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S. Aggarwal1, Y. Salem1,2, H. Liu1, A. Mendez1, M. Quiben1
1University of North Texas Health Science Center, Physical Therapy, Fort Worth, United States, 2Cairo University, Cairo, Egypt
Background: Stroke, or cerebrovascular accident (CVA), is the second leading cause of mortality and third leading cause of disability worldwide. Proprioceptive neuromuscular facilitation (PNF) has been utilized in treating patients post-stroke in a functional manner with good outcomes.
Purpose: The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) for treatment of patients post stroke.
Methods: A search of electronic databases (Pubmed, CINHAL, PeDRO, and Scopus) was completed in May 2020 with no year range set. The keywords searched together were “proprioceptive neuromuscular facilitation” and “stroke”. Randomized control trials (RCTs) included were based on population: adults 18 years and older after a cerebrovascular accident (CVA), PNF as the main intervention, and availability in English. The electronic search was complemented with hand search of the reference list of retrieved articles to identify additional relevant articles. The methodological quality of each study was assessed by using the Quality Assessment Tool for Quantitative Studies. Eligibility for meta-analysis was dependent on a minimum of three data sets of pre- and post- test statistics per outcome measure. Forest plots and effect sizes were generated with Microsoft Excel.
Results: The initial search produced 172 articles, which was reduced to 89 after duplicates were removed. From these, 30 articles were kept as they met inclusion criteria. A total of seventeen RCTs were obtained after screening. In total, 656 subjects (aged 32-82) were included. Intervention parameters were 10-60 minutes for session length, 1-6 times per week for frequency, and 1-6 weeks for duration. Further meta-analysis showed that, with 9 studies eligible for statistical compatibility of data from outcome assessments, significant improvements were identified in functional reach (Z = 3.2458, p = 0.0012), and Berg Balance Scale (Z = 2.639, p = 0.0083); but not seen in Timed Up & Go, Trunk Impairment Scale, Walking Speed, and Performance-Oriented Mobility Assessment (POMA).
Conclusion(s): Based on this review, PNF intervention techniques may be effective for addressing balance deficit, but not sure for physical function recovery in the stroke population. No adverse outcomes were reported. There is variability in study design concerning population (time since CVA, hemorrhagic vs. ischemic), frequency, duration, PNF techniques, and outcome measures. The majority of studies had small sample sizes and the overall number of studies is low. This impacts the validity of claims by the authors to generalize to all patients affected with stroke. Additional research is needed to further support the effectiveness of PNF usage with patients post CVA.
Implications: Though PNF has existed since the 1950s, the literature has not thoroughly supported its clinical usage. The results of this study showed that PNF seems to be an effective treatment intervention to address several dysfunctions seen in patients with stroke.
Funding, acknowledgements: No funding to declare.
Keywords: stroke, PNF, rehabilitation
Topic: Neurology: stroke
Did this work require ethics approval? No
Institution: n/a
Committee: n/a
Reason: meta-analysis & systematic review
All authors, affiliations and abstracts have been published as submitted.
