Index > Vol. 39/2007 > Iss. 8/October > pp. 627-632 > Abstract
Original report | Stroke

Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke

doi: 10.2340/16501977-0097

Abstract:

Objective: To measure the effects of Bobath-based (BB) therapy on depression, shoulder pain and health-related quality of life (HRQoL) of patients during one year after stroke.
Design: In a prospective, non-randomized design, the use of BB therapy was compared with a more task-oriented therapy and no BB therapy.
Subjects: A total of 324 patients in 12 hospitals.
Methods: Patients in the intervention group received BB therapy, whereas patients in the control group received no BB therapy and a more task-oriented therapy. HRQoL was measured using the SF-36; depression was measured with the Center of Epidemiological Studies Depression Scale and shoulder pain was measured with the Visual Analogue Scale at discharge, 6 and 12 months. Linear and logistic regression analyses were performed.
Results: No effects of BB therapy on HRQoL or shoulder pain were found. After one year fewer patients were depressed in the BB group (30%) than in the non-BB group (43%); the adjusted odds ratio was 0.6 (95% confidence interval 0.3–1.0).
Conclusion: BB therapy did not have any effect on HRQoL or shoulder pain in stroke patients. Healthcare professionals should reconsider the use of BB therapy in the care of stroke patients.

Authors:

Thóra B. Hafsteinsdóttir, Jaap Kappelle, Maria H. F. Grypdonck and Ale Algra

Key words:

stroke, Bobath therapy, health-related quality of life, depression, shoulder pain.

References

  1. Lennon S, Baxter D, Ashburn A. Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK. Disabil Rehabil 2001; 15: 254–262.
  2. Latash MA, Anson JG. What are “normal movements” in atypical populations? Behav Brain Sci 1996; 19: 55–106.
  3. Davidson I, Waters K. Physiotherapists working with stroke patients: a national survey. Physiotherapy 2000; 86: 69–80.
  4. Post MW, de Witte LP, Schrijvers AJ. Quality of life and the ICIDH: towards an integrated conceptual model for rehabilitation outcomes research. Clin Rehabil 1999; 13: 5–15. Link to article
  5. Niemi ML, Laaksonen R, Kotila M, Waltimo O. Quality of life 4 years after stroke. Stroke 1988; 19: 1101–1107.
  6. van de Weg FB, Kuik DJ, Lankhorst GJ. Post-stroke depression and functional outcome: a cohort study investigating the influence of depression on functional recovery from stroke. Clin Rehabil 1999; 13: 268–272. Link to article
  7. Bender L, McKenna K. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil 2001; 23: 698–705.
  8. Pomeroy VM, Niven DS, Barrow S, Faragher EB, Tallis RC. Unpacking the black box of nursing and therapy practice for post-stroke shoulder pain: a precursor to evaluation. Clin Rehabil 2001; 15: 67–83.
  9. Snels IA, Beckerman H, Lankhorst GJ, Bouter LM. Treatment of hemiplegic shoulder pain in the Netherlands: results of a national survey. Clin Rehabil 2000; 14: 20–27.
  10. Dickstein R, Hocherman S, Pillar T, Shaham R, Stern FM, Gorga D. Stroke rehabilitation. Three exercise therapy approaches. Phys Ther 1986; 66: 1233–1238.
  11. Mulder T, Hulstijn W, van der Meer J. EMG feedback and the restoration of motor control. A controlled group study of 12 hemiparetic patients. Am J Phys Med 1986; 65: 173–188.
  12. Wagenaar RC, Meijer OG, van Wieringen PC, Kuik DJ, Hazenberg GJ, Lindeboom J, et al. The functional recovery of stroke: a comparison between neuro-developmental treatment and the Brunnstrom method. Scand J Rehabil Med 1990; 22: 1–8.
  13. Langhammer B, Stanghelle JK. Bobath or Motor Relearning Programme? A comparison of two different approaches of physio­therapy in stroke rehabilitation: a randomized controlled study. Clin Rehabil 2000; 14: 361–369.
  14. Logigian MK, Samuels MA, Falconer JA, Agar R. Clinical exercise trial for stroke patients. Arch Phys Med Rehabil 1983; 64: 364–367.
  15. Basmajian JV, Gowland C, Brandstater ME, Swanson L, Trotter J. EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study. Arch Phys Med Rehabil 1982; 63: 613–616.
  16. Lewis NA. Functional gains in CVA patients: a nursing approach. Rehabil Nurs 1986; 11: 25–27.
  17. Wang RY, Chen HI, Chen CY, Yang YR. Efficacy of Bobath versus orthopaedic approach on impairment and function at different motor recovery stages after stroke: a randomized controlled study. Clin Rehabil 2005; 19: 155–164.
  18. Luke C, Dodd KJ, Brock K. Outcomes of the Bobath concept on upper limb recovery following stroke. Clin Rehabil 2004; 18: 888–898.
  19. Platz T, Eickhof C, van KS, Engel U, Pinkowski C, Kalok S, et al. Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial. Clin Rehabil 2005; 19: 714–724.
  20. Lord JP, Hall K. Neuromuscular re-education versus traditional programs for stroke rehabilitation. Arch Phys Med Rehabil 1986; 67: 88–91. Link to article
  21. van Vliet P, Lincoln NB, Robinson E. Comparison of the content of two physiotherapy approaches for stroke. Clin Rehabil 2001; 15: 398–414.
  22. Hafsteinsdóttir TB, Algra A, Kappelle LJ, Grypdonck MHF. Neurodevelopmental treatment (NDT) after stroke: a comparative study. J Neurol Neurosurg Psychiatry 2005; 76: 788–792.
  23. Hafsteinsdóttir TB, Grypdonck M. NDT-nursing competence measured with nurses in the rehabilitation of stroke patients. J Neurosci Nurs 2004; 36: 289–294.
  24. Hafsteinsdóttir TB, van Meeteren N, Grypdonck M. Is Bobath therapy used by physiotherapists in the care of stroke patients? Adv Physiother 2005; 7: 176–182.
  25. World Health Organization. Recommendations on stroke prevention, diagnosis, and therapy: report of the WHO Task Force on Stroke and other cerebrovascular disorders. Stroke 1989; 20: 1407–1431.
  26. Teasdale G, Murray G, Parker L, Lennet B. Adding up the Glasgow Coma Scale. Acta Neurochi (Wien) 1979; 28: 13–16.
  27. Bamford JL, Sandercock PAG, Warlow CP, Slattery J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989; 20: 828.
  28. Ware JEjr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Conceptual framework and item selection. Med Care 1992; 30: 473–483. Link to article
  29. Radloff LS, Teri L, editors. Use of the Center for Epidemiological Studies Depression scale with older adults. Clinical Gerontology. New York: The Hawthorne Press; 1986, p. 119–136.
  30. Turner-Stokes L, Rusconi S. Screening for ability to complete a questionnaire: a preliminary evaluation of the AbilityQ and ShoulderQ for assessing shoulder pain in stroke patients. Clin Rehabil 2003; 17: 150–157.
  31. Hafsteinsdóttir TB, Kruitwagen C, Strijker K, Van der Weide L, Grypdonck M. Assessing quality of nursing care as a confounding variable in an outcome study on Neurodevelopmental treatment. J Nurs Care Quality in press.
  32. de Heide M, van de Mortel M. Measuring the quality of care with paralyzed patients: an instrument for measuring quality of care in a rehabilitation center. [Het meten van zorgkwaliteit bij dwarslesie-revalidanten; een kwaliteitsinstrument voor het revalidatiecentrum. ] Lochem: De Tijdstroom; 1992 (in Dutch). 
.
  33. Visser G, Hollands L, de Bekker J, van Bergen B. The development and feasibility of an instrument for measuring the quality of nursing care in hospitals. [Beslag ten eis – Ontwikkeling en gebruik van referentiekaders voor verpleegkwaliteit in algemene ziekenhuizen. ] Lochem: De Tijdstroom; 1992 (in Dutch). 
.
  34. van Vliet PM, Lincoln NB, Foxall A. Comparison of Bobath based and movement science based treatment for stroke: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2005; 76: 503–508.
  35. Salter J, Camp Y, Pierce LL, Mion LC. Rehabilitation nursing approaches to cerebrovascular accident: a comparison of two approaches. Rehabil Nurs 1991; 16: 62–66.
  36. Viitanen M, Fugl-Meyer KS, Bernspång B, Fugl-Meyer AR. Life satisfaction in long-term survivors after stroke. Scand J Rehabil Med 1988; 20: 17–24.
  37. Chantraine A, Baribeault A, Uebelhart D, Gremion G. Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil 1999; 80: 328–331.
  38. Van Peppen RP, Kwakkel G, Wood-Dauphinee S, Hendriks HJ, Van der Wees PJ, Dekker J. The impact of physical therapy on functional outcomes after stroke: what’s the evidence? Clin Rehabil 2004; 18: 833–862.
  39. Nannetti L, Paci M, Pasquini J, Lombardi B, Taiti PG. Motor and functional recovery in patients with post-stroke depression. Disabil Rehabil 2005; 27: 170–175.