J Neurol Neurosurg Psychiatry 82:136-143 doi:10.1136/jnnp.2009.196428
  • Research paper

Efficacy of physiotherapy interventions late after stroke: a meta-analysis

  1. Mauro Di Bari3
  1. 1Unit of Functional Rehabilitation, Prato, Italy
  2. 2Unit of Functional Rehabilitation, Azienda Sanitaria di Firenze, and Motion Analysis Laboratory, Piero Palagi Hospital, Florence, Italy
  3. 3Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  1. Correspondence to Mr Francesco Ferrarello, Unit of Functional Rehabilitation, Azienda USL 4 Prato. Piazza dell'Ospedale 5, 59100 Prato, Italy; francescoferrarello{at}
  • Received 29 September 2009
  • Revised 31 March 2010
  • Accepted 6 April 2010
  • Published Online First 8 September 2010


Objective Physiotherapy is usually provided only in the first few months after stroke, while its effectiveness and appropriateness in the chronic phase are uncertain. The authors conducted a systematic review and meta-analysis of randomised clinical trials (RCT) to evaluate the efficacy of physiotherapy interventions on motor and functional outcomes late after stroke.

Methods The authors searched published studies where participants were randomised to an active physiotherapy intervention, compared with placebo or no intervention, at least 6 months after stroke. The outcome was a change in mobility and activities of daily living (ADL) independence. The quality of the trials was evaluated using the PEDro scale. Findings were summarised across studies as effect size (ES) or, whenever possible, weighted mean difference (WMD) with 95% CI in random effects models.

Results Fifteen RCT were included, enrolling 700 participants with follow-up data. The meta-analysis of primary outcomes from the original studies showed a significant effect of the intervention (ES 0.29, 95% CI 0.14 to 0.45). The efficacy of the intervention was particularly evident when short- and long-distance walking were considered as separate outcomes, with WMD of 0.05 m/s (95% CI 0.008 to 0.088) and 20 m (95% CI 3.6 to 36.0), respectively. Also, ADL improvement was greater, though non-significantly, in the intervention group. No significant heterogeneity was found.

Interpretation A variety of physiotherapy interventions improve functional outcomes, even when applied late after stroke. These findings challenge the concept of a plateau in functional recovery of patients who had experienced stroke and should be valued in planning community rehabilitation services.


  • Funding The study was financed with institutional funds of the University of Florence.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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