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Nakano H, Fujiwara T, Tsujimoto Y, Morishima N, Kasahara T, Ameya M, Tachibana K, Sanada S, Toufukuji S, Hato N. Physical therapy for peripheral facial palsy: A systematic review and meta-analysis. Auris Nasus Larynx 2024; 51:154-160. [PMID: 37149416 DOI: 10.1016/j.anl.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This study aimed to reveal the efficacy of physical therapy for patients with peripheral facial palsy. METHODS A literature search was conducted using PubMed, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trials comparing the physical therapy versus placebo/non-treatment for peripheral facial palsy such as Bell's palsy, Ramsay Hunt syndrome, and traumatic facial palsy were included for meta-analysis. The primary outcome was non-recovery at the end of the follow-up. Non-recovery was defined according to the authors' definition. The secondary outcomes were the composite score of the Sunnybrook facial grading system and sequelae (presence of synkinesis or hemifacial spasm) at the end of the follow-up. Data was analyzed using Review Manager software and pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated. RESULTS Seven randomized controlled trials met the eligible criteria. The data on non-recovery from four studies was obtained and included 418 participants in the meta-analysis. Physical therapy might reduce non-recovery (RR = 0.51 [95% CI = 0.31-0.83], low quality). Pooling the data of composite score of the Sunnybrook facial grading system from three studies (166 participants) revealed that physical therapy might increase the composite scores (MD = 12.1 [95% CI = 3.11-21.0], low quality). Moreover, we obtained data on sequelae from two articles (179 participants). The evidence was very uncertain about the effect of physical therapy on reduction of sequelae (RR = 0.64 [95% CI = 0.07-5.95], very low quality). CONCLUSION The evidence suggested that physical therapy reduces non-recovery in patients with peripheral facial palsy and improves the composite score of the Sunnybrook facial grading system, whereas the efficacy of physical therapy in reducing sequelae remained uncertain. The included studies had high risk of bias, imprecision, or inconsistency; therefore, the certainty of evidence was low or very low. Further well-designed randomized controlled trials are needed to confirm its efficacy.
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Affiliation(s)
- Haruki Nakano
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki city, Okayama, 710-8602, Japan
| | - Yasushi Tsujimoto
- Oku Medical Clinic, Shinmori 7-1-4, Asahi-ku, Osaka city, Osaka, 535-0022, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Naohito Morishima
- Department of Rehabilitation, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takashi Kasahara
- Department of Rehabilitaion Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Misato Ameya
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
| | - Keita Tachibana
- Department of Central Rehabilitation Medicine, Osaka Rosai Hospital, Sakai, Japan
| | - Shota Sanada
- Department of Rehabilitation, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Saori Toufukuji
- Department of Rehabilitation Services, Tokai University Hospital, 143 Shimokasuya, Isehara-shi, Kanagawa 259-1193, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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