Bobath therapy is inferior to task-specific training and not superior to other interventions in improving lower limb activities after stroke: a systematic review. Bobath is inferior

Question: Does Bobath training improve lower limb activity performance compared to other or no intervention in adults with stroke?
Design: Systematic review of randomised trials with meta-analysis.
Participants: Adults after stroke.
Intervention: Bobath training compared with other interventions.
Outcome measures: Lower limb activities including walking and impairments included lower limb strength. Trial quality was assessed using the PEDro scale.
Results: Twenty-two trials were included in the review and 17 in the meta-analyses. The methodological quality of the selected trials varied. Meta-analyses were performed on the effect of Bobath training on lower limb activities compared to other interventions including; task specific training (nine trials), combined interventions (four trials), proprioceptive neuromuscular facilitation (one trial) and strength training (two trials). Task specific training was more effective than Bobath training for improving lower limb activities (SMD 0.48, 95% CI 0.01 to 0.95, I 2 = 84%), though the effect may be small.
There was no clear estimate of an effect when Bobath training was compared to a
combined intervention (SMD=-0.11, 95% CI -0.74 to 52, I 2 = 52%) or to strength training for improving lower limb activities (SMD=0.60, 95% CI -0.15 to 1.35, I2=0%). Bobath training was more effective than proprioceptive neuromuscular facilitation for improving standing balance after stroke (SMD -1.40, 95% CI -1.92 to -0.88).
Conclusions: Bobath training was not superior to comparison interventions with the exception of proprioceptive neuromuscular facilitation. Prioritising Bobath training over other interventions is not supported by current evidence.
Review registration: PROSPERO CRD42019112451.