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 article

Dorsch, Simone, Carling, Cameron, Cao, Zheng, Fanayan, Emma, Graham, Petra L., McCluskey, Annie, Schurr, Karl, Scrivener, Katharine and Tyson, Sarah. (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), pp. 15-22. https://doi.org/10.1016/j.jphys.2022.11.008
AuthorsDorsch, Simone, Carling, Cameron, Cao, Zheng, Fanayan, Emma, Graham, Petra L., McCluskey, Annie, Schurr, Karl, Scrivener, Katharine and Tyson, Sarah
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.

Keywordsphysical therapy; occupational therapy; upper extremity; rehabilitation
Year2023
JournalJournal of Physiotherapy
Journal citation69 (1), pp. 15-22
PublisherElsevier B.V.
ISSN1836-9561
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jphys.2022.11.008
PubMed ID36529640
Scopus EID2-s2.0-85144345399
Open accessPublished as ‘gold’ (paid) open access
Page range15-22
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online2023
Publication process dates
Deposited21 Jun 2023
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