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While the interdisciplinary character of stroke rehabilitation is paramount, the availability of specific, up-to-date, and professional evidence-based guidelines for the physical therapy profession is crucial for making adequate evidence-based clinical decisions –. One of the key disciplines in interdisciplinary stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining ADLs, usually starting within the first days and often continuing into the chronic phase poststroke.
Interdisciplinary complex rehabilitation interventions, are assumed to represent the mainstay of poststroke care. In the long term, 25–74% of patients have to rely on human assistance for basic ADLs like feeding, self-care, and mobility. Only 12% of the patients with stroke are independent in basic activities of daily living (ADL) at the end of the first week.
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Even though acute stroke care has improved, for example by large-scale application of recombinant tissue plasminogen activator (rTPA), and organized interdisciplinary inpatient stroke care, and although mortality rates have been decreasing, a large number of patients still remain disabled regardless of the time that has elapsed poststroke. The prevalence of stroke is likely to increase in the future due to the aging population.
The prevalence of chronic stroke in the USA is estimated at about 7 million, with about 80% of patients with stroke being over the age of 65. Prospective studies have estimated that about 795.000 people in the USA suffer a first or recurrent stroke each year. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This research project was supported by the Royal Dutch Society for Physical Therapy (KNGF grant no. Received: OctoAccepted: DecemPublished: February 4, 2014Ĭopyright: © 2014 Veerbeek et al. Quinn, University of Glasgow, United Kingdom (2014) What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing.Ĭitation: Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, et al. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. 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. 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. 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. The search yielded 467 RCTs (N = 25373 median PEDro score 6 ), identifying 53 interventions. A best evidence synthesis was performed for neurological treatment approaches. Differences between phases poststroke were explored in subgroup analyses. RCTs with a low risk of bias were quantitatively analyzed. Outcomes were classified according to the ICF. Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search.
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