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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.
KCE reports vol. 40 APPENDICES Physiotherapy 171 Table 12 Gait disorders in elderly people: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Muscle strengthening 91 ± 3% Balance rehabilitation 90 ± 4% Type of evidence Evidence for (weak to moderate) Evidence for (weak) Mobilizations 83 ± 5% ? Education of the patient 71 ± 5% ? Proprioceptive rehabilitation 67 ± 6% ? Coordination exercises 59 ± 6% ? Home exercises 52 ± 6% ? Transfer exercises 46 ± 6% ? Evidence available in the literature on physiotherapy of gait rehabilitation in the elderly There is weak to moderate evidence that muscle strengthening has a beneficial effect in gait ability. Weak evidence exists in favour of balance training in elderly people in improving gait and balance both objectively and subjectively. After balance training, gait ability is improved at least for a few months. No information was available in the literature review. No information was available in the literature review. No information was available in the literature review. No information was available in the literature review. No information was available in the literature review. No information was available in the literature review. Stretching 31 ± 6% ? No information was available in the literature review. Pick-up techniques 30 ± 6% ? No information was available in the literature review. Aerobic exercises 30 ± 6% Evidence for (weak to moderate) There is weak to moderate evidence that aerobic exercises have a beneficial effect in gait ability. Massage 05 ± 3% ? No information was available in the literature review.
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