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

Simone Dorsch; Cameron Carling; Zheng Cao; Emma Fanayan; Petra L Graham; Annie McCluskey; Karl Schurr; Katharine Scrivener; Sarah Tyson

doi:10.1016/j.jphys.2022.11.008

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

J Physiother. 2023 Jan;69(1):15-22. doi: 10.1016/j.jphys.2022.11.008. Epub 2022 Dec 16.

Authors

Simone Dorsch¹, Cameron Carling², Zheng Cao³, Emma Fanayan⁴, Petra L Graham⁵, Annie McCluskey⁶, Karl Schurr⁷, Katharine Scrivener⁸, Sarah Tyson⁹

Affiliations

¹ Faculty of Health Sciences, Australian Catholic University, Sydney, Australia; The StrokeEd Collaboration, Sydney, Australia. Electronic address: simone.dorsch@acu.edu.au.
² Concentric Rehabilitation Services, Perth, Australia.
³ Concentric Rehabilitation Services, Sydney, Australia.
⁴ Faculty of Health Sciences, Australian Catholic University, Sydney, Australia.
⁵ School of Mathematical and Physical Sciences, Macquarie University, Sydney, Australia.
⁶ The StrokeEd Collaboration, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
⁷ The StrokeEd Collaboration, Sydney, Australia.
⁸ The StrokeEd Collaboration, Sydney, Australia; Department of Health Sciences, Macquarie University, Sydney, Australia.
⁹ School of Health Sciences, University of Manchester, Manchester, UK.

PMID: 36529640
DOI: 10.1016/j.jphys.2022.11.008

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.

Keywords: Occupational therapy; Physical therapy; Rehabilitation; Stroke; Upper extremity.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Activities of Daily Living
Adult
Arm
Humans
Recovery of Function
Stroke Rehabilitation*
Stroke* / therapy