Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study

Abstract

Objective: To investigate the effectiveness of Bobath on stroke patients at different motor stages by comparing their treatment with orthopaedic treatment.

Design: A single-blind study, with random assignment to Bobath or orthopaedic group.

Setting: Physical therapy department of a medical centre.

Subjects: Twenty-one patients with stroke with spasticity and 23 patients with stroke at relative recovery stages participated.

Interventions: Twenty sessions of Bobath programme or orthopaedic treatment programme given in four weeks.

Main outcome measures: Stroke Impairment Assessment Set (SIAS), Motor Assessment Scale (MAS), Berg Balance Scale (BBS) and Stroke Impact Scale (SIS) for impairment and functional limitation level.

Results: Participants with spasticity showed greater improvement in tone control (change score: 1.20 +/- 1.03 versus 0.08 +/- 0.67, p = 0.006), MAS (change score: 7.64 +/- 4.03 versus 4.00 +/- 1.95, p = 0.011), and SIS (change score: 7.30 +/- 6.24 versus 1.25 +/- 5.33, p = 0.023) after 20 sessions of Bobath treatment than with orthopaedic treatment. Participants with relative recovery receiving Bobath treatment showed greater improvement in MAS (change score: 6.14 +/- 5.55 versus 2.77 +/- 9.89, p = 0.007), BBS (change score: 19.18 +/- 15.94 versus 6.85 +/- 5.23, p = 0.015), and SIS scores (change score: 8.50 +/- 3.41 versus 3.62 +/- 4.07, p = 0.006) than those with orthopaedic treatment.

Conclusion: Bobath or orthopaedic treatment paired with spontaneous recovery resulted in improvements in impairment and functional levels for patient with stroke. Patients benefit more from the Bobath treatment in MAS and SIS scores than from the orthopaedic treatment programme regardless of their motor recovery stages.