Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review
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Date
2007-05Author
Pollock, A.
Baer, Gill
Langhorne, P.
Pomeroy, V. M.
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Pollock, A., Baer, G., Langhorne, P. & Pomeroy, V. (2007) Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review, Clinical Rehabilitation, vol. 21, , pp. 395-410,
Abstract
Objectives: To determine whether there is a difference in global dependency and
functional independence in patients with stroke associated with different
approaches to physiotherapy treatment.
Data sources: We searched the Cochrane Stroke Group Trials Register (last
searched May 2005), Cochrane Central Register of Controlled Trials (CENTRAL)
(Cochrane Library Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1980
to May 2005) and CINAHL (1982 to May 2005). We contacted experts and
researchers with an interest in stroke rehabilitation.
Review methods: Inclusion criteria were: (a) randomized or quasi-randomized
controlled trials; (b) adults with a clinical diagnosis of stroke; (c) physiotherapy
treatment approaches aimed at promoting postural control and lower limb function;
(d) measures of disability, motor impairment or participation. Two independent
reviewers categorized identified trials according to the inclusion/exclusion criteria,
documented the methodological quality and extracted the data.
Results: Twenty trials (1087 patients) were included in the review. Comparisons
included: neurophysiological approach versus other approach; motor learning
approach versus other approach; mixed approach versus other approach for the
outcomes of global dependency and functional independence. A mixed approach
was significantly more effective than no treatment control at improving functional
independence (standardized mean difference (SMD) 0.94, 95% confidence interval
(CI) 0.08 to 1.80). There were no significant differences found for any other
comparisons.
Conclusions: Physiotherapy intervention, using a 'mix' of components from different
'approaches' is more effective than no treatment control in attaining functional
independence following stroke. There is insufficient evidence to conclude that any
one physiotherapy 'approach' is more effective in promoting recovery of disability
than any other approach.