Efficacy of Multimodal Physiotherapy Interventions in the Functional Recovery of Stroke-Induced Hemiplegia: A Longitudinal Mixed-Methods Study

Abstract

Background: Stroke-induced hemiplegia severely impacts functional abilities and quality of life. Multimodal physiotherapy offers a comprehensive approach, but evidence on its long-term efficacy and cost-effectiveness remains limited.

Objective: This study evaluates the long-term efficacy of a multimodal physiotherapy intervention for stroke-induced hemiplegia, explores patient and caregiver experiences, and assesses cost-effectiveness compared to standard care.

Methods: A mixed methods randomized controlled trial was conducted with 200 stroke patients (100 intervention, 100 control) over 12 months. The multimodal intervention included task-oriented training, constraint-induced movement therapy, robot-assisted therapy, virtual reality exercises, transcranial magnetic stimulation, and aerobic exercises. Standard care was provided to the control group. Quantitative outcomes were measured using the Fugl-Meyer Assessment (FMA), Modified Barthel Index (MBI), Stroke Impact Scale (SIS), and 6-Minute Walk Test (6MWT). Qualitative data were collected via interviews and focus groups. Cost-effectiveness was analyzed using quality-adjusted life years (QALYs).

Results: The intervention group demonstrated greater improvements in FMA (+29.3 vs. +13.8 points, p<0.001), MBI (+40.4 vs. +23.4 points, p<0.001), SIS (p<0.05 across domains), and 6MWT (+180.1 vs. +100.3 meters, p<0.001). Qualitative findings highlighted themes of empowerment, holistic recovery, and technological engagement. Cost-effectiveness analysis yielded an incremental cost-effectiveness ratio of $24,643 per QALY.

Conclusion: Multimodal physiotherapy demonstrated superior efficacy, improved quality of life, and cost-effectiveness, supporting its adoption in stroke rehabilitation.