BACKGROUND AND AIM: Over the past 2 years, Dutch clinical guidelines on physiotherapy for stroke were developed on the basis of a systematic review of physiotherapy interventions aimed at improving functional outcome after stroke. METHODS: An extensive search in Medline, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, PEDro, Embase and DocOnline was performed up to 31 December 2003. Studies with controlled and uncontrolled designs were included. Physiotherapy was divided into 10 distinct intervention categories, which were analysed separately. Methodological quality of the randomized controlled trials (RCTS) was rated with the Physiotherapy Evidence Database (PEDrO) scale. If statistical pooling (weighted summary effect sizes) was not possible due to lack of comparability between interventions, patient characteristics, or measures of outcome, a best-evidence synthesis was performed. RESULTS: Two hundred and thirty-five studies were included in this systematic review: 123 RCTS, 28 controlled clinical trials (CCTS), and 84 preexperimental studies. The median methodological quality of all RCTS was 5 points on the 10-point PEDro-scale (range 2 to 8 points). High-quality RCTS provided strong evidence in favour of task-oriented exercise training to restore balance and gait and for strengthening the lower paretic limb. Calculated summary effect sizes (SES) for functional outcomes ranged from 0.13 (95% CI 0.03 to 0.23) for effects of higher intensity exercise training to 0.92 (95% CI 0.54 to 1.29) for improving symmetry from sit to stand. Strong evidence was also found for therapies that focused on functional training, such as constraint-induced movement therapy (SES 0.46; 95% CI 0.07 to 0.91); treadmill training with or without body weight support, 0.70 (95% CI 0.29 to 1.10) and 1.09 (95% CI 0.56 to 1.61), respectively; aerobics (SES 0.39; 95% CI 0.05 to 0.74); external auditory rhythms during gait (SES 0.91; 95% CI 0.40 to 1.42); and neuromuscular stimulation for glenohumeral subluxation (SES 1.41; 95% CI 0.76 to 2.06). No or insufficient evidence in terms of functional outcome was found for traditional neurological treatment approaches; exercises for the upper limb; biofeedback; functional and neuromuscular electrical stimulation aimed at improving dexterity or gait performance; orthotics for the lower extremities, walking devices and slings; and physiotherapy for reducing hemiplegic shoulder pain and hand oedema.

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