Physical rehabilitation approaches for the recovery of function and mobility following stroke.

After a stroke, physiotherapists draw on many different approaches to help people regain movement and independence, but which approach works best has long been debated. This large Cochrane review pooled 267 randomised trials involving nearly 22,000 people to ask whether physical rehabilitation helps at all, whether more of it helps further, and whether one style of therapy beats another. The broad picture is that physical rehabilitation, using a mix of treatment components, likely improves daily activity independence, motor function, balance, and walking speed compared with no or minimal rehabilitation, and adding extra rehabilitation on top of usual care may bring further gains.

Approaches built around practising real functional tasks looked promising, while approaches based on neurophysiological theories were not shown to be better, and in some outcomes did worse. The evidence is limited by small, heterogeneous studies, inconsistent reporting, and generally low or very low certainty, so these patterns should be read as encouraging rather than settled.

If you or someone you know is recovering from a stroke, you may wonder whether the specific type of physiotherapy matters, or whether just doing more therapy is what counts. This review combined results from 267 studies with almost 22,000 participants to look at exactly that question.

Overall, physical rehabilitation programmes, which usually combine several techniques, appear to help people become more independent in daily activities, regain motor function, improve balance, and walk faster compared with receiving little or no therapy. Getting extra rehabilitation sessions beyond the usual amount also seemed to bring additional benefit in these areas. When researchers compared different therapy styles against each other, approaches that focused on practising everyday tasks, like standing up, walking, or reaching, seemed to work somewhat better than other methods, and these benefits lasted over time.

Approaches based on specific neurological theories did not show a clear advantage and sometimes performed less well. It's important to know that most of the underlying studies were small and quite different from one another, and many had weaknesses in how they were designed, so the certainty of these findings is generally low.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This Cochrane update pooled 267 randomised controlled trials (21,838 participants, conducted across 36 countries, half in China) comparing physical rehabilitation approaches for function and mobility after stroke. Only 14 studies contributing to meta-analyses were judged at low risk of bias across all domains, and roughly a third of studies in primary outcome analyses were rated high risk of bias, so heterogeneity and methodological limitations temper interpretation throughout. Compared with no or minimal rehabilitation, physical rehabilitation showed low-certainty improvements in independence in activities of daily living (standardised mean difference 1.32) and motor function (SMD 1.01), with moderate-certainty improvement in gait velocity (SMD 0.23) and low-certainty improvement in balance, though long-term benefit was only evident for the activity and motor outcomes.

Additional rehabilitation on top of usual care showed similar low-certainty gains across these outcomes. Functional task training may outperform other approaches for activities of daily living (SMD 0.58, low certainty) and motor function (SMD 0.72, very low certainty), with sustained long-term benefit for the former, whereas neurophysiological approaches were less effective for activities of daily living (SMD -0.34, low certainty) and showed no clear difference for motor function, balance, or gait velocity.

Evidence on adverse events and length of stay remains very uncertain across all comparisons.