Abstract
Objectives: Bobath based (BB) and movement science based (MSB) physiotherapy interventions are widely used for patients after stroke. There is little evidence to suggest which is most effective. This single-blind randomised controlled trial evaluated the effect of these treatments on movement abilities and functional independence.
Methods: A total of 120 patients admitted to a stroke rehabilitation ward were randomised into two treatment groups to receive either BB or MSB treatment. Primary outcome measures were the Rivermead Motor Assessment and the Motor Assessment Scale. Secondary measures assessed functional independence, walking speed, arm function, muscle tone, and sensation. Measures were performed by a blinded assessor at baseline, and then at 1, 3, and 6 months after baseline. Analysis of serial measurements was performed to compare outcomes between the groups by calculating the area under the curve (AUC) and inserting AUC values into Mann-Whitney U tests.
Results: Comparison between groups showed no significant difference for any outcome measures. Significance values for the Rivermead Motor Assessment ranged from p = 0.23 to p = 0.97 and for the Motor Assessment Scale from p = 0.29 to p = 0.87.
Conclusions: There were no significant differences in movement abilities or functional independence between patients receiving a BB or an MSB intervention. Therefore the study did not show that one approach was more effective than the other in the treatment of stroke patients.
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Selected References
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- Bamford J., Sandercock P., Dennis M., Burn J., Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991 Jun 22;337(8756):1521–1526. doi: 10.1016/0140-6736(91)93206-o. [DOI] [PubMed] [Google Scholar]
- Bohannon R. W., Smith M. B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 Feb;67(2):206–207. doi: 10.1093/ptj/67.2.206. [DOI] [PubMed] [Google Scholar]
- Carr J. H., Shepherd R. B., Nordholm L., Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther. 1985 Feb;65(2):175–180. doi: 10.1093/ptj/65.2.175. [DOI] [PubMed] [Google Scholar]
- Collin C., Wade D. T., Davies S., Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10(2):61–63. doi: 10.3109/09638288809164103. [DOI] [PubMed] [Google Scholar]
- Dean C. M., Shepherd R. B. Task-related training improves performance of seated reaching tasks after stroke. A randomized controlled trial. Stroke. 1997 Apr;28(4):722–728. doi: 10.1161/01.str.28.4.722. [DOI] [PubMed] [Google Scholar]
- Dickstein R., Hocherman S., Pillar T., Shaham R. Stroke rehabilitation. Three exercise therapy approaches. Phys Ther. 1986 Aug;66(8):1233–1238. doi: 10.1093/ptj/66.8.1233. [DOI] [PubMed] [Google Scholar]
- Ernst E. A review of stroke rehabilitation and physiotherapy. Stroke. 1990 Jul;21(7):1081–1085. doi: 10.1161/01.str.21.7.1081. [DOI] [PubMed] [Google Scholar]
- Feys H. M., De Weerdt W. J., Selz B. E., Cox Steck G. A., Spichiger R., Vereeck L. E., Putman K. D., Van Hoydonck G. A. Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke. 1998 Apr;29(4):785–792. doi: 10.1161/01.str.29.4.785. [DOI] [PubMed] [Google Scholar]
- Kottke F. J. From reflex to skill: the training of coordination. Arch Phys Med Rehabil. 1980 Dec;61(12):551–561. [PubMed] [Google Scholar]
- Kwakkel G., Wagenaar R. C., Koelman T. W., Lankhorst G. J., Koetsier J. C. Effects of intensity of rehabilitation after stroke. A research synthesis. Stroke. 1997 Aug;28(8):1550–1556. doi: 10.1161/01.str.28.8.1550. [DOI] [PubMed] [Google Scholar]
- Kwakkel G., Wagenaar R. C., Twisk J. W., Lankhorst G. J., Koetsier J. C. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet. 1999 Jul 17;354(9174):191–196. doi: 10.1016/S0140-6736(98)09477-X. [DOI] [PubMed] [Google Scholar]
- Langhammer B., Stanghelle J. K. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clin Rehabil. 2000 Aug;14(4):361–369. doi: 10.1191/0269215500cr338oa. [DOI] [PubMed] [Google Scholar]
- Langhorne P., Wagenaar R., Partridge C. Physiotherapy after stroke: more is better? Physiother Res Int. 1996;1(2):75–88. doi: 10.1002/pri.6120010204. [DOI] [PubMed] [Google Scholar]
- Lincoln N. B., Parry R. H., Vass C. D. Randomized, controlled trial to evaluate increased intensity of physiotherapy treatment of arm function after stroke. Stroke. 1999 Mar;30(3):573–579. doi: 10.1161/01.str.30.3.573. [DOI] [PubMed] [Google Scholar]
- Lincoln N., Leadbitter D. Assessment of motor function in stroke patients. Physiotherapy. 1979 Feb;65(2):48–51. [PubMed] [Google Scholar]
- Logigian M. K., Samuels M. A., Falconer J., Zagar R. Clinical exercise trial for stroke patients. Arch Phys Med Rehabil. 1983 Aug;64(8):364–367. [PubMed] [Google Scholar]
- Lord J. P., Hall K. Neuromuscular reeducation versus traditional programs for stroke rehabilitation. Arch Phys Med Rehabil. 1986 Feb;67(2):88–91. doi: 10.1016/0003-9993(86)90108-5. [DOI] [PubMed] [Google Scholar]
- Matthews J. N., Altman D. G., Campbell M. J., Royston P. Analysis of serial measurements in medical research. BMJ. 1990 Jan 27;300(6719):230–235. doi: 10.1136/bmj.300.6719.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mulder T. A process-oriented model of human motor behavior: toward a theory-based rehabilitation approach. Phys Ther. 1991 Feb;71(2):157–164. doi: 10.1093/ptj/71.2.157. [DOI] [PubMed] [Google Scholar]
- Paci Matteo. Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies. J Rehabil Med. 2003 Jan;35(1):2–7. doi: 10.1080/16501970306106. [DOI] [PubMed] [Google Scholar]
- Platz T., Winter T., Müller N., Pinkowski C., Eickhof C., Mauritz K. H. Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind, randomized, controlled trial. Arch Phys Med Rehabil. 2001 Jul;82(7):961–968. doi: 10.1053/apmr.2001.23982. [DOI] [PubMed] [Google Scholar]
- Sunderland A., Tinson D. J., Bradley E. L., Fletcher D., Langton Hewer R., Wade D. T. Enhanced physical therapy improves recovery of arm function after stroke. A randomised controlled trial. J Neurol Neurosurg Psychiatry. 1992 Jul;55(7):530–535. doi: 10.1136/jnnp.55.7.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sunderland A., Tinson D., Bradley L., Hewer R. L. Arm function after stroke. An evaluation of grip strength as a measure of recovery and a prognostic indicator. J Neurol Neurosurg Psychiatry. 1989 Nov;52(11):1267–1272. doi: 10.1136/jnnp.52.11.1267. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Turton A. J., Fraser C. M. A test battery to measure the recovery of voluntary movement control following stroke. Int Rehabil Med. 1986;8(2):74–78. doi: 10.3109/03790798609166179. [DOI] [PubMed] [Google Scholar]
- Visintin M., Barbeau H., Korner-Bitensky N., Mayo N. E. A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation. Stroke. 1998 Jun;29(6):1122–1128. doi: 10.1161/01.str.29.6.1122. [DOI] [PubMed] [Google Scholar]
- Wade D. T., Wood V. A., Hewer R. L. Recovery after stroke--the first 3 months. J Neurol Neurosurg Psychiatry. 1985 Jan;48(1):7–13. doi: 10.1136/jnnp.48.1.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wagenaar R. C., Meijer O. G., van Wieringen P. C., Kuik D. J., Hazenberg G. J., Lindeboom J., Wichers F., Rijswijk H. The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method. Scand J Rehabil Med. 1990;22(1):1–8. [PubMed] [Google Scholar]
- van Vliet P. M., Lincoln N. B., Robinson E. Comparison of the content of two physiotherapy approaches for stroke. Clin Rehabil. 2001 Aug;15(4):398–414. doi: 10.1191/026921501678310207. [DOI] [PubMed] [Google Scholar]
- van der Lee J. H., Wagenaar R. C., Lankhorst G. J., Vogelaar T. W., Devillé W. L., Bouter L. M. Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999 Nov;30(11):2369–2375. doi: 10.1161/01.str.30.11.2369. [DOI] [PubMed] [Google Scholar]