BOBATH THERAPY IS INFERIOR TO TASK-SPECIFIC TRAINING AND NOT SUPERIOR TO OTHER INTERVENTIONS IN IMPROVING ARM OUTCOMES AFTER STROKE

S. Dorsch^1,2, C. Carling³, Z. Cao¹, E. Fanayan¹, P. Graham⁴, A. McCluskey^5,2, K. Schurr², K. Scrivener^6,2, S. Tyson⁷

¹Australian Catholic University, School of Allied Health, Sydney, Australia, ²The StrokeEd Collaboration, Sydney, Australia, ³Concentric Rehabilitation, Perth, Australia, ⁴Macquarie University, School of Mathematical and Physical Sciences, Sydney, Australia, ⁵The University of Sydney, Faculty of Health Sciences, Sydney, Australia, ⁶Macquarie University, Department of Health Sciences, Sydney, Australia, ⁷The University of Manchester, School of Health Sciences, Sydney, Australia

Background: Bobath therapy has been a predominant approach to stroke rehabilitation globally for many years. Despite its extensive clinical use, the effectiveness of Bobath therapy to improve outcomes for the affected arm after stroke has never been established. Hence there was a need for a comprehensive review including meta-analysis of all relevant trials in order to evaluate the effectiveness of this therapy for the affected arm after stroke.

Purpose: To evaluate the effect of Bobath therapy on outcomes for the affected arm after stroke. Our research question was: does Bobath therapy improve arm activity outcomes after stroke more than a comparison intervention or no intervention? A secondary question was: does Bobath therapy improve arm motor impairment outcomes after stroke more than a comparison intervention or no intervention?

Methods: Systematic review of randomised trials with meta-analysis. The participants were adult stroke survivors. The intervention was Bobath therapy targeting the affected arm and the comparators were other interventions delivered at the same dose as the Bobath therapy or no intervention. The outcome measures were measures of arm activity outcomes which were direct measures of task performance and measures of arm motor impairment outcomes. The PEDro scale was used to assess trial quality. The review was prospectively registered: PROSPERO CRD42021251630.

Results: Thirteen trials met the selection criteria. The PEDro scale scores ranged from five to eight. The comparator interventions were categorised as: task-specific training (five trials), arm movements (five trials), robotics (two trials) and mental practice (one trial). The pooled data of five trials involving 262 participants indicated that Bobath therapy is less effective than Task-specific training for improving arm activities, SMD -1.07, 95% CI -1.59 to -0.55, I²68%. The pooled data of five trials involving 262 participants indicated no significant difference in outcomes for Bobath therapy compared with arm movements for improving arm activities, SMD -0.18, 95% CI -0.44 to 0.09, I² 45%. One trial indicated that Bobath therapy is less effective than mental practice and one trial indicated that Bobath therapy is less effective than robotics for improving arm activities. The pooled data of five trials involving 247 participants indicated that Bobath therapy is less effective than Task-specific training for improving arm motor impairment, SMD -0.53, 95% CI -0.93 to -0.13, I² 80%. The pooled data of two trials involving 81 participants indicated no significant difference in outcomes for Bobath therapy compared with robotics for improving arm motor impairment, SMD -0.25, 95% CI -0.69 to 0.19, I²0%, One trial indicated that Bobath therapy is less effective than mental practice for improving arm motor impairment.

Conclusions: Bobath therapy is less effective than task-specific training, robotics and mental practice for improving arm activities after stroke. Bobath therapy is less effective than Task-specific training and mental practice for improving arm motor impairments after stroke. Future work should inform clinicians on the implementation of evidence-based interventions for improving arm outcomes after stroke.

Implications: The use of Bobath therapy to improve arm outcomes after stroke, in preference to other interventions, is not supported.

Funding acknowledgements: Nil

Keywords:
Bobath
stroke
rehabilitation

Topics:
Neurology: stroke
Neurology
Research methodology, knowledge translation & implementation science

Did this work require ethics approval? No

Reason: This was a systematic review using secondary analysis of published trials, hence not requiring ethics approval.