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What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis
Open accessAbstract
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,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 the citing paper
“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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Metadata
- 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
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-02-04
- Volume
- 9
- Issue
- 2
- Pages
- e87987
- ISSN
- 1932-6203 (ISSN-L)
- 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
- FWCI
- 11.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- 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 › Clinical Neurology › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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