title: Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review.
abstract: OBJECTIVE
  To determine whether there is a difference in global dependency and functional independence in patients with stroke associated with different approaches to physiotherapy treatment.
  
  
  METHODS
  We searched the Cochrane Stroke Group Trials Register (last searched May 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2005), MEDLINE (1966 to May 2005), EMBASE (1980 to May 2005) and CINAHL (1982 to May 2005). We contacted experts and researchers with an interest in stroke rehabilitation.
  
  
  METHODS
  Inclusion criteria were: (a) randomized or quasi-randomized controlled trials; (b) adults with a clinical diagnosis of stroke; (c) physiotherapy treatment approaches aimed at promoting postural control and lower limb function; (d) measures of disability, motor impairment or participation. Two independent reviewers categorized identified trials according to the inclusion/exclusion criteria, documented the methodological quality and extracted the data.
  
  
  RESULTS
  Twenty trials (1087 patients) were included in the review. Comparisons included: neurophysiological approach versus other approach; motor learning approach versus other approach; mixed approach versus other approach for the outcomes of global dependency and functional independence. A mixed approach was significantly more effective than no treatment control at improving functional independence (standardized mean difference (SMD) 0.94, 95% confidence interval (CI) 0.08 to 1.80). There were no significant differences found for any other comparisons.
  
  
  CONCLUSIONS
  Physiotherapy intervention, using a 'mix' of components from different 'approaches' is more effective than no treatment control in attaining functional independence following stroke. There is insufficient evidence to conclude that any one physiotherapy 'approach' is more effective in promoting recovery of disability than any other approach.
authors.affiliation: Stroke Therapy Evaluation Programme, Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK. alex@strokerehab.fsnet.co.uk
authors.forename: Alex
authors.initials: A
authors.lastname: Pollock
authors.forename: Gillian
authors.initials: G
authors.lastname: Baer
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
authors.forename: Valerie
authors.initials: V
authors.lastname: Pomeroy
mesh_terms: D000203:Activities of Daily Living; D006801:Humans; D035002:Lower Extremity / Q000502:physiology*; D008875:Middle Aged; D009043:Motor Activity; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D000071939:Stroke Rehabilitation