Critically Appraised Paper for “Bobath concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: A randomized controlled trial.” Clinical Rehabilitation
The researchers used a Level I, single-blinded, randomized controlled trial design to compare the functional arm recovery of 22 high-functioning poststroke participants. Participants were evenly assigned to receive therapy using the Bobath concept or constraint-induced movement therapy (CIMT).
The first intervention group received therapy using the Bobath concept, a neurodevelopmental treatment focused on specific handling techniques that guide the patient’s affected arm through initiation and completion of tasks. The intervention consisted of 1 hr of training per day in an outpatient clinic and a 24-hr home program for 10 consecutive weekdays. The second intervention group received CIMT, a rehabilitation treatment focused on repetitive, task-oriented exercises using the patient’s affected arm. The intervention was 3 hr of outpatient training for 10 consecutive weekdays. Additionally, the patients’ affected hand was placed in a protective safety mitt for 90% of their waking hours for 12 consecutive days. Both interventions were carried out by the same physical therapist.
Therapy using the Bobath concept and CIMT yielded similar improvements in functional ability, performance time, quality of movement (QOM), and levels of independence in performance of activities of daily living. Although functional outcomes were not significantly different, participants receiving CIMT perceived greater improvements in the amount of use (AOU) and QOM of their affected hand. These findings indicate that occupational therapists may effectively treat high-functioning poststroke patients with either therapy using the Bobath concept or CIMT.
However, the limitations that potentially affected the outcomes of this study must be considered. The intervention biases included unequal intervention durations for each group and the physical therapist’s variable proficiency in each intervention, given that the therapist was more familiar with CIMT. These intervention biases limit the reliability of the study. Additionally, the variability in the amount of time between the patient’s stroke and the study increases the probability of confounding variables, which threaten the validity of the study. The small sample size limits the generalizability of the researchers’ findings to the greater poststroke population.
Although this study contributes to the evidence supporting therapy using the Bobath concept and CIMT, clinicians cannot look to the outcomes of this study as a recommendation for clinical practice, given the plethora of intervention biases. Rather, through clinical reasoning, clinicians should discern the merit of both treatment approaches and choose the approach that best suits each unique client. Because of the numerous biases, additional research should be done that examines functional arm recovery with therapy using the Bobath concept. Until further research with better construct validity is conducted and a consensus on the most effective treatment for functional hand recovery among highfunctioning poststroke patients is reached, it is up to the clinician to stay current with the literature and to use client-centered, pragmatic reasoning.
Garnica, Emily; Hancock, Savannah; Huang, Tiffany; Phung, Jessica; and Li, Kitsum, "Critically Appraised Paper for “Bobath concept versus constraint-induced movement therapy to improve arm functional recovery in stroke patients: A randomized controlled trial.” Clinical Rehabilitation" (2017). Occupational Therapy | Critically Appraised Papers Series. 17.