Physiotherapy Interventions for Chronic Stroke: A Systematic Review of Functionality and Quality of Life Outcomes

IntroductionStroke is a neurological alteration which significantly impacts patient's functional abilities and quality of life. Physiotherapy interventions, including therapeutic exercise, robotic therapy, electrotherapy and hydrotherapy, have demonstrated positive effects in addressing the sequelae that persist in the chronic phase.MethodsThis systematic review was registered in PROSPERO (CRD420251102428). Searches were conducted in Cochrane, PubMed, PEDro, Scopus, and Google Scholar. Randomized controlled trials of physiotherapy interventions in chronic stroke were included if they reported outcomes for functionality and quality of life. Methodological quality was assessed using the PEDro scale. 35 articles met the inclusion criteria, of which 18 focused on therapeutic exercise, 8 on robotic therapy, 8 on electrotherapy, and 1 on hydrotherapy, comprising a total of 2,412 patients.ResultsTherapeutic exercise is the most extensively studied intervention in chronic stroke, consistently demonstrating the most favorable outcomes in functionality. Robotic therapy was the second modality showing improvements in functionality, particularly in gait, balance and hand function. Electrotherapy, along with robotic therapy showed the greatest impact on quality of life outcomes. Evidence for hydrotherapy remains limited, with a single trial reporting improvements in balance. Overall, these results suggest that no single physiotherapy modality is superior across all domains, emphasizing the need for a multimodal and individualized approach in chronic stroke rehabilitation.ConclusionPhysiotherapy interventions in chronic stroke show clear benefits, with therapeutic exercise showing the greatest impact on functional recovery and electrotherapy and robotic therapy on quality of life.