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Evidence summaries

Physical Therapy for Bell's Palsy (Idiopathic Facial Paralysis)

In idiopathic facial paralysis the evidence is insufficient whether physical therapy in the form of electrical stimulation or facial exercises would provide any significant benefit or harm. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 12 studies with a total of 872 subjects. Four trials studied the efficacy of electrical stimulation (n=313), three trials exercises (n=199), and five compared or combined some form of physical therapy with acupuncture (n=360). For the primary outcome of incomplete recovery after 6 months, electrostimulation produced no benefit over placebo (1 study, n= 86). Comparisons of electrostimulation with prednisolone) (n=149) or the addition of electrostimulation to hot packs, massage and facial exercises (n=22), reported no significant differences. Similarly a meta-analysis from two studies (n=142), one and three months of duration, found no difference in synkinesis, a complication of Bell's palsy, between participants receiving electrostimulation and controls. Worse functional recovery was found with electrostimulation at three months follow-up (MD 12.00 points (scale of 0 to 100), 95% CI 1.26 to 22.74; 1 trial, n=56).Two trials of facial exercises found no difference in incomplete recovery at 6 months when exercises were compared to waiting list controls or conventional therapy. Exercises were beneficial on measures of facial disability to people with chronic facial palsy when compared with controls (MD 20.40 points, 95% CI 8.76 to 32.04; 1 trial, n=34). In another trial acute cases treated for 3 months had significantly less facial motor synkinesis after exercise (RR 0.24, 95% CI 0.08 to 0.69; 1 trial, n=145). The same study showed significant reduction in time for complete recovery, mainly in more severe cases (MD -2.10 weeks, 95% CI -3.15 to -1.05, n=47) but this was not a prespecified outcome in this meta analysis.Acupuncture studies did not provide useful data.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, short follow-up time), imprecise results (limited study size for each comparison) and inconsistency (heterogeneity of outcomes and variability in results across studies).

    References

    • Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2011;12:CD006283. [PubMed]

Primary/Secondary Keywords