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Abstract
A short cut review was carried out to establish whether electrical stimulation had any advantages over facial exercises in promoting recovery after Bell’s palsy. Altogether 270 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.
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Report by Susan Buttress,Research Physiotherapist Checked by Katrina Herren, Research Fellow
Clinical scenario
A 50 year old presents with Bell’s palsy. You have heard that physiotherapy is an effective treatment but wonder whether facial exercises produce a better outcome than treatment with electrical stimulation.
Three part question
In [facial nerve palsy] are [facial exercises better than electrical stimulation] at improving [time to function/facial symmetry]?
Search strategy
Medline and CINAHL 1966–06/02, AMED 1985–04/02 using the OVID interface. Medline and CINAHL: [{facial nerve palsy.mp OR exp facial paralysis OR exp bells palsy}] AND [“trophic stimulation”.mp OR exp physical therapy techniques OR “physiotherapy”.mp OR exp electric stimulation/ OR exp electric stimulation therapy/ OR “electrical stimulation”.mp OR electrotherapy.mp}] LIMIT to human AND English. AMED: {exp peripheral nerve disease} AND {exp electrotherapy}.
Search outcome
Medline and CINAHL: 253 papers were identified, AMED: 17 papers found 11 of which were relevant, but 10 papers were excluded as these described electromyographic feedback (EMG feedback training), which is not a form of electrical stimulation. The remaining paper is shown in table 1.
Comment(s)
No papers were found that involved physiotherapy treatment of Bell’s palsy in the acute setting. The above paper describes significant differences in the outcomes used for patients with long term facial nerve palsy using electrical stimulation, however this was not a rigorous study.
CLINICAL BOTTOM LINE
There is no evidence to suggest that either exercises or electrical stimulation is beneficial to patients with acute Bell’s palsy. Evidence does exist to justify the use of electrical stimulation in patients with long term Bell’s palsy, although the study could have been more rigorous.
Report by Susan Buttress,Research Physiotherapist Checked by Katrina Herren, Research Fellow