The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Without pointing to or creating stroke rehab protocols this is useless for survivors. There is absolutely nothing here that any survivor can take to their therapists and have them use it as is to recover from their stroke. 

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

The impact of physical therapy on functionaloutcomes after stroke: what’s the evidence?
RPS Van Peppen
 Department of Physical Therapy, VU University Medical Center, Amsterdam,
 G Kwakkel
 Department ofPhysical Therapy, VU University Medical Center, Amsterdam and Center of Excellence for Rehabilitation Medicine ‘deHoogstraat’, Utrecht, The Netherlands,
 S Wood-Dauphinee
 School of Physical and Occupational Therapy, Department ofEpidemiology and Biostatistics, McGill University, Montreal, Canada,
HJM Hendriks
Dutch Institute of Allied Health Care (Npi),Amersfoort and Maastricht University, Department of Epidemiology, Maastricht,
 PhJ Van der Wees
 Royal Dutch Society forPhysical Therapy (KNGF), Amersfoort and
 J Dekker
 Institute for Research in Extramural Medicine (EMGO Institute),Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The NetherlandsReceived 23rd March 2004; returned for revisions 10th June 2004; revised manuscript accepted 25th July 2004.
Objective
: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke.(You can't improve outcomes until you write protocols. Are you that fucking stupid? The stupid - it burns)
Methods
: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials,Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnlinewere searched for controlled studies. Physical therapy was divided into 10intervention categories, which were analysed separately. If statistical pooling(weighted summary effect sizes) was not possible due to lack of comparabilitybetween interventions, patient characteristics and measures of outcome, a best-research synthesis was performed. This best-research synthesis was based onmethodological quality (PEDro score).
Results
: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs).  Methodological quality of all RCTs had a median of 5 points on the 10-point PEDroscale (range 2 /8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% CI 0.03/0.23) for effects of high intensity of exercise training to 0.92 (95% CI 0.54/1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% CI 0.07/0.91), treadmill training with or without body weight support, respectively 0.70 (95% CI 0.29/1.10) and 1.09 (95% CI 0.56/1.61), aerobics (SES 0.39; 95% CI 0.05/0.74), external auditory rhythms during gait (SES 0.91; 95% CI 0.40/1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% CI 0.76/2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches;exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive
Address for correspondence: Gert Kwakkel, Department of Physical Therapy, VU University Medical Center, PO Box 7057,1007 MB Amsterdam, The Netherlands.