The impact of physical therapy on functional outcomes after stroke: what's the evidence?

Van Peppen, R PS; Kwakkel, G; Wood-Dauphinee, S; Hendriks, H JM; Van der Wees, Ph J; Dekker, J

doi:10.1191/0269215504cr843oa

Cited by 942Stroke Rehabilitation and RecoveryAcute Ischemic Stroke ManagementMedical Practices and Rehabilitation

The impact of physical therapy on functional outcomes after stroke: what's the evidence?

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Van Peppen, R PS, Kwakkel, G, Wood-Dauphinee, S, Hendriks, H JM, Van der Wees, Ph J, Dekker, J·2004·Clinical Rehabilitation

DOI 10.1191/0269215504cr843oa

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Abstract

Objective: To determine the evidence for physical therapy interventions aimed at improving functional outcome after stroke. Methods: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, EMBASE and DocOnline were searched for controlled studies. Physical therapy was divided into 10 intervention categories, which were analysed separately. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics and measures of outcome, a bestresearch synthesis was performed. This best-research synthesis was based on methodological quality (PEDro score). Results: In total, 151 studies were included in this systematic review; 123 were randomized controlled trials (RCTs) and 28 controlled clinical trials (CCTs). Methodological quality of all RCTs had a median of 5 points on the 10-point PEDro scale (range 2–8 points). Based on high-quality RCTs strong evidence was found in favour of task-oriented exercise training to restore balance and gait, and for strengthening the lower paretic limb. Summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% CI 0.03–0.23) for effects of high intensity of exercise training to 0.92 (95% CI 0.54–1.29) for improving symmetry when moving from sitting to standing. Strong evidence was also found for therapies that were focused on functional training of the upper limb such as constraint-induced movement therapy (SES 0.46; 95% CI 0.07–0.91), treadmill training with or without body weight support, respectively 0.70 (95% CI 0.29–1.10) and 1.09 (95% CI 0.56–1.61), aerobics (SES 0.39; 95% CI 0.05–0.74), external auditory rhythms during gait (SES 0.91; 95% CI 0.40–1.42) and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% CI 0.76–2.06). No or insufficient evidence in terms of functional outcome was found for: traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics and assistive devices; and physical therapy interventions for reducing hemiplegic shoulder pain and hand oedema. Conclusions: This review showed small to large effect sizes for task-oriented exercise training, in particular when applied intensively and early after stroke onset. In almost all high-quality RCTs, effects were mainly restricted to tasks directly trained in the exercise programme.

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Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence
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Biofeedback for robotic gait rehabilitation
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Neural Reorganization Underlies Improvement in Stroke‐induced Motor Dysfunction by Music‐supported Therapy
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Self-citation
Assessment of Upper-Limb Sensorimotor Function of Subacute Stroke Patients Using Visually Guided Reaching
Coderre, A. M., Zeid, A. A., Dukelow, S. P., Demmer, M. J., Moore, K. D., Demers, M. J., Bretzke, H., Herter, T. M., Glasgow, J., Norman, K. E., et al. (2010) · Neurorehabilitation and neural repair · doi:10.1177/1545968309356091 · Cited by 274 · see citing works
Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review
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A Pneumatic Glove and Immersive Virtual Reality Environment for Hand Rehabilitative Training After Stroke
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The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis
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The Effect of Physical Exercise on Cancer-related Fatigue during Cancer Treatment: a Meta-analysis of Randomised Controlled Trials
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Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now?
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A Self-Administered Graded Repetitive Arm Supplementary Program (GRASP) Improves Arm Function During Inpatient Stroke Rehabilitation: A Multi-Site Randomized Controlled Trial
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Gait Coordination After Stroke: Benefits of Acoustically Paced Treadmill Walking
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Bilateral arm training: Why and who benefits?
Waller, S. M., & Whitall, J. (2008) · Neurorehabilitation · doi:10.3233/nre-2008-23104 · Cited by 253 · see citing works
Rehabilitation of Gait Speed After Stroke: A Critical Review of Intervention Approaches
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Cognitive impairment six months after ischaemic stroke: a profile from the ASPIRE-S study
on behalf of the ASPIRE-S study group, Mellon, L., Brewer, L., Hall, P., Horgan, F., Williams, D. J., & Hickey, A. (2015) · BMC Neurology · doi:10.1186/s12883-015-0288-2 · Cited by 256 · see citing works
Time Course of Trunk, Arm, Leg, and Functional Recovery After Ischemic Stroke
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Effects of Task-Specific Locomotor and Strength Training in Adults Who Were Ambulatory After Stroke: Results of the STEPS Randomized Clinical Trial
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Interventions for improving upper limb function after stroke
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Stretch for the treatment and prevention of contractures
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Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis
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Effects of Task-Oriented Circuit Class Training on Walking Competency After Stroke
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Strength Training Improves Upper-Limb Function in Individuals With Stroke
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Gait training with the newly developed ‘LokoHelp’-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury. A feasibility study
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Community ambulation in patients with chronic stroke: how is it related to gait speed?
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Importance of Specificity, Amount, and Intensity of Locomotor Training to Improve Ambulatory Function in Patients Poststroke
Hornby, T. G., Straube, D., Kinnaird, C. R., Holleran, C. L., Echauz, A. J., Rodriguez, K. S., Wagner, E. J., & Narducci, E. (2011) · Topics in Stroke Rehabilitation · doi:10.1310/tsr1804-293 · Cited by 204 · see citing works
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Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008
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Effects of Unilateral Upper Limb Training in Two Distinct Prognostic Groups Early After Stroke
Kwakkel, G., Winters, C., van Wegen, E. E. H., Nijland, R. H. M., van Kuijk, A. A., Visser‐Meily, A., de Groot, J. H., de Vlugt, E., Arendzen, J. H., Geurts, A. C. H., et al. (2016) · Neurorehabilitation and neural repair · doi:10.1177/1545968315624784 · Cited by 199 · see citing works
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Botulinum toxin assessment, intervention and after‐care for upper limb hypertonicity in adults: international consensus statement
Sheean, G. L., Lannin, N. A., Turner‐Stokes, L. F., Rawicki, B., & Snow, B. J. (2010) · European Journal of Neurology · doi:10.1111/j.1468-1331.2010.03129.x · Cited by 198 · see citing works
Effectiveness of Stretch for the Treatment and Prevention of Contractures in People With Neurological Conditions: A Systematic Review
Katalinic, O. M., Harvey, L. A., & Herbert, R. (2010) · Physical Therapy · doi:10.2522/ptj.20100265 · Cited by 196 · see citing works
Hand Rehabilitation Following Stroke: A Pilot Study of Assisted Finger Extension Training in a Virtual Environment
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An IoT-Enabled Stroke Rehabilitation System Based on Smart Wearable Armband and Machine Learning
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Effects of Exercise Training Programs on Walking Competency After Stroke
van de Port, I. G. L., Wood-Dauphinée, S., Lindeman, E., & Kwakkel, G. (2007) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e31802ee464 · Cited by 190 · see citing works
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Physical Activity in Hospitalised Stroke Patients
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BoTULS: a multicentre randomised controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A
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Post-stroke balance training: Role of force platform with visual feedback technique
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Bilateral and Unilateral Arm Training Improve Motor Function Through Differing Neuroplastic Mechanisms
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The effects of increased dose of exercise-based therapies to enhance motor recovery after stroke: a systematic review and meta-analysis
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Authors: Van Peppen, R. P., Kwakkel, G., Wood-Dauphinee, S., Hendriks, H. J., Van der Wees, P. J., & Dekker, J.
Affiliations: Department of Physical Therapy, VU University Medical Center, Amsterdam, The Netherlands
Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
School of Physical and Occupational Therapy, Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
Maastricht University (NL)
Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, Amsterdam, The Netherlands
ORCID: Kwakkel, G
Dekker, J
Venue: Clinical Rehabilitation
Publisher: SAGE Publications
Published: 2004-12
Volume: 18
Issue: 8
Pages: 833-862
ISSN: 0269-2155 (ISSN-L)
1477-0873
DOI: 10.1191/0269215504cr843oa
OpenAlex: W2095683367
Cited by: 942
References: 223
Citations by year: 2026: 9 · 2025: 17 · 2024: 25 · 2023: 23 · 2022: 26 · 2021: 44 · 2020: 35 · 2019: 46 · 2018: 50 · 2017: 55 · 2016: 52 · 2015: 53 · 2014: 67 · 2013: 68 · 2012: 56
FWCI: 5.15
Type: journal article
Language: en
Open access: green
hdl.handle.net
Licence: other-oa
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Clinical Rehabilitation (publishedVersion)
PubMed (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Pure Amsterdam UMC (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Topics: Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: physiotherapy, stroke rehabilitation, functional outcome, task-oriented training, constraint-induced movement therapy, treadmill training, body weight support, neuromuscular electrical stimulation, glenohumeral subluxation, methodological quality of trials
MeSH terms: Stroke Rehabilitation, Biofeedback, Psychology, Edema, Hand, Humans, Orthotic Devices, Oxygen Consumption, Physical Fitness, Muscle, Skeletal, Shoulder Pain, Recovery of Function, Stroke, Physical Therapy Modalities

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