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166 APPENDICES Physiotherapy KCE reports vol. B Table 11 Hemiplegia/hemiparesis: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Type of evidence Evidence available in the literature on physiotherapy of hemiplegia/hemiparesis due to stroke Education of the patient 59 ± 6% ? No information was available in the literature review. Functional rehabilitation (ADL) 53 ± 6% Bobath technique 33 ± 6% Kabat technique (PNF) 31 ± 6% Evidence for (moderate to strong) Evidence for (weak) No evidence for nor against There is moderate to strong evidence that, for the specific objectives of improving reaching for objects, a task-specific approach should be used rather than an impairment-focused approach. Strong evidence exists in favour of task-oriented exercise training to restore balance and gait and for strengthening the lower paretic limb. There is strong evidence in favour of task-specific training to improve performance of selected tasks. Adopted under the term specific movement therapies . No specific movement therapy should be assumed to be more efficacious than others. Comparisons of the Bobath concept with other approaches do not demonstrate superiority of one approach over the other at improving upper limb impairment, activity or participation. The Bobath concept was found to reduce shoulder pain better than cryotherapy and to reduce tone better than no intervention or PNF. There is weak evidence that Bobath technique is beneficial to improve gait in relatively high-level patients. Adopted under the term specific movement therapies . No specific movement therapy should be assumed to be more efficacious than others. Comparisons of the Bobath concept with other approaches do not demonstrate superiority of one approach over the other at improving upper limb impairment, activity or participation. The Bobath concept was found to reduce shoulder pain better than cryotherapy and to reduce tone better than no intervention or PNF.
KCE reports vol. 40 APPENDICES Physiotherapy 167 Table 11 Hemiplegia/hemiparesis: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Aerobic exercises 20 ± 5% Type of evidence Evidence for (strong) Evidence available in the literature on physiotherapy of hemiplegia/hemiparesis due to stroke There is strong evidence in favour of cardiovascular training to improve aerobic fitness through large muscle exercises (e.g., walking, treadmill, stationary cycling). Aerobic exercises is thus recommended to increase independence in activities of daily living, walking speed and efficiency, to improve tolerance to prolonged physical activity and to reduce risk of cardiovascular disease. Sensitive rehabilitation 16 ± 4% ? No information was available in the literature review. Electrophysiotherapy 10 ± 4% Massage 05 ± 3% Evidence against except to treat shoulder pain (strong to moderate) Conflicting evidence Evidence for (weak) Treadmill training 04 ± 2% Conflicting evidence TENS : Strong evidence is available suggesting that TENS is not recommended in post-stroke patients. However, one exception occurs for high-intensity TENS that seems effective to treat shoulder pain (strong to moderate evidence). Functional electric stimulation (FES): Conflicting evidence was found in the literature about FES. There is weak to moderate evidence that FES is effective in patients with paretic muscles, shoulder subluxation and for gait training. However, FES must not be assumed to have sustained effects. Consequently, FES should not be used on a routine basis. Weak evidence was found in the literature supporting massage to treat shoulder pain in the affected upper limb. Conflicting evidence was found about treadmill training with or without partial body weight support. Although, it will have positive cardiovascular effects, further trials are required to confirm findings of a positive effect on gait function of treadmill with partial bodyweight support. Consequently, treadmill training should not be used on a routine basis.
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