Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review

Simone Dorsch; Cameron Carling; Zheng Cao; Emma Fanayan; Petra L. Graham; Annie McCluskey; Karl Schurr; Katharine Scrivener; Sarah Tyson

doi:10.1016/j.jphys.2022.11.008

Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review

Simone Dorsch, Cameron Carling, Zheng Cao, Emma Fanayan, Petra L. Graham, Annie McCluskey, Karl Schurr, Katharine Scrivener, Sarah Tyson

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Abstract

Question: What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke?

Design: Systematic review of randomised trials with meta-analysis.

Participants: Adults after stroke.

Intervention: Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy.

Outcome measures: Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale.

Results: Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD -1.07, 95% CI -1.59 to -0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD -0.18, 95% CI -0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD -1.08); however, this estimate had substantial uncertainty (95% CI -3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD -7.84, 95% CI -12.99 to -2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain.

Conclusions: After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score.

Registration: PROSPERO CRD42021251630.

Original language	English
Pages (from-to)	15-22
Number of pages	8
Journal	Journal of Physiotherapy
Volume	69
Issue number	1
Early online date	16 Dec 2022
DOIs	https://doi.org/10.1016/j.jphys.2022.11.008
Publication status	Published - 1 Jan 2023

Bibliographical note

Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Stroke
Physical therapy
Occupational therapy
Upper extremity
Rehabilitation

Access to Document

10.1016/j.jphys.2022.11.008Licence: CC BY-NC-ND

Publisher version (open access)Final published version, 540 KBLicence: CC BY-NC-ND

Cite this

Dorsch, S., Carling, C., Cao, Z., Fanayan, E., Graham, P. L., McCluskey, A., Schurr, K., Scrivener, K., & Tyson, S. (2023). Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review. Journal of Physiotherapy, 69(1), 15-22. https://doi.org/10.1016/j.jphys.2022.11.008

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title = "Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review",

abstract = "Question: What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke?Design: Systematic review of randomised trials with meta-analysis.Participants: Adults after stroke.Intervention: Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy.Outcome measures: Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale.Results: Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD -1.07, 95% CI -1.59 to -0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD -0.18, 95% CI -0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD -1.08); however, this estimate had substantial uncertainty (95% CI -3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD -7.84, 95% CI -12.99 to -2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain.Conclusions: After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score.Registration: PROSPERO CRD42021251630.",

keywords = "Stroke, Physical therapy, Occupational therapy, Upper extremity, Rehabilitation",

author = "Simone Dorsch and Cameron Carling and Zheng Cao and Emma Fanayan and Graham, {Petra L.} and Annie McCluskey and Karl Schurr and Katharine Scrivener and Sarah Tyson",

note = "Copyright {\textcopyright} 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

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Dorsch, S, Carling, C, Cao, Z, Fanayan, E, Graham, PL, McCluskey, A, Schurr, K, Scrivener, K & Tyson, S 2023, 'Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review', Journal of Physiotherapy, vol. 69, no. 1, pp. 15-22. https://doi.org/10.1016/j.jphys.2022.11.008

TY - JOUR

T1 - Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke

T2 - a systematic review

AU - Dorsch, Simone

AU - Carling, Cameron

AU - Cao, Zheng

AU - Fanayan, Emma

AU - Graham, Petra L.

AU - McCluskey, Annie

AU - Schurr, Karl

AU - Scrivener, Katharine

AU - Tyson, Sarah

N1 - Copyright © 2022 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2023/1/1

Y1 - 2023/1/1

N2 - Question: What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke?Design: Systematic review of randomised trials with meta-analysis.Participants: Adults after stroke.Intervention: Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy.Outcome measures: Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale.Results: Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD -1.07, 95% CI -1.59 to -0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD -0.18, 95% CI -0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD -1.08); however, this estimate had substantial uncertainty (95% CI -3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD -7.84, 95% CI -12.99 to -2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain.Conclusions: After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score.Registration: PROSPERO CRD42021251630.

AB - Question: What is the effect of Bobath therapy on arm activity and arm strength compared with a dose-matched comparison intervention or no intervention after stroke?Design: Systematic review of randomised trials with meta-analysis.Participants: Adults after stroke.Intervention: Bobath therapy compared with no intervention or other interventions delivered at the same dose as the Bobath therapy.Outcome measures: Arm activity outcomes and arm strength outcomes. Trial quality was assessed with the PEDro scale.Results: Thirteen trials were included; all compared Bobath with another intervention, which were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The PEDro scale scores ranged from 5 to 8. Pooled data from five trials indicated that Bobath therapy was less effective than task-specific training for improving arm activities (SMD -1.07, 95% CI -1.59 to -0.55). Pooled data from five trials indicated that Bobath therapy was similar to or less effective than arm movements for improving arm activities (SMD -0.18, 95% CI -0.44 to 0.09). One trial indicated that Bobath therapy was less effective than robotics for improving arm activities and one trial indicated similar effects of Bobath therapy and mental practice on arm activities. For strength outcomes, pooled data from two trials indicated a large benefit of task-specific training over Bobath therapy (SMD -1.08); however, this estimate had substantial uncertainty (95% CI -3.17 to 1.01). The pooled data of three trials indicated that Bobath therapy was less effective than task-specific training for improving Fugl-Meyer scores (MD -7.84, 95% CI -12.99 to -2.69). The effects of Bobath therapy relative to other interventions on strength outcomes remained uncertain.Conclusions: After stroke, Bobath therapy is less effective than task-specific training and robotics in improving arm activity and less effective than task-specific training on the Fugl-Meyer score.Registration: PROSPERO CRD42021251630.

KW - Stroke

KW - Physical therapy

KW - Occupational therapy

KW - Upper extremity

KW - Rehabilitation

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DO - 10.1016/j.jphys.2022.11.008

M3 - Article

C2 - 36529640

SN - 1836-9553

VL - 69

SP - 15

EP - 22

JO - Journal of Physiotherapy

JF - Journal of Physiotherapy

IS - 1

ER -

Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review

Abstract

Bibliographical note

Keywords

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Evidence synthesis to improve outcomes

Cite this

Bobath therapy is inferior to task-specific training and not superior to other interventions in improving arm activity and arm strength outcomes after stroke: a systematic review

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Fingerprint

Projects

Evidence synthesis to improve outcomes

Cite this