Hands-on physiotherapy interventions and stroke and International Classification of Functionality, Disability and Health outcomes: A systematic review

The effectiveness of “hands-on” physiotherapy for stroke is unclear. The objective here is to analyze the effectiveness of such interventions on movement-related International Classification of Functionality, Disability and Health (ICF) categories. A systematic review was undertaken of randomized controlled trials published since 1980, using the following criteria: stroke, humans, ≥ 18 years, outcomes related to ICF movement-related categories, physiotherapeutic handling techniques, control group as placebo or no intervention, including experiments where both groups have the same intervention and the experimental group has one extra intervention. Nine studies were included and a best evidence synthesis is presented. Recommendations with limited evidence favor slow-stroke back massage for shoulder pain, range-of-motion exercises for upper-limb and lower-limb structures and functions of muscles and joints, proprioceptive neuromuscular facilitation (PNF) for gait step, walking backwards with hip facilitation for gait parameters and performance, and conventional physiotherapy with facilitation techniques for gait parameters. Recommendations with indicative findings favor PNF with trunk rhythmic stabilizations for function and mobility of upper limbs. Recommendations with limited evidence show the non-efficacy of Bobath therapy for upper-limb function and activity and facilitation of the step on body weight support treadmill training for gait parameters and performance. In conclusion, some hands-on interventions have limited evidence in stroke rehabilitation.