Physical rehabilitation approaches for the recovery of function and mobility following stroke.

Abstract:

BACKGROUND:Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. OBJECTIVES:To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach.For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality.In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention. SEARCH METHODS:We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation. SELECTION CRITERIA:Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches. DATA COLLECTION AND ANALYSIS:Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data. MAIN RESULTS:We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported.Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL).We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL).No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions. AUTHORS' CONCLUSIONS:Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.

authors

Pollock A,Baer G,Campbell P,Choo PL,Forster A,Morris J,Pomeroy VM,Langhorne P

doi

10.1002/14651858.CD001920.pub3

subject

Has Abstract

pub_date

2014-04-22 00:00:00

pages

CD001920

issue

4

issn

1469-493X

pub_type

杂志文章,meta分析,评审
  • WITHDRAWN: Conjugate vaccines for preventing Haemophilus influenzae type B infections.

    abstract:BACKGROUND:Haemophilus influenzae (H. influenzae) is an important cause of meningitis and pneumonia in children. Vaccine cost is a significant barrier to use in low income countries. Determining the size of the effects of the vaccine will enable cost-effectiveness comparisons with competing priorities in low income cou...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001729.pub3

    authors: Swingler GH,Michaels D,Hussey GG

    更新日期:2009-10-07 00:00:00

  • Theory-based interventions for contraception.

    abstract:BACKGROUND:The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, many educati...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007249.pub5

    authors: Lopez LM,Grey TW,Chen M,Tolley EE,Stockton LL

    更新日期:2016-11-23 00:00:00

  • Laser treatment of drusen to prevent progression to advanced age-related macular degeneration.

    abstract:BACKGROUND:Drusen are amorphous yellowish deposits beneath the sensory retina. People with drusen, particularly large drusen, are at higher risk of developing age-related macular degeneration (AMD). The most common complication in AMD is choroidal neovascularisation (CNV), the growth of new blood vessels in the centre ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006537.pub3

    authors: Virgili G,Michelessi M,Parodi MB,Bacherini D,Evans JR

    更新日期:2015-10-23 00:00:00

  • Continuous positive airways pressure for obstructive sleep apnoea in adults.

    abstract:BACKGROUND:Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of breathing due to narrowing or occlusion of the upper airway during sleep. The main symptom is daytime sleepiness and it has been suggested it is linked to premature death, hypertension, ischaemic heart disease, stroke and...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001106.pub3

    authors: Giles TL,Lasserson TJ,Smith BH,White J,Wright J,Cates CJ

    更新日期:2006-07-19 00:00:00

  • The effect of vitamin B6 on cognition.

    abstract:BACKGROUND:Micronutrient status can affect cognitive function at all ages. Vitamin deficiencies could influence memory function and might contribute to age-associated cognitive impairment and dementia. Vitamin B6, comprising three chemically distinct compounds pyridoxal, pyridoxamine, and pyridoxine, is involved in the...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004393

    authors: Malouf R,Grimley Evans J

    更新日期:2003-01-01 00:00:00

  • Intramedullary nails for extracapsular hip fractures in adults.

    abstract:BACKGROUND:Intramedullary nails may be used for the surgical fixation of extracapsular hip fractures in adults. They may be inserted from the top (cephalocondylic) or from the bottom (condylocephalic) end of the femur. OBJECTIVES:To compare different types or design modifications of intramedullary nails used in the fi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004961.pub3

    authors: Parker MJ,Handoll HH

    更新日期:2006-07-19 00:00:00

  • Bisphosphonates and other bone agents for breast cancer.

    abstract:BACKGROUND:Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab, inhibit key pathways in the vicious cycle of bone metastases. OBJECTIVES:To assess the effect of bisphosphonates...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003474.pub3

    authors: Wong MH,Stockler MR,Pavlakis N

    更新日期:2012-02-15 00:00:00

  • Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne.

    abstract:BACKGROUND:Hirsutism is the presence of excessive hair growth in women and is an important cosmetic condition often resulting in severe distress. Hirsutism is most often caused by increased production of male sex hormones also known as androgens. It is also affected by increased sensitivity to androgens in the hair fol...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000194

    authors: Lee O,Farquhar C,Toomath R,Jepson R

    更新日期:2000-01-01 00:00:00

  • Vitamin C for preventing and treating tetanus.

    abstract:BACKGROUND:Tetanus is a severe infection that can be prevented by vaccination. In developing countries vaccination coverage is not always high and in developed countries cases may still occur, particularly in elderly people owing to their reduced immunoprotection. It has been estimated that there are about one million ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006665.pub2

    authors: Hemilä H,Koivula TT

    更新日期:2008-04-16 00:00:00

  • Treatment and prevention of pouchitis after ileal pouch-anal anastomosis for chronic ulcerative colitis.

    abstract:BACKGROUND:Pouchitis occurs in approximately 50% of patients following ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (UC). OBJECTIVES:The primary objective was to determine the efficacy and safety of medical therapies for prevention or treatment of acute or chronic pouchitis. SEARCH METHODS:We se...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD001176.pub4

    authors: Nguyen N,Zhang B,Holubar SD,Pardi DS,Singh S

    更新日期:2019-05-28 00:00:00

  • Lithium for schizophrenia.

    abstract:BACKGROUND:Many people with schizophrenia do not achieve a satisfactory treatment response with ordinary antipsychotic drug treatment. In these cases, various add-on medications are used, among them lithium. OBJECTIVES:To review the effects of lithium for the treatment of schizophrenia and schizophrenia-like psychoses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003834

    authors: Leucht S,McGrath J,Kissling W

    更新日期:2003-01-01 00:00:00

  • Domiciliary oxygen for interstitial lung disease.

    abstract:BACKGROUND:Retrospective survival data have suggested poor effectiveness of oxygen therapy in patients with interstitial lung disease (ILD). OBJECTIVES:To determine the effect of domiciliary oxygen therapy on survival and quality of life in patients with a diagnosis of ILD and hypoxaemia. SEARCH STRATEGY:Randomized C...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002883

    authors: Crockett AJ,Cranston JM,Antic N

    更新日期:2001-01-01 00:00:00

  • Antipsychotic medications for cocaine dependence.

    abstract:BACKGROUND:Cocaine dependence is a public health problem characterized by recidivism and a host of medical and psychosocial complications. Cocaine dependence remains a disorder for which no pharmacological treatment of proven efficacy exists, although considerable advances in the neurobiology of this addiction could gu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006306.pub2

    authors: Amato L,Minozzi S,Pani PP,Davoli M

    更新日期:2007-07-18 00:00:00

  • Interventions for treating scabies.

    abstract:BACKGROUND:Scabies is a common public health problem with an estimated global prevalence of 300 million. Infestation can cause considerable discomfort and intense itching. Severe adverse effects have been reported for some drugs used to treat scabies. OBJECTIVES:The objective of this review is to assess the effects an...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000320

    authors: Walker GJ,Johnstone PW

    更新日期:2000-01-01 00:00:00

  • Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment.

    abstract:BACKGROUND:Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creatio...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003170.pub4

    authors: Wilkinson CP

    更新日期:2014-09-05 00:00:00

  • Surgical versus conservative interventions for treating fractures of the middle third of the clavicle.

    abstract:BACKGROUND:Clavicle fractures are common, accounting for 2.6% to 4% of all fractures. Eighty per cent of clavicle fractures are located in the middle third of the clavicle. Although treatment of these fractures is usually non-surgical, displaced clavicle fractures may be considered for surgical treatment because of the...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD009363.pub3

    authors: Lenza M,Buchbinder R,Johnston RV,Ferrari BA,Faloppa F

    更新日期:2019-01-22 00:00:00

  • Rescue high frequency oscillatory ventilation vs conventional ventilation for infants with severe pulmonary dysfunction born at or near term.

    abstract:BACKGROUND:Pulmonary disease is a major cause of mortality and morbidity in term and near term infants. Conventional ventilation (CV) has been used for many years but may lead to lung injury, require the subsequent use of more invasive treatment such as extra corporeal membrane oxygenation (ECMO), or result in death. T...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002974

    authors: Bhuta T,Clark RH,Henderson-Smart DJ

    更新日期:2001-01-01 00:00:00

  • Multidisciplinary rehabilitation for adults with multiple sclerosis.

    abstract:BACKGROUND:Multidisciplinary rehabilitation (MD) is an important component of symptomatic and supportive treatment for Multiple sclerosis (MS), but evidence base for its effectiveness is yet to be established. OBJECTIVES:To assess the effectiveness of organized MD rehabilitation in adults with MS. To explore rehabilit...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006036.pub2

    authors: Khan F,Turner-Stokes L,Ng L,Kilpatrick T

    更新日期:2007-04-18 00:00:00

  • Trihexyphenidyl for dystonia in cerebral palsy.

    abstract:BACKGROUND:Cerebral palsy occurs in up to 2.1 of every 1000 live births and encompasses a range of motor problems and movement disorders. One commonly occurring movement disorder amongst those with cerebral palsy is dystonia: sustained or intermittent involuntary muscle spasms and contractions that cause twisting, repe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD012430.pub2

    authors: Harvey AR,Baker LB,Reddihough DS,Scheinberg A,Williams K

    更新日期:2018-05-15 00:00:00

  • Psychological interventions to foster resilience in healthcare professionals.

    abstract:BACKGROUND:Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD012527.pub2

    authors: Kunzler AM,Helmreich I,Chmitorz A,König J,Binder H,Wessa M,Lieb K

    更新日期:2020-07-05 00:00:00

  • Pneumococcal vaccines for preventing otitis media.

    abstract:BACKGROUND:Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Long term effects of recurrent episodes of otitis media, rapid emergence of drug resistant bacteria associated with AOM worldwide and huge estimated direct and indirect annual costs associated with otitis media have e...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001480.pub2

    authors: Straetemans M,Sanders EA,Veenhoven RH,Schilder AG,Damoiseaux RA,Zielhuis GA

    更新日期:2004-01-01 00:00:00

  • Exercise for haemophilia.

    abstract:BACKGROUND:Haemophilia is a bleeding disorder associated with haemorrhaging into joints and muscles. Exercise is often used to aid recovery after bleeds, and to improve joint function in the presence of arthropathy. OBJECTIVES:Our objective was to systematically review the available evidence on the safety and effectiv...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD011180.pub2

    authors: Strike K,Mulder K,Michael R

    更新日期:2016-12-19 00:00:00

  • Remote ischaemic conditioning for preventing and treating ischaemic stroke.

    abstract:BACKGROUND:Remote ischaemic conditioning (RIC) has been developed as a neuroprotective strategy to prevent and treat ischaemic stroke. It usually involves restricting blood flow to limbs and then releasing the ischaemic blood to promote a neuroprotective effect. Preclinical studies have suggested that RIC may have bene...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD012503.pub2

    authors: Zhao W,Zhang J,Sadowsky MG,Meng R,Ding Y,Ji X

    更新日期:2018-07-05 00:00:00

  • Skin preparation for preventing infection following caesarean section.

    abstract:BACKGROUND:The risk of maternal mortality and morbidity (particularly postoperative infection) is higher for caesarean section (CS) than for vaginal birth. With the increasing rate of CS, it is important to minimise the risks to the mother as much as possible. This review focused on different forms and methods of preop...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD007462.pub4

    authors: Hadiati DR,Hakimi M,Nurdiati DS,da Silva Lopes K,Ota E

    更新日期:2018-10-22 00:00:00

  • Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation.

    abstract:BACKGROUND:Chronic pulmonary infection is a hallmark of lung disease in cystic fibrosis. Infections dominated by organisms of the Burkholderia cepacia complex, a group of at least 18 closely-related species of gram-negative bacteria, are particularly difficult to treat. These infections may be associated with a fulmina...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章

    doi:10.1002/14651858.CD009529.pub4

    authors: Lord R,Jones AM,Horsley A

    更新日期:2020-04-02 00:00:00

  • Pramipexole for levodopa-induced complications in Parkinson's disease.

    abstract:OBJECTIVES:To compare the efficacy and safety of adjuvant pramipexole therapy versus inactive placebo in patients with Parkinson's disease, already established on levodopa. SEARCH STRATEGY:Electronic searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register. Handsearching of the neurology literature as p...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002261

    authors: Clarke C E,Speller J M,Clarke J A

    更新日期:2000-01-01 00:00:00

  • Embolisation therapy for pulmonary arteriovenous malformations.

    abstract:BACKGROUND:Pulmonary arteriovenous malformations are abnormal direct connections between the pulmonary artery and pulmonary vein which result in a right-to-left shunt. They are associated with substantial morbidity and mortality mainly from the effects of paradoxical emboli. Potential complications include stroke, cere...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008017.pub2

    authors: Hsu CC,Kwan GN,Thompson SA,van Driel ML

    更新日期:2010-05-12 00:00:00

  • Household interventions for preventing domestic lead exposure in children.

    abstract:BACKGROUND:Lead poisoning is associated with physical, cognitive and neurobehavioural impairment in children and trials have tested many household interventions to prevent lead exposure. This is an update of the original review by the same authors first published in 2008. OBJECTIVES:To determine the effectiveness of h...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006047.pub4

    authors: Yeoh B,Woolfenden S,Lanphear B,Ridley GF,Livingstone N,Jorgensen E

    更新日期:2014-12-15 00:00:00

  • Decompressive craniectomy for the treatment of high intracranial pressure in closed traumatic brain injury.

    abstract:BACKGROUND:High intracranial pressure (ICP) is the most frequent cause of death and disability after severe traumatic brain injury (TBI). It is usually treated with general maneuvers (normothermia, sedation, etc.) and a set of first-line therapeutic measures (moderate hypocapnia, mannitol, etc.). When these measures fa...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD003983.pub3

    authors: Sahuquillo J,Dennis JA

    更新日期:2019-12-31 00:00:00

  • Nutritional support in children and young people with cancer undergoing chemotherapy.

    abstract:BACKGROUND:It is well documented that malnutrition is a common complication of paediatric malignancy and its treatment. Malnutrition can often be a consequence of cancer itself or a result of chemotherapy. Nutritional support aims to reverse malnutrition seen at diagnosis, prevent malnutrition associated with treatment...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003298.pub3

    authors: Ward EJ,Henry LM,Friend AJ,Wilkins S,Phillips RS

    更新日期:2015-08-24 00:00:00