after stroke: a comparative study

Hafsteinsdøttir

Algra

Kappelle³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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Background: Neurodevelopmental treatment (NDT) is a rehabilitation approach increasingly used in the care of stroke patients, although no evidence has been provided for its efficacy. Objective: To investigate the effects of NDT on the functional status and quality of life (QoL) of patients with stroke during one year after stroke onset. Methods: 324 consecutive patients with stroke from 12 Dutch hospitals were included in a prospective, non-randomised, parallel group study. In the experimental group (n = 223), nurses and physiotherapists from six neurological wards used the NDT approach, while conventional treatment was used in six control wards (n = 101). Functional status was assessed by the Barthel index. Primary outcome was ''poor outcome'', defined as Barthel index ,12 or death after one year. QoL was assessed with the 30 item version of the sickness impact profile (SA-SIP30) and the visual analogue scale. Results: At 12 months, 59 patients (27%) in the NDT group and 24 (24%) in the non-NDT group had poor outcome (corresponding adjusted odds ratio = 1.7 (95% confidence interval, 0.8 to 3.5)). At discharge the adjusted odds ratio was 0.8 (0.4 to 1.5) and after six months it was 1.6 (0.8 to 3.2). Adjusted mean differences in the two QoL measures showed no significant differences between the study groups at six or 12 months after stroke onset. Conclusions: The NDT approach was not found effective in the care of stroke patients in the hospital setting. Health care professionals need to reconsider the use of this approach.

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“…Management of the neurological deficit requires a multidisciplinary approach involving neurophysiotherapy, occupational therapy, and speech and language therapy. [22][23][24] Current medical management of vertebral artery dissection recommends either anticoagulation or antiplatelet agents to prevent thromboembolism from intraluminal clots. 25 A meta-analysis of non-randomised trials and retrospective analyses have found no difference in the risk of death or recurrent stroke between antiplatelet therapy and anticoagulation.…”

Section: Long Answermentioning

confidence: 99%