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

The DOI matches its Crossref record; 222 of the 223 references it cites were found in a registry or an index.

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

Open access
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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Crossref · 10.1191/0269215504cr843oa

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222 of 222 references verified0 citation errors · 0 not checkable

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Citations

Cites

Show all 223 references

Research works printed but not linked: 56

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Metadata

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
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
Licence
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 › Clinical Neurology › 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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