[BLOG POST] When EBP meets neurological physiotherapy …

Hello, I’m Sarah Tyson, Professor of Rehabilitation at the University of Manchester, neurological physiotherapist and enthusiast for improving outcomes for people neurological conditions using research and other evidence.

This blog has been set up in response to the discussion that was generated to an icsp (the discussion forum for the CSP) thread about the evidence-base for neuro physios and more specifically, the evidence for or against Bobath therapy (found here http://www.csp.org.uk/icsp/topics/rationale-evidence-bobath-neurological-physio  and http://www.csp.org.uk/icsp/topics/novak-review-casts-doubt-efficacy-bobath-should-we-embrace-or-ignore-it  ) Many got in touch to let me know that they would like a more open forum, so here it is. Having said that, icsp is a good resource for MCSPs – I’d encourage you to register and use it. However I’d like to expand the remit beyond the icsp thread to open a discussion (polite and respectful discussion) about evidence based neurological physiotherapy; what that means in reality, and how we could/ should/ would be delivering it.  I also doubt that I’ll be able to resist letting folk know about the rehabilitation research for people with stroke and other conditions we are doing at Manchester. So it’s only fair and reasonable that I invite others to do the same.

My original aim was to present the main topics of discussion about the evidence (or otherwise) for the Bobath concept as they appeared in the icsp discussion and to let all contributors make their points in a wider forum. However this has fallen foul of the terms and conditions of icsp and their copyright rules, so I have to summarise the contributions in my own words. I have tried to do this as openly and even-handedly as I can. You can always go back to the original icsp thread to check it out, but let me know if there is anything you object to about the way I have precise’d and I will be happy to change it.

Let’s have a lively debate.

Source: Home – When EBP meets neurological physiotherapy …

[Review] Hands-on physiotherapy interventions and stroke and International Classification of Functionality, Disability and Health outcomes

Abstract

The effectiveness of “hands-on” physiotherapy for stroke is unclear. The objective here is to analyze the effectiveness of such interventions on movement-related International Classification of Functionality, Disability and Health (ICF) categories. A systematic review was undertaken of randomized controlled trials published since 1980, using the following criteria: stroke, humans, ≥ 18 years, outcomes related to ICF movement-related categories, physiotherapeutic handling techniques, control group as placebo or no intervention, including experiments where both groups have the same intervention and the experimental group has one extra intervention. Nine studies were included and a best evidence synthesis is presented. Recommendations with limited evidence favor slow-stroke back massage for shoulder pain, range-of-motion exercises for upper-limb and lower-limb structures and functions of muscles and joints, proprioceptive neuromuscular facilitation (PNF) for gait step, walking backwards with hip facilitation for gait parameters and performance, and conventional physiotherapy with facilitation techniques for gait parameters. Recommendations with indicative findings favor PNF with trunk rhythmic stabilizations for function and mobility of upper limbs. Recommendations with limited evidence show the non-efficacy of Bobath therapy for upper-limb function and activity and facilitation of the step on body weight support treadmill training for gait parameters and performance. In conclusion, some hands-on interventions have limited evidence in stroke rehabilitation.

via Taylor & Francis Online :: Hands-on physiotherapy interventions and stroke and International Classification of Functionality, Disability and Health outcomes: A systematic review – European Journal of Physiotherapy –.

[ARTICLE] A STUDY ON THE EFFECTIVENESS OF BOBATH APPROACH VERSUS CONSTRAINT INDUCED MOVEMENT THERAPY (CIMT) TO IMPROVE THE ARM MOTOR FUNCTION AND THE HAND DEXTERITY FUNCTION IN POST STROKE PATIENTS – Full Text PDF

Abstract

Objective: To compare the effects of the Bobath Therapy and Constraint-Induced Movement Therapy on arm motor function and hand dexterity function among stroke patients with a high level of function on the affected side.

Materials and Methods: Study has conducted at theOutpatient physiotherapy department of a stroke unit. With a total of 30 patients were conveniently recruited and then randomized to Bobath Concept group and constraintinduced movement therapy group. Intervention included were the Bobath Concept group was treated for 1.5 hours per day during 5 consecutive weekdays for 4 weeks whereas the constraint-induced movement therapy group received training for 2 hours per day during 5 consecutive weekdays for 3 weeks. Outcome measures by the Wolf Motor Function Test, and Jebsen Taylor Hand Function Test.

Results: The two groups were found to be homogeneous based on demographic variables and baseline measurements. There were no significant differencesin Wolf Motor Function Test at post test (p = 0.861) and at follow up (p = 0.395). There is a significantimprovementin JTHFT in both the groupswith sight better improvement in group B (except writing components post test p=0.752and checkers at post test p=0.197 and follow up p=0.167)) as compared to Group A.

Conclusions: Bobath therapy and the Constraint-induced movementtherapy have similar efficienciesin improving arm motor function in the paretic arm among stroke patients with a high level of function. Constraint-induced movement therapy seems to be slightly more efficient than the Bobath Concept in improving hand dexterity function.

Full Text PDF