Background and Purpose-In the Western world, the Bobath Concept or neurodevelopmental treatment is the most popular treatment approach used in stroke rehabilitation, yet the superiority of the Bobath Concept as the optimal type of treatment has not been established. This systematic review of randomized, controlled trials aimed to evaluate the available evidence for the effectiveness of the Bobath Concept in stroke rehabilitation. Method-A systematic literature search was conducted in the bibliographic databases MEDLINE and CENTRAL (March 2008) and by screening the references of selected publications (including reviews). Studies in which the effects of the Bobath Concept were investigated were classified into the following domains: sensorimotor control of upper and lower limb; sitting and standing, balance control, and dexterity; mobility; activities of daily living; health-related quality of life; and cost-effectiveness. Due to methodological heterogeneity within the selected studies, statistical pooling was not considered. Two independent researchers rated all retrieved literature according to the Physiotherapy Evidence Database (PEDro) scale from which a best evidence synthesis was derived to determine the strength of the evidence for both effectiveness of the Bobath Concept and for its superiority over other approaches. Results-The search strategy initially identified 2263 studies. After selection based on predetermined criteria, finally, 16 studies involving 813 patients with stroke were included for further analysis. There was no evidence of superiority of Bobath on sensorimotor control of upper and lower limb, dexterity, mobility, activities of daily living, health-related quality of life, and cost-effectiveness. Only limited evidence was found for balance control in favor of Bobath. Because of the limited evidence available, no best evidence synthesis was applied for the health-related quality-of-life domain and cost-effectiveness. Conclusions-This systematic review confirms that overall the Bobath Concept is not superior to other approaches. Based on best evidence synthesis, no evidence is available for the superiority of any approach. This review has highlighted many methodological shortcomings in the studies reviewed; further high-quality trials need to be published. Evidence-based guidelines rather than therapist preference should serve as a framework from which therapists should derive the most effective treatment. (Stroke. 2009;40:e89-e97.)

Objective: To analyse the functional outcomes of adults following acquired brain injury attending an intensive outpatient neuro-rehabilitation programme relative to a comprehensive TBI day programme service in the United States. Method: Design: Retrospective audit of all admissions over a two-year period (2001)(2002)(2003) to an outpatient neuro-rehabilitation service utilising an interdisciplinary team model. Setting: Outpatient neuro-rehabilitation service. Participants: 89 patients in receipt of 2+ therapies attending for intensive day neuro-rehabilitation programme. Main Outcome Measures: Routine FIM+FAM UK scores were compiled on admission and discharge. The FIM+FAM UK is a widely employed outcome measure of activity and participation comprising 30 items across a range of domains including self care, domestic skills, mobility, communication, cognitive and social abilities. The scale is divided into two broad domains of functioning (motor and cognitive). Data Analysis: Descriptive analysis of demographic, patient diagnosis, referral patterns and time since injury to attendance was undertaken. Analysis of FIM+FAM UK admission and discharge scores was performed. Results: Complete admission and discharge scores were available for 65 patients. Significant mean improvements in motor (12.0 point change), cognitive (7.3 point change) and composite FIM+FAM UK (19.3 point change) scores were observed indicating reduced functional dependence following an intensive period of outpatient neuro-rehabilitation. Conclusion:The FIM+FAM UK measure demonstrated sensitivity to change across functional domains relevant to goal directed intensive outpatient interdisciplinary neuro-rehabilitation.

At present, there is a paucity of evidence regarding physiotherapy efficacy to inform the management of patients in vegetative or minimally conscious state. Clearer agreed definitions of clinically important difference in passive range of movement are required to allow better interpretation of outcomes. Interventions should be aimed at minimising carer burden and developing individualised disability management programmes. Further research documenting the long-term outcomes in such patients is warranted.