Download the supplement (208 p.) - KCE

170 APPENDICES Physiotherapy KCE reports vol. 40
The treatment modalities more rarely applied by ambulatory physiotherapists include aerobic exercises,
sensitive rehabilitation, electrophysiotherapy, massage, treadmill training, Johnstone and Perfetti techniques,
EMG biofeedback, constraint-induced movement therapy, Picard and Brunnström techniques.
The treatment modalities and the proportion of physiotherapists in our survey treating at least one patient
with hemiplegia/hemiparesis are confronted in Table 4.11 with the results of the literature review on evidencebased
therapeutic modalities. Overall, there is moderate evidence in favour of the most common treatment
modalities applied by Belgian ambulatory physiotherapists to treat patients with hemiplegia/hemiparesis, with
the exception of patient s education treatment modality for which no information was available in the
literature review. On the contrary, the treatment modalities more rarely used by Belgian physiotherapists
present conflicting evidence, no evidence for nor against, are not feasible on a routine basis or are ineffective.
Weak to strong evidence was just demonstrated for aerobic exercises, massage, and Bobath technique.
Although Bobath and Kabat techniques were the most specific movement therapies applied by Belgian
physiotherapists, they do not demonstrated superiority with regard to other specific movement therapies.
However, one study has shown that the Bobath concept seems to reduce shoulder pain better than
cryotherapy and to reduce tone better than no intervention or Kabat technique. Another study has also found
weak evidence in favour of Bobath technique in improving gait in relatively high-level patients. More studies
investigating other specific movement therapies than Bobath therapy are however required before drawing any
conclusion about the evidence/non-evidence of specific movement therapies. Finally, it is interesting to note
that there is only conflicting evidence for the most frequent electrophysiotherapeutic modality used in
ambulatory practice, namely electric stimulation.
Gait disorders in elderly people
The most common treatment modalities applied by Belgian ambulatory physiotherapists to treat elderly
patients with gait disorders were, from the most prevalent to the least: muscle strengthening, balance
rehabilitation, mobilizations, education of the patient, proprioceptive rehabilitation, coordination exercises, and
home exercises. The following treatment modalities were also common but to a lesser extent: transfer
exercises, stretching, pick-up techniques, and aerobic exercises. The treatment modalities rarely applied by
ambulatory physiotherapists include massage and Tai Chi Quan.