[REVIEW] What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis – Full Text PDF

Abstract

Background: Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT.

Methods and Findings: Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5–7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03–0.70; I2 = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84–4.11; I2 = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02–0.39; I2 = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41–0.82; I2 = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing.

Conclusions: There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given.

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[ARTICLE] Using Commercial Video Games for Upper Limb Stroke Rehabilitation: Is This the Way of the Future?

Abstract

Background: The increasing number of people living with poststroke sequelae has stimulated the search for novel ways of providing poststroke rehabilitation without putting additional stress on overburdened health care systems. One of them is the use of commercially available technology and off-the-shelf video games for hemiparetic upper limb rehabilitation.

Methods: The MEDLINE, EMBASE, and Cochrane Library databases were searched using key word synonyms for stroke, upper limb, and video games. Included studies investigated upper limb stroke rehabilitation using commercially available consoles and video games, reported outcomes that included measures of upper limb functionality, and were published in a peer-reviewed journal written in English.

Results: Thirteen studies were identified – 6 published as full articles and 7 as abstracts. Studies were generally small and only 3 were randomized. The gaming systems investigated were the Nintendo Wii (n = 10), EyeToy PlayStation (n = 2), and CyWee Z (n = 1). The Nintendo Wii appears to provide the greatest benefits to patients, with improvements seen in upper extremity function measures such as joint range of motion, hand motor function, grip strength, and dexterity. Three studies indicate that video therapy appears to be safe and that long-term improvements continue at follow-up.

Conclusions: At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints.

via Topics in Stroke Rehabilitation – online access – Volume 21 – Number 2 / Mar-Apr 2014 – What’s New in Measurement and Management of Motor Control in Stroke? – Using Commercial Video Games for Upper Limb Stroke Rehabilitation: Is This the Way of the Future?.

[EDITORIAL] Poststroke Outcomes. Stroke Research and Treatment Volume 2014 (2014)

…In conclusion, several opportunities exist to expand the scientific underpinnings and therapeutic options pertaining to poststroke outcomes. Periodic journal issues wholly dedicated to covering the state of the science in this research area are crucial for identifying gaps, stimulating ideas, and planning for future evidence-based treatments. That was the objective of this particular issue. Fortunately, improving poststroke outcomes is now clearly a priority item on the agenda of policy makers at various levels of medical research funding and healthcare delivery. We sincerely hope that these ongoing endeavors will lead to major breakthroughs in stroke recovery/rehabilitation and secondary prevention, thereby optimizing our ability to further enhance outcomes after stroke in the not-too-distant future…

via Poststroke Outcomes.

[ARTICLE] Using Commercial Video Games for Upper Limb Stroke Rehabilitation: Is This the Way of the Future?

…At present, the evidence that the use of commercial video games in rehabilitation improves upper limb functionality after stroke is very limited. However, this approach has the potential to provide easily available and affordable stroke rehabilitation therapy in settings where access to therapy is limited by geographical or financial constraints…

via Topics in Stroke Rehabilitation – online access – Volume 21 – Number 2 / Mar-Apr 2014 – What’s New in Measurement and Management of Motor Control in Stroke? – Using Commercial Video Games for Upper Limb Stroke Rehabilitation: Is This the Way of the Future?.