Effect of Action Observation Therapy in the Rehabilitation of Neurologic and Musculoskeletal Conditions: A Systematic Review

Abstract

Objective: To investigate the effect of action observation therapy (AOT) in the rehabilitation of neurologic and musculoskeletal conditions.

Data sources: Searches were completed until July 2020 from the electronic databases Allied and Complementary Medicine Database (via OVID SP), Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, MEDLINE, and the Physiotherapy Evidence Database.

Study selection: Randomized controlled trials comparing AOT with standard care were assessed. Musculoskeletal (amputee, orthopedic) and neurologic (dementia, cerebral palsy, multiple sclerosis, Parkinson disease, stroke) conditions were included. There were no age limitations. Articles had to be available in English.

Data extraction: Two reviewers independently screened titles, abstracts and full extracts of studies for eligibility and assessed the risk of bias of each study using the Cochrane Risk of Bias Tool. Data extraction included participant characteristics and intervention duration, frequency, and type.

Results: The effect of AOT in different outcome measures (OMs) was referenced in terms of body structures and functions, activities and participation, and environmental factors as outlined by the International Classification of Functioning, Disability, and Health (ICF). Of the 3448 articles identified, 36 articles with 1405 patients met the inclusion criteria. Seven of the 11 meta-analyses revealed a significant effect of intervention, with results presented using the mean difference and 95% CI. A best evidence synthesis was used across all OMs. Strong evidence supports the use of AOT in the rehabilitation of individuals with stroke and Parkinson disease; moderate evidence supports AOT in the rehabilitation of populations with orthopedic and multiple sclerosis diagnoses. However, moderate evidence is provided for and against the effect of AOT in persons with Parkinson disease and cerebral palsy.

Conclusions: This review suggests that AOT is advantageous in the rehabilitation of certain conditions in improving ICF domains. No conclusions can be drawn regarding treatment parameters because of the heterogeneity of the intervention. AOT has been considerably less explored in musculoskeletal conditions.

Keywords: 10MWT, 10-m walk test; ADL, activities of daily living; AHA, Assisting Hand Assessment; AOT, action observation therapy; BBS, Berg Balance Scale; BBT, Box and Block Test; FOG, freezing of gait; ICF, International Classification of Functioning Disability, and Health; MAS, Modified Ashworth Scale; MCID, minimum clinically important difference; MD, mean difference; MDC, minimal detectable change; MI, motor imagery; MNS, mirror neuron system; MUUL, Melbourne Assessment of Unilateral Upper Limb Function; Neuronal plasticity; OM, outcome measures; PDQ-39, 39-item Parkinson Disease Questionnaire; ROM, range of motion; Rehabilitation; RoB, risk of bias; SF-36, Short Form-36 Health Survey; Systematic review; TUG, Timed Up and Go; UPDRS, Unified Parkinson Disease Rating Scale; VAS, Visual Analog Scale; WOMAC, Western Ontario McMaster Universities Osteoarthritis Index.

Fig 1

PRISMA flowchart. Abbreviations: AMED, Allied and Complementary Medicine Database; CINAHL, Cumulative Index to Nursing and Allied Health; PEDro, Physiotherapy Evidence Database; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Fig 2

Risk of bias.

Fig 3

Pooled analysis for the Tinetti scale in patients with orthopedic conditions.

Fig 4

Pooled analysis for the Berg Balance Scale in patients with Parkinson disease.

Fig 5

Pooled analysis for the FOG Questionnaire in patients with Parkinson disease.

Fig 6

Pooled analysis for the TUG in patients with Parkinson disease.

Fig 7

Pooled analysis for the 39-Item Parkinson Disease Questionnaire.

Fig 8

Pooled analysis for the BBT in patients with stroke.

Fig 9

Pooled analysis for the Fugl-Meyer Assessment in patients with stroke.

Fig 10

Pooled analysis for the Wolf Motor Function Test in patients with stroke.

Fig 11

Pooled analysis for the Modified Barthel Index in patients with stroke.

Fig 12

Pooled analysis for the TUG in patients with stroke.

Fig 13

Pooled analysis for the 10MWT in patients with stroke.