Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review

Alex Pollock, Gillian Baer, Peter Langhorne and Valerie Pomeroy

The objective of this study was to determine whether there is a difference in global dependency and functional independence in patients with stroke associated with different approaches to physiotherapy treatment.  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.  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. There were no significant differences found for any other comparisons.  The authors concluded that 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.

Clinical Rehabilitation, 2007, 21(5), 395-410

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