What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

Veerbeek, Janne Marieke; van Wegen, Erwin; van Peppen, Roland; van der Wees, Philip Jan; Hendriks, Erik; Rietberg, Marc; Kwakkel, Gert

doi:10.1371/journal.pone.0087987

Cited by 1,203Stroke Rehabilitation and RecoveryMedical Practices and RehabilitationAcute Ischemic Stroke Management

What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

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Veerbeek, Janne Marieke, van Wegen, Erwin, van Peppen, Roland, van der Wees, Philip Jan, Hendriks, Erik, Rietberg, Marc, Kwakkel, Gert·2014·PLoS ONE

DOI 10.1371/journal.pone.0087987PMC PMC3913786

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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; I(2) = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I(2) = 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; I(2) = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I(2) = 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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Greater amounts of physical training poststroke is associated with improved outcomes (without harm) in a number of meta-analyses.
“Greater amounts of physical training poststroke is associated with improved outcomes (without harm) in a number of meta-analyses,5,6 and many guidelines recommend increasing training dose.”
From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [5]
In humans, a number of systematic reviews and meta-analyses suggest a dose-response relationship, with more intensive therapy resulting in improved functional outcome after stroke.
“In humans, a number of systematic reviews and meta-analyses suggest a dose-response relationship, with more intensive therapy resulting in improved functional outcome after stroke.5,6,15”
From Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT) (2016) · cites this paper as [5]

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ROLE OF PHYSIOTHERAPY IN POST-STROKE REHABILITATION
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Limited evidence of physical therapy on balance after stroke: A systematic review and meta-analysis
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Authors: Veerbeek, J. M., van Wegen, E., van Peppen, R., van der Wees, P. J., Hendriks, E., Rietberg, M., & Kwakkel, G.
Affiliations: Amsterdam Movement Sciences (NL)
Maastricht University (NL)
Reade (NL)
Corresponding author: Kwakkel, Gert
ORCID: Veerbeek, Janne Marieke
Rietberg, Marc
Kwakkel, Gert
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2014-02-04
Volume: 9
Issue: 2
Pages: e87987
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0087987
PMC: PMC3913786
OpenAlex: W2075019019
Cited by: 1,203
References: 591
Citations by year: 2026: 67 · 2025: 101 · 2024: 76 · 2023: 111 · 2022: 130 · 2021: 138 · 2020: 97 · 2019: 102 · 2018: 108 · 2017: 87 · 2016: 95 · 2015: 68 · 2014: 20 · 2013: 1
FWCI: 11.17
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Research Publications (Maastricht University) (publishedVersion, cc-by)
Pure Amsterdam UMC (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
VU Research Portal (publishedVersion, other-oa)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
Radboud Repository (Radboud University) (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion, other-oa)
Research Publications (Maastricht University) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
Funders: Royal Society
Vrije Universiteit Amsterdam
Koninklijk Nederlands Genootschap voor Fysiotherapie
Topics: Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords: physiotherapy, stroke rehabilitation, gait training, activities of daily living, physical fitness, sitting balance, motor function, muscle strength, task-oriented training, repeated practice, rehabilitation timing, International Classification of Functioning, Disability and Health
MeSH terms: Stroke Rehabilitation, Humans, Randomized Controlled Trials as Topic, Stroke, Physical Therapy Modalities, Muscle Strength

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What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis

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