Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke

 

Abstract

Background

There are a number of different approaches to physiotherapy treatment following stroke that, broadly speaking, are based on neurophysiological, motor learning and orthopaedic principles. Some physiotherapists base their treatment on a single approach, while others use a mixture of components from a number of different approaches.

Objectives

To determine if there is a difference in the recovery of postural control and lower limb function in patients with stroke if physiotherapy treatment is based on orthopaedic or neurophysiological or motor learning principles, or on a mixture of these treatment principles.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched May 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The 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.

Selection criteria

Randomised or quasi-randomised controlled trials of physiotherapy treatment approaches aimed at promoting the recovery of postural control and lower limb function in adult participants with a clinical diagnosis of stroke. Outcomes included measures of disability, motor impairment or participation.

Data collection and analysis

Two review authors independently categorised the identified trials according to the inclusion and exclusion criteria, documented their methodological quality, and extracted the data.

Main results

Twenty-one trials were included in the review, five of which were included in two comparisons. Eight trials compared a neurophysiological approach with another approach; eight compared a motor learning approach with another approach; and eight compared a mixed approach with another approach. A mixed approach was significantly more effective than no treatment or placebo control for improving functional independence (standardised mean difference (SMD) 0.94, 95% confidence intervals (CI) 0.08 to 1.80). There was no significant evidence that any single approach had a better outcome than any other single approach or no treatment control.

Authors' conclusions

There is evidence that physiotherapy intervention, using a mix of components from different approaches, is significantly more effective than no treatment or placebo control in the recovery of functional independence following stroke. There is insufficient evidence to conclude that any one physiotherapy approach is more effective in promoting recovery of lower limb function or postural control following stroke than any other approach. We recommend that future research should concentrate on investigating the effectiveness of clearly described individual techniques and task-specific treatments, regardless of their historical or philosophical origin.

 

Plain language summary

Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke

Physiotherapy, using a mix of components from different treatment approaches, appears best for promoting functional independence following stroke; no single physiotherapy approach is clearly best for promoting recovery after stroke. A stroke interrupts the blood flow to the brain, often leading to damage to some brain functions. This can cause paralysis of some parts of the body or other difficulties with various physical functions. Physiotherapy is an important part of rehabilitation for people who have had a stroke. A number of physiotherapy approaches have been developed based on different ideas about how people recover after a stroke. This review of 21 trials found there is no evidence that any one approach was clearly better than another for improving leg strength, balance, walking speed or the ability to perform everyday tasks. However, physiotherapy using a mixture of components from the different approaches was better than no treatment or placebo treatment for improving aspects of function following a stroke.

 

摘要

背景

物理治療幫助中風後姿勢控制和下肢功能的恢復

有一些不同方法用於中風後的物理治療，一般說來，是根據神經生理學，運動學習和骨科原則。有一些物理治療師以單一的方法來治療，而其他人採用混合的方式從多個不同的方法來治療

目標

要決定腦中風患者接受的物理治療是基於骨科或神經生理學或運動學習的原則，或在這些混合的治療原則對於姿勢控制和下肢功能的恢復兩者是否有差別.

搜尋策略

我們檢索了Cochrane腦中風試驗註冊資料庫(最後搜查至2005年5月的)，Cochrane中心臨床對照試驗(中環)(Cochrane圖書館第2期，2005)，MEDLINE(1966年至2005年5月)，EMBASE(1980年至2005年5月)和CINAHL(1982年至2005年5月)。我們接洽了對中風復健有興趣的專家和研究人員.

選擇標準

隨機或半隨機對照試驗的物理治療方法，針對臨床診斷為中風的成年參與者,目標是促進姿勢控制及下肢功能的恢復。結果包括殘疾的測量，運動系統損傷或參與。

資料收集與分析

兩個文獻回顧作者各自獨立地根據納入和排除標準將已選出的試驗分類，並記錄了方法學上的品質，並摘取數據

主要結論

21個試驗被納入了回顧，其中5個被列入兩個比較。八個試驗比較了神經生理學方法與其他方法;八個比較運動學習方法和其他方法相比,八個比較混合方法和其他方法相比。與未治療組或安慰劑組相比,對於改善獨立功能,混合法是非常有效的(標準化平均差(SMD)0.94,95%可信區間為0.08 – 1.80(CI)。沒有明顯的證據表明任何單一的方法比其他任何一種方法或沒有治療的控制會有更好的結果

作者結論

有證據表明,物理治療的介入,若採用不同方法混合,與未治療組或安慰劑相比,對於中風後獨立功能的恢復是非常有效的。沒有足夠的證據說明任何一個物理治療方法在中風後能更有效地促進下肢功能的回復或姿勢控制會比任何其它的方法有效。不論歷史或哲學的來源為何,建議後續研究應該集中調查那些有清楚描述個別的有效治療技術和任務型的治療.

翻譯人

本摘要由奇美醫院何乘彰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

運用混合式的物理治療方法對於中風後獨立功能的促進似乎是最好的;沒有任何一種單一的物理治療方法對於中風後功能的恢復是最好的. 中風導致中斷血液流到大腦,常常導致傷害到一些大腦功能。這可能會導致身體部位的癱瘓,或是其他身體功能的不同障礙。對於中風病患,物理治療是復健的重要組成。基於人們是如何在中風之後恢復功能,根據不同觀點的已經有大量的物理治療方法被開發。本文發現,沒有任何證據表明任何方法之一對於改善腿的力量,平衡、行走速度和完成每天工作的能力是明顯優於另一項的。然而,對於改善中風後的功能,使用混合組成不同方法的物理治療明顯優於未治療組或安慰劑治療。