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Can physiotherapy after stroke based on the Bobath concept result in improved quality of movement compared to the motor relearning programme |
Langhammer B, Stanghelle JK |
Physiotherapy Research International 2011 Jun;16(2):69-80 |
clinical trial |
7/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
BACKGROUND AND PURPOSE: The primary aim of the present study was to investigate, based on data from our study in 2000, whether the Bobath approach enhanced quality of movement better than the motor relearning programme (MRP) during rehabilitation of stroke patients. METHODS: A randomized controlled stratified trial of acute stroke patients. The patients were treated according to motor relearning programme and Bobath approach and assessed with Motor Assessment Scale, Sodring Motor Evaluation Scale, Nottingham Health Profile and the Barthel Index. A triangulation of the test scores was made in reference to the Movement Quality Model and biomechanical, physiological, psycho-socio-cultural, and existential themes. RESULTS: The items arm (p = 0.02 to 0.04) sitting (p = 0.04) and hand (p = 0.01 to 0.03) were significantly better in the motor relearning programme group than in the Bobath group, in both Sodring Motor Evaluation Scale and Motor Assessment Scale. Leg function, balance, transfer, walking and stair climbing did not differ between the groups. The Movement Quality Model and the movement qualities biomechanical, physiological and psycho-socio-cultural showed higher scoring in the motor relearning programme group, indicating better quality of movement in all items. Regression models established the relationship with significant models of motor performance and self reported physical mobility (adjusted R2 = 0.30 to 0.68, p < 0.0001), energy (adjusted R2 = 0.13 to 0.14, p = 0.03 to 0.04, emotion (adjusted R2 = 0.30 to 0.38, p < 0.0001) and social interaction (arm function, adjusted R2 = 0.25, p = 0.0001). CONCLUSIONS: These analyses confirm that task oriented exercises of the motor relearning programme type are preferable regarding quality of movement in the acute rehabilitation of patients with stroke.
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