What is the evidence for physical therapy post stroke?
Physical therapy is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the "state of the art" evidence for stroke rehabilitation interventions in the domain of PT. Since the implementation of the Stroke Guideline in the Netherlands in 2004, the available evidence has quadrupled; this makes it virtually impossible for individual physical therapists to identify and ascertain the content of each article: time for an update!
467 RCT's were reviewed, involving 25.373 patients and stating 53 interventions. The interventions were classified in:
- gait and mobility-related functions and activities (eg. balance training, treadmill, orthosis, early mobilization)
- arm-hand activities (eg. positioning, splints, CIMT, motor imagery, mirror therapy)
- ADL in general (eg. gestural training for apraxia)
- physical fitness (eg strength exercises, cardiorespiratory training)
- inspiratory muscle training
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. There is strong evidence that a higher dose of practice is better, (at least 17 hours "clean" intervention in 10 weeks) and timing does not matter; therapy is beneficial in all phases (acute to chronic) post stroke. Neurological treatment approaches (NDT) to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. There is strong evidence for PT interventions favoring intensive, high repetitive, task-oriented and task-specific training in all phasespoststroke. Effects are mostly restricted to the actually trained functions and activities.
> From: Veerbeek et al., PLoS One 9 (2014) e87987. All rights reserved to The Author(s). Click here for the Pubmed summary.
