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

The evidence is that therapy after stroke is a complete fucking failure; only 10% get to full recovery from it. But you're using the tyranny of low expectations to declare success from failure.  You ask one question of your patients: Are you 100% recovered? Y/N? That will give you the correct answer to your recovery question.

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

2004, Clinical Rehabilitation

  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 atimproving functional outcome after stroke.
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 comparability between 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 infavour of task-oriented exercise training to restore balance and gait, and forstrengthening the lower paretic limb. Summary effect sizes (SES) for functionaloutcomes ranged from 0.13 (95% CI 0.03-0.23) for effects of high intensity ofexercise training to 0.92 (95% CI 0.54-1.29) for improving symmetry when movingfrom sitting to standing. Strong evidence was also found for therapies that werefocused on functional training of the upper limb such as constraint-inducedmovement therapy (SES 0.46; 95% CI 0.07-0.91), treadmill training with or withoutbody 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 glenohumeralsubluxation (SES 1.41; 95% CI 0.76-2.06). No or insufficient evidence in terms offunctional outcome was found for: traditional neurological treatment approaches;exercises for the upper limb; biofeedback; functional and neuromuscular electricalstimulation aimed at improving dexterity or gait performance; orthotics and assistive  devices; and physical therapy interventions for reducing hemiplegic shoulder pain andhand oedema.
Conclusions: 

 

This review showed small to large effect sizes for task-orientedexercise training, in particular when applied intensively and early after stroke onset. Inalmost all high-quality RCTs, effects were mainly restricted to tasks directly trained inthe exercise programme
Address for correspondence: Gert Kwakkel, Department of Physical Therapy, VU University Medical Center, PO Box 7057,1007 MB Amsterdam, The Netherlands.