on January 29, 2009
Published online before print January 29, 2009, doi: 10.1161/STROKEAHA.108.533828
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Submitted on August 5, 2008
From the Research Bureau (B.J.K.), Isala Academy, Isala klinieken, Zwolle, The Netherlands; the Health and Rehabilitation Sciences Research Institute (S.L., B.L.), University of Ulster, Newtownabbey, Northern Ireland; Royal Victoria Hospital (B.L.), Belfast, Northern Ireland; the Regional Acquired Brain Injury Unit (L.W.-S.), Belfast, Northern Ireland; the Faculty of Human Movement Science (M.S., G.K.), VU University, Amsterdam, The Netherlands; Roessingh Research and Development (J.H.B.), Enschede, The Netherlands; Rehabilitation Foundation Limburg (SRL; J.H.), Rehabilitation Centre Hoensbroek, Hoensbroek, The Netherlands; the Department of Rehabilitation (A.C.H.G.), Radboud University Medical Centre, Nijmegen, The Netherlands, Department of Rehabilitation (A.C.H.G.), St Maartenskliniek, Nijmegen, The Netherlands; and the Department of Rehabilitation Medicine, VU Medical Centre, Amsterdam (G.K.), Rudolf Magnus Institute (G.K.), UMC Utrecht, The Netherlands. * To whom correspondence should be addressed. E-mail: b.j.kollen{at}isala.nl.
Background and Purpose—In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation. Method—A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches. Results—The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness. Conclusions—This systematic review confirms that overall the Bobath Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published. Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment.
Accepted on August 28, 2008
The Effectiveness of the Bobath Concept in Stroke Rehabilitation. What is the Evidence?
Boudewijn J. Kollen PhD*;
Key words: Bobath • cerebrovascular disorders • neurodevelopmental treatment • physical therapy • rehabilitation • systematic review