2009 - The Effectiveness of the Bobath Concept in Stroke

If Bobath is not superior why the hell would you recommend further trials? Since this was written in 2009 have your therapists discontinued using Bobath?

2009 - The Effectiveness of the Bobath Concept in Stroke

Boudewijn J. Kollen, PhD; Sheila Lennon, PhD; Bernadette Lyons, MSc; Laura Wheatley-Smith, BSc;Mark Scheper, MSc; Jaap H. Buurke, PhD; Jos Halfens;Alexander C.H. Geurts, MD, PhD; Gert Kwakkel, PhD

Purpose 

In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation.

Method  

(March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lowerlimb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database(PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches.

Results

The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studiesinvolving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath onsensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidenceavailable, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness.

Conclusions 

This systematic review confirms that overall the Bobath Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published.Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment.  Stroke . 2009;40:e89-e97.)