An investigation of the optimum intensity of physiotherapy after stroke
We do not known the optimum amount of physiotherapy for individual patients and recent trials have been inconclusive. We conducted an individual-patient-data meta-analysis of trials testing increased levels of physiotherapy input. Results: We incorporated 9 trials (951 subjects). We found no statistically significant differences between patients receiving intensive or standard amounts of physiotherapy, in terms of overall disability or overall impairment scores, length of hospital stay or survival. Secondary analyses showed improvements on Motricity Index scores for the upper limbs (5.2 units, 95% CI 1.5 to 8.8, P=0.0058) and lower limbs (6.8 units, 95% CI 2.2-11.4, P=0.0042), Improvements were also seen in Action Research Arm Test scores (1.8 units, 95% CI – 1.2 to 4.8, P=0.25) in younger patients (under 70 years) and those with higher baseline Barthel scores, and in recovery of walking speed (increase of 0.0.56 m/s, 95% CI -0.018 to 0.130, P=0.14) (when the target of treatment was lower limb or gait focused). There was no significant difference in change in ADL (measured by BI (7 trials)) between the groups (0.15 units of change in BI, 95% CI -0.38 to 0.67, P=0.58). There were increased odds of a “good recovery” i.e. (improvement of 6 points or up to the maximum of 20 / 20 on BI), (odds ratio 1.33; 0.96 – 1.85; P=0.09) and of “excellent recovery” (> 8 points or up to the maximum on BI), (odds ratio 1.47; 1.03 – 2.05; P=0.04) in the augmented group. The higher contrast trials in our study (typically 15 – 44 hrs additional physiotherapy, with earlier onset at 7-10 days after admission, higher daily contrast and longer duration) are more likely to show treatment effects than lower contrast trials, with respect to impairment measured by the Motricity index and disability measured by the BI.