EFFICACY OF PHYSIOTHERAPY INTERVENTIONS LATE AFTER STROKE: A META-ANALYSIS

Francesco Ferrarello (1) , Marco Baccini (2) , Lucio Antonio Rinaldi (3) , Maria Chiara Cavallini (3) , Enrico Mossello (3) , Giulio Masotti (3) , Niccolò Marchionni (3) , Mauro Di Bari (3)

1 Unit of Functional Rehabilitation, Azienda USL 4 Prato. Italy
2 Unit of Functional Rehabilitation, Azienda Sanitaria di Firenze, and Motion Analysis Laboratory, Pie
3 Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, University of

Objective. Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. We conducted a systematic review and meta-analysis of randomized clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke. Methods. We searched published studies where participants were randomized to an active physiotherapy intervention, compared to placebo or no intervention, at least 6 months after stroke. Outcome was change in mobility and activities of daily living (ADL) independence. Quality of trials was evaluated using the PEDro scale. Findings were summarized across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% confidence interval (CI) in random effects models. Results. Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14–0.45). Efficacy of the intervention was particularly evident when short- and long- distance walking (SDW, LDW) were considered as separate outcomes, with WMD of 0.05 m/sec (95% CI 0.008–0.088) and 20 m (95% CI 3.6–36.0), respectively. Also ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found. Interpretation. A variety of physiotherapy interventions improve functional outcomes even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients that had experienced stroke and should be valued in planning community rehabilitation services.

Mots clés: META-ANALYSIS; REHABILITATION; STROKE

Francesco Ferrarello, Marco Baccini, Lucio Antonio Rinaldi, Maria Chiara Cavallini, Enrico Mossello, et al.. EFFICACY OF PHYSIOTHERAPY INTERVENTIONS LATE AFTER STROKE: A META-ANALYSIS. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 82 (2), pp.136. ⟨10.1136/jnnp.2009.196428⟩. ⟨hal-00574384⟩