The effect of rehabilitation interventions on physical function and immobility-related complications in severe stroke: a systematic review

Abstract

ObjectiveTo evaluate the effectiveness of rehabilitation interventions on physical function and immobility-related complications in severe stroke.DesignSystematic review of electronic databases (Medline, Excerpta Medica database, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, Database of Research in Stroke, Cochrane Central Register of Controlled Trials) searched between January 1987 and November 2018.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the review. Randomised controlled trials comparing the effect of one type of rehabilitation intervention to another intervention, usual care or no intervention on physical function and immobility-related complications for patients with severe stroke were included. Studies that recruited participants with all levels of stroke severity were included only if subgroup analysis based on stroke severity was performed. Two reviewers screened search results, selected studies using predefined selection criteria, extracted data and assessed risk of bias for selected studies using piloted proformas. Marked heterogeneity prevented meta-analysis and a descriptive review was performed. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess evidence strength.Results28 studies (n=2677, mean age 72.7 years, 49.3% males) were included in the review. 24 studies were rated low or very low quality due to high risk of bias and small sample sizes. There was high-quality evidence that very early mobilisation (ie, mobilisation with 24 hours poststroke) and occupational therapy in care homes were no more effective than usual care. There was moderate quality evidence supporting short-term benefits of wrist and finger neuromuscular electrical stimulation in improving wrist extensor and grip strength, additional upper limb training on improving upper limb function and additional lower limb training on improving upper limb function, independence in activities of daily living, gait speed and gait independence.ConclusionsThere is a paucity of high-quality evidence to support the use of rehabilitation interventions to improve physical function and reduce immobility-related complications after severe stroke. Future research investigating more commonly used rehabilitation interventions, particularly to reduce poststroke complications, is required.PROSPERO registration numberCRD42017077737

Local and Contralateral Effects after the Application of Neuromuscular Electrostimulation in Lower Limbs

“…It has been repeatedly reported that neuromuscular electrostimulation (NMES) is a useful tool and gold standard in several rehabilitation procedures [1,2]. Among its most well known benefits are the improvements of muscle strength [3] and neuro-muscular activation [4].…”

“…The thermal effects resulting from NMES, as well as other strategies employed in the fields of rehabilitation and sports medicine, can be measured using infrared thermography (IRT), a precise and noninvasive technology [17]. Analysis of images captured by IRT enables the quantitative measurement of variations in the thermal pattern of surfaces under study, commonly called the "region of interest" (ROI), which are indicators of changes in metabolism, in hemodynamics, or in neuronal thermoregulatory processes [2,18]. Investigations that are based on the combination of thermal images with laser Doppler have postulated that Tsk can be translated into quantity of skin blood flow, so that at higher temperatures, there is greater skin blood flow, and vice versa [19].…”

How active are stroke patients in physiotherapy sessions and is this associated with stroke severity?

“…It is the largest observational study of active exercise time within physiotherapy sessions. To our knowledge, it is the first study to include patients with severe and very severe strokes, a population who are greatly underrepresented in the literature [36]. Consequently, the inclusion of patients presenting with a range of stroke severity levels increases the generalisability of findings to clinical practice.…”

Rehabilitation of Stroke Patients in India: An Exploratory Study from a National-Level Survey Data

“…In our study, nearly 90% of the stroke survivors reported any form of movement impairments in their upper or lower extremity, which needs professional intervention. Therapeutic methods have shown an effect on improvement in both upper and lower extremities, resulting in improved motor function and hand function [22,23] . Problems like motor function have day-to-day implications in a patient's life in contrast to other impairments like swallowing, thinking, and difficult vision.…”