Physiotherapy Interventions in Post-Stroke Rehabilitation: A Narrative Review of Contemporary Evidence
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Abstract
Background: Stroke is a leading cause of long-term disability and is frequently associated with motor impairment, balance dysfunction, gait limitation, reduced endurance, and dependency in activities of daily living. Physiotherapy is central to post-stroke recovery, but the growing range of conventional and technology-assisted interventions requires clinically meaningful synthesis. Objective: This narrative review aimed to synthesize contemporary evidence on physiotherapy interventions used in post-stroke rehabilitation, with emphasis on mechanisms, clinical benefits, evidence strength, and practical implications. Methods: A structured literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar. English-language literature published primarily between 2005 and 2024 was reviewed, with older landmark publications included where conceptually relevant. Evidence was synthesized narratively across major intervention categories, including task-oriented training, repetitive practice, neurodevelopmental treatment, strength and aerobic exercise, balance and gait training, robotic-assisted therapy, virtual reality, functional electrical stimulation, and constraint-induced movement therapy. Results: The strongest and most consistent evidence supported active, repetitive, task-specific rehabilitation strategies, including task-oriented training, repetitive task practice, strengthening, aerobic exercise, balance training, gait training, and constraint-induced movement therapy in selected patients. Neurodevelopmental treatment demonstrated mixed evidence and appears more appropriate as an adjunct than as an isolated intervention. Robotic-assisted therapy, virtual reality, and functional electrical stimulation showed moderate-to-strong potential as adjunctive modalities, particularly when they increased repetition, feedback, motivation, or task-specific neuromuscular activation. Conclusion: Post-stroke physiotherapy should be individualized, intensive, progressive, and functionally oriented. Core rehabilitation should prioritize evidence-supported active interventions, while technology-assisted and facilitation-based approaches should be integrated selectively according to patient needs, clinical goals, and resource availability.
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References
1. Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World Stroke Organization (WSO): global stroke fact sheet 2022. Int J Stroke. 2022;17(1):18-29.
2. Johnson CO, Nguyen M, Roth GA, Nichols E, Alam T, Abate D, et al. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-58.
3. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693-702.
4. Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, et al. Physical rehabilitation approaches for recovery of function, balance and walking after stroke. Cochrane Database Syst Rev. 2014;(4):CD001920.
5. Veerbeek JM, van Wegen E, van Peppen R, Van der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One. 2014;9(2):e87987.
6. Winstein CJ, Stein J, Arena R, Bates B, Cherney L, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-e169.
7. Bernhardt J, Hayward KS, Kwakkel G, Ward NS, Wolf SL, Borschmann K, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the Stroke Recovery and Rehabilitation Roundtable taskforce. Int J Stroke. 2017;12(5):444-50.
8. Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2018;(9):CD006876.
9. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225-39.
10. Dobkin BH. Rehabilitation after stroke. N Engl J Med. 2005;352(16):1677-84.
11. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. Philadelphia: Lippincott Williams & Wilkins; 2007.
12. Saunders DH, Greig CA, Young A, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2004;(1):CD003316.
13. Ada L, Dorsch S, Canning CG. Strengthening interventions increase strength and improve activity after stroke: a systematic review. Aust J Physiother. 2006;52(4):241-8.
14. Eraifej J, Clark W, France B, Desando S, Moore D. Effectiveness of upper limb functional electrical stimulation after stroke for the improvement of activities of daily living and motor function: a systematic review and meta-analysis. Syst Rev. 2017;6(1):40.
15. Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev. 2015;(10):CD004433.
16. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Chapman M, et al. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2025;(6):CD008349.