So it took 24 years to come to a conclusion! Wow, Just wow!
In 1994, these therapists had no Theoretical basis of stroke rehab
So I'm not convinced that this will do anything unless we get a great stroke association to deliver this information to all therapists. And I really don't consider this very good evidence since I doubt there was any objective measurement of dead/damaged neurons. Thus making any repeatability impossible.
What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis
Terence J. Quinn, Editor
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 poststroke 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 the paretic 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 poststroke 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.
=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 the paretic 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 poststroke 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.Conclusions
There
is strong evidence for PT interventions favoring intensive high
repetitive task-oriented and task-specific training in all phases
poststroke. Effects are mostly restricted to the actually trained
functions and activities. Suggestions for prioritizing PT stroke
research are given.
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