Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review.
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.
Pollock
Alex
A
Stroke Therapy Evaluation Programme, Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK. alex@strokerehab.fsnet.co.uk
Baer
Gillian
G
Langhorne
Peter
P
Pomeroy
Valerie
V
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