What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

You may have found strong evidence but this is totally useless since it is not put into a publicly available database for others to find. Bad research, the mentors and senior researchers need to be keel hauled.  There was this from 1990;

A review of stroke rehabilitation and physiotherapy. This was written in 1990 

And this from 2014:

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

This is what is so fucking bad about stroke. They don't mention updating any stroke protocols.  29 years and still no protocols.  Which means every therapist in the world needs to analyze this and create their own. Aren't you lucky your therapist is guessing what might work in your rehab. 

 

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

Janne Marieke Veerbeek 1, Erwin van Wegen1, Roland van Peppen2, Philip Jan van der Wees3,Erik Hendri4, Marc Rietberg1, Gert Kwakkel1,5*1Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, The Netherlands, 2Department of Physiotherapy, University of Applied Sciences Utrecht, Utrecht, The Netherlands, 3 Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, 4Department of Epidemiology, Maastricht University, Maastricht, The Netherlands, 5Department of Neurorehabilitation, Reade Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands

Abstract 

Background:  Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.
Methods and Findings:  Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed.Differences between phases post stroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N=25373; median PEDro score 6 [IQR 5–7]), identifying 53 interventions. No adverse events were reported. 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.
Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2=0%) for therapeutic positioning of theparetic arm to 2.47 (95%CI 0.84–4.11; I2=77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2=6%) for motor function of the paretic arm to 0.61(95%CI 0.41–0.82; I2=41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing post stroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing.(The main limitation is that you aren't updating a protocol, so what you have done is useless.)
Conclusions:  There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases post stroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.
Citation: Veerbeek JM,
van Wegen E,
van Peppen R,
van der Wees PJ,
Hendriks E, et al. (2014)
What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. PLoS ONE 9(2): e87987. doi:10.1371/journal.pone.0087987Editor: Terence J. Quinn, University of Glasgow, United Kingdom Received> October 29, 2013; Accepted December 30, 2013; Published February 4, 2014 Copyright:  2014 Veerbeek et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This research project was supported by the Royal Dutch Society for Physical Therapy (KNGF grant no. 8091.1; http://www.fysionet.nl/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Competing Interests: The authors have declared that no competing interests exist.* E-mail: g.kwakkel@vumc.nl

Introduction

Prospective studies have estimated that about 795,000 people in the USA suffer a first or recurrent stroke each year [1]. The prevalence of chronic stroke in the USA is estimated at about 7 million [1], with about 80% of patients with stroke being over the age of 65. The prevalence of stroke is likely to increase in the future due to the aging population. Even though acute stroke care has improved, for example by large-scale application of recombinant tissue plasminogen activator (rTPA) [1,2] and organized interdisciplinary inpatient stroke care [3], and although mortalityrates have been decreasing [1], a large number of patients still remain disabled regardless of the time that has elapsed poststroke.Only 12% of the patients with stroke are independent in basicactivities of daily living (ADL) at the end of the first week [4]. In the long term 25-74% of patients have to rely on human assistance for basic ADLs like feeding, self-care, and mobility [5].Interdisciplinary complex rehabilitation interventions [6,7] are assumed to represent the mainstay of post stroke care [8]. One of the key disciplines interiplinary stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining ADLs, usually starting within the first days and often continuing into chronic phase post stroke [8]. 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 ]. The recommendations in the first Dutch evidence-based ‘Clinical Practice Guideline for physical therapy in patients with stroke’were based on meta-analyses of 123 randomized controlled trials(RCTs) and date back to 2004 [12]. In view of the tremendous growth in the number of RCTs in this field, it is now necessary to re-establish the ‘‘state of the art concerning the evidence for PLOS ONE