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The efficacy of rehabilitation in people with Guillain-Barrè syndrome: a
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The efficacy of rehabilitation in people with
Guillain-Barrè syndrome: a systematic review of
randomized controlled trials
Sara Sulli, Luca Scala, Anna Berardi, Antonella Conte, Viola Baione, Daniele
Belvisi, Giorgio Leodori & Giovanni Galeoto
To cite this article: Sara Sulli, Luca Scala, Anna Berardi, Antonella Conte, Viola Baione, Daniele
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EXPERT REVIEW OF NEUROTHERAPEUTICS
https://doi.org/10.1080/14737175.2021.1890034
SYSTEMATIC REVIEW
The efficacy of rehabilitation in people with Guillain-Barrè syndrome: a systematic
review of randomized controlled trials
Sara Sullia, Luca Scalaa, Anna Berardi
and Giovanni Galeoto b
b
, Antonella Conteb,c, Viola Baioneb, Daniele Belvisib,c, Giorgio Leodorib,c
a
c
Sapienza University of Rome, Rome, Italy; bDepartment of Human Neurosciences, Sapienza University of Rome, Viale Dell’ Università, Rome, Italy;
IRCSS Neuromed, Pozzilli, Italy
ABSTRACT
ARTICLE HISTORY
Introduction: Individuals with Guillain-Barrè syndrome (GBS) showed significant longer-term psycho­
logical sequelae, due to persistent disability. In recent years, great advances have been made in medical
care for patients with GBS. However, the focus has been mainly on patient care in the acute phase and
improving survival instead of long-term disability. The purpose of this study was to evaluate the efficacy
of rehabilitation in people with GBS through a systematic review of randomized controlled trials.
Area Covered: PRISMA guidelines were used to perform this systematic review. Six bibliographic
databases were searched: PUBMED, WEB OF SCIENCE, PEDro, CINHAL, PSYCHINFO, and SCOPUS.
Papers included in the systematic review should have a search design of a randomized controlled
trial. The quality of the clinical trials included was evaluated according to Jadad score.
Expert Opinion: After eliminating duplicates, 472 records got screened, three RCTs were included in
the systematic review. Overall, the analysis of the three randomized controlled trials showed that
various types of rehabilitation interventions are correlated to an improvement in the patient’s wellbeing. Finally, it is not possible to extrapolate definite conclusions on the effectiveness of rehabilitation
treatment in patients with GBS. Therefore, high-quality future studies are needed to confirm these
hypotheses.
Received 16 December 2020
Accepted 10 February 2021
1. Introduction
Guillain-Barrè syndrome (GBS) is an acute immune-mediated
polyradiculoneuropathy caused by inflammation of the per­
ipheral nerves and nerve roots [1]. An immune response direc­
ted toward peripheral myelin induces the process that is often
preceded by a viral or bacterial infection, surgery, immuniza­
tion, lymphoma, or toxins exposure [2]. GBS is a complex and
heterogeneous syndrome induced by various types of lesions.
The most common one is the acute inflammatory demyelinat­
ing polyradiculoneuropathy (AIDP), manifesting with primarily
demyelinating features; acute axonal motor neuropathy
(AMAN) is less common and is characterized by primarily
axonal injury and pure motor involvement; acute motor sen­
sory axonal polyneuropathy (AMSAN) shows a similar patho­
genesis to AMAN with additional sensory involvement [3]. One
of the main target regions of the autoimmune attack is the
node of Ranvier; the nodal area, resulting in Nodopathy, and
the internodal area may also be affected [4].
A worldwide epidemiological systemic review denotes that
the overall incidence of GBS is around 1.1 to 1.8/100,000/year in
adults, and it increases with age after 50 years, from 1.7/100,000/
year to 3.3/100,00/year [5]. In addition to this, there is
a significantly higher risk in men of developing the disease [3].
GBS has an acute phase, which reaches the nadir within
four weeks; because of the patchy nature of the inflammatory
CONTACT Giovanni Galeoto,
Rome, Italy.
giovanni.galeoto@uniroma1.it
© 2021 Informa UK Limited, trading as Taylor & Francis Group
KEYWORDS
Guillain-Barrè syndrome;
proprioceptive
Neuromuscular Facilitation;
quality of life; rehabilitation;
systematic review
attack, demyelination of peripheral axons produces an acute
symmetrical ascending paralysis, usually with progressive
weakness, loss of deep tendon reflexes, and loss of sensation.
These peripheral axonal lesions may be spontaneously more
or less reversible. In 50% of cases, the cranial nerves are
involved, with diplopia, facial, and bulbar weakness.
Autonomic dysfunction, such as fluctuation in bloody pres­
sure, cardiac arrhythmias, and respiratory failure, often occur
[6,7]. In percentage, 25% of people require ventilatory support
due to respiratory tract involvement, and 5–10% of patients
die in the acute phase [8]. After the progressive phase, the
condition has a plateau of 1–2 weeks, and then a prolonged
recovery phase begins [9]. Even if the relative mortality to
Guillain-Barrè syndrome is low, and the outcomes are gener­
ally favorable, 20% of patients have a permanent severe dis­
ability, with deficits in ambulation, and ventilator assistance
12 months later, weakness, fatigue, pain, and sensory loss
[10,11]. Furthermore, GBS’s impact on daily activities, work,
social activities and health-related quality of life (HRQoL) is
considerable two years after onset and presumably persists
even after [12]. Many patients showed significant longer-term
psychological sequelae, depression, and anxiety than
a normative population due to persistent disability. In recent
years, great advances have been made in medical care for
patients with GBS. However, the focus has been mainly on
Department of Human Neurosciences, Sapienza University of Rome, Viale Dell’ Università,
2
S. SULLI ET AL.
Article highlights
The aim of this systematic review was to evaluate the efficacy of
rehabilitation in people with Guillain-Barrè syndrome.
● A total of 748 studies were retrieved from the search and 141 were
evaluated after the first screening. After excluding 138 studies, 3
suitable randomized controlled trials were included.
● The analysis of the three randomized controlled trials showed that
various types of rehabilitation interventions are correlated to an
improvement in the patient’s well-being.
● Patients who survive the acute phase of Guillain-Barrè syndrome can
develop different types of disabilities. Only one RCT evaluated differ­
ent outcomes and used a multidisciplinary approach for the treat­
ment of GBS.
● Our review highlighted that there is little quality evidence in GuillainBarrè rehabilitation. However, it is performed extensively in clinical
practice, and for this reason, higher quality studies with high levels of
evidence are required.
●
patient care in the acute phase and improving survival instead
of long-term disability, QoL improvement, and social participa­
tion. Indeed, long-term clinical care for patients with GBS
remains fragmented [10]. Therefore, a multidisciplinary
approach seems to be necessary because of the heterogeneity
of symptoms.
Even the most recent review [6] conducted on this topic
showed a lack of standardized protocols for treating this
disease.
Therefore, this systematic review’s main purpose was to
provide a summary of the primary studies available on the
rehabilitation of Guillain-Barrè syndrome to support and justify
the efficacy of this treatment, evaluating its effects. Also, our
review serves as an update of the most recent evidence
regarding this theme.
2. Body
Health professionals of Sapienza University of Rome and
ROMA – Rehabilitation & Outcome Measures Assessment
Association performed the study. The research group has
conducted many outcome measures in Italy [13–23].
or no therapies, were also included. All studies based on
physical therapy to relieve discomfort and promote physical
well-being were considered in individuals with GBS. No restric­
tions were applied to the type of interventions used. Papers
concerning numerous rehabilitation aspects (fatigue, motor
deficiencies, postural balance, muscle strength, gait training,
cardiorespiratory response, sphincter control, endurance, and
depression) were considered. Restrictions were applied to
study designs. Only Randomized Controlled Trials were
included. No language restrictions were applied in the
research. There were no restrictions on the publication period.
Inclusion criteria: The prerequisites of the studies necessary
to be included in the systematic review were: (a) studies
having a research design of randomized controlled trial; (b)
studies published in English.
Exclusion criteria: none.
2.3. Search methods
All the studies in the published literature that include the key­
words (‘Guillain-Barrè syndrome’; ‘rehabilitation’) connected by
the Boolean operator ‘AND’ were considered. Studies were
selected for inclusion through individualized systematic
searches of six electronic databases. Two reviewers selected all
potential studies. The following electronic databases were sys­
tematically searched from May 2020 until July 2020: PUBMED,
SCOPUS, WEB OF SCIENCE, CYNAL, PSYCINFO, PEDRO.
2.4. Selection of studies
Titles, abstracts, and keywords selected through the databases
were screened independently by two physiotherapists. After
the first screening, the primary reviewer identified the relevant
studies and rated them according to the inclusion criteria.
Then, a second reviewer cross-checked the studies. After
the second screening, studies that did not meet the inclusion
criteria were systematically excluded, and others that seemed
relevant were identified. A final list of studies eligible for
inclusion was made, and any disagreements were resolved
by the third reviewer or by consensus. Studies that met the
criteria were then subjected to a full text review to select
studies to decide whether to include them in the review.
2.1. Protocol and registration
The protocol was recorded on the Prospero website, the inter­
national prospective register of systematic reviews, available
at https://www.crd.york.ac.uk/prospero/. This review was then
performed according to the 27-item PRISMA Statement for
Reporting Systematic Reviews based on MECIR.
2.2. Eligibility criteria for considering studies for this
review: types of studies, participants, and intervention
Studies were limited to people with Guillain-Barrè syndrome,
independently of clinical course or length of time since diag­
nosis. Studies with mixed diagnosis samples were included if
a subgroup of participants could be identified and for which
separate data were available. Studies that include comparing
physical therapy and conventional therapies, other therapies,
2.5. Data extraction and risk of bias
The data mining approach was chosen based on Cochrane
methods. Two reviewers independently extracted patient
demographics and descriptive information, and each study
was equipped with keywords for generic issues such as lan­
guage, country, focus, population, and so on.
Regarding the analysis and discussion of the results, the
following data were extracted for the study and design: author
and study design. For study participants: number, age, gender,
treatment groups. For the intervention protocol: type of exer­
cise, intervention time, intensity; conclusions of the study.
The risk of bias was assessed using one of the available tools
appropriate for the studies to be evaluated. The Jadad scale
was applied to each included study, a full table of risk of bias is
applied in the published review, including evidence to support
EXPERT REVIEW OF NEUROTHERAPEUTICS
3
each judgment. The authors did not apply the Jadad scale to
non-randomized study designs but instead assessed the evi­
dence’s validity as part of the interpretation of any results.
studies were excluded. After excluding 138 studies for the
inappropriate design of the research, three studies [10,24,25]
were included in the quantitative synthesis figure 1.
2.6. Strategy for data synthesis
3.2. Study characteristics: types of design and types of
participants
A narrative summary of the results of the included studies was
provided, structured according to the type of intervention, the
characteristics of the target population, the type of outcome,
and the intervention’s object. A quantitative synthesis of the
benefits of rehabilitation in people with GBS was discussed.
2.7. Data items in the included studies
The following items were analyzed for each article included in
the review [1]: participants’ details (age, type of GBS) [2];
intervention (control and experimental group) [5]; rates of
treatment [3]; outcomes measurement tools [6]; follow-up
[7]; conclusions [8]; Jadad score.
3. Conclusion
3.1. Search result
A total of 748 studies were identified. No article has been
added through other resources. Two hundred seventy-six
duplicate studies were excluded, and the remaining 472
were screened. After reading the titles and abstracts, 330
At the end of the screening and selection process, three studies
have been identified, all of which are randomized-controlled
trials, compatible with this systematic review’s objective.
The sample size in three studies [10,24,25] ranged from 30
[24] to 79 [10]; only in one study [25] was the sample size not
calculated, and 22 participants were recruited. In two studies
[10,25], the majority of participants were men; in the remain­
ing study [24], gender has not been reported. Studies use
different ways to report the ages of participants. Therefore,
table 1 contains this information.
From the summary of the records, different treatment
modalities used for the experimental group were found. The
interventions include PNF techniques associated with dia­
phragmatic breathing exercises [24], exercises on strength
and resistance at high intensity, gait training [10], pranayama
sessions added to regular rehabilitation care [25]. The organi­
zations of the intervention sessions are contained in Table 1.
The control group received usual care or regular rehabilitation
program performed in part or completely.
Studies have different primary outcome measurement
tools: EMG biofeedback and portable electronic spirometer
Record identified through database
Additional records identified through
searching (n°=748)
other sources (n°= 0)
IDENTIFICATION
Records after duplicates
removed (n°=471)
SCREENING
Records excluded after reading
Record screened (n°=471)
title and abstract (n°=330)
ELIGIBILITY
INCLUDED
Full-text valuated for
Records excluded for
eligibility(n°=141)
inappropriate design (n°=138)
Studies included in the
quantitative synthesis (n°=3)
Figure 1. Represents the study’s selection process.
4
S. SULLI ET AL.
Table 1. Characteristics of the study.
Author
Vidhyadhari
B.S.
L. et al.
2015
Khan
F. et al.
2011
Ragupathy
S. et all.
2013
Participants
Intervention
(G.S)
Rates of
treatment
Control groups (G.
C.)
N = 30
PNF techniques
15 minutes, 3 Diaphragmatic
EG = 15; CG = 15
(repeated
repetions,
breathing
Age:
stabilization,
3 sets for
exercises
EG = 30–50
rhythmic
7 days in
CG = 30–50
contractions),
a week, for
GENDER = male
diaphragmatic
1 week
and female
breathing
exercises
N = 79
High intensity
1 h, 3 times Less intensive
EG = 40; CG = 39
program
for week,
home based
Age:
(strengthening,
for
program
EG = 54.9
endurance,
12 weeks
(walking,
(SD = 17.1)
Gait training)
(half hour
stretching)
CG = 55.7
blocks of
(SD = 19.4)
therapy
GENDER:
sessions)
F = 31
M = 48
POST FOLLOW UP
N = 69
EG = 31; CG = 38
Age:
EG = 56.8
(SD = 15.1)
CG = 52
(SD = 20.1)
GENDER:
F = 26
M = 43
N(Randomized) = 22 Yoga intervention 15 sessions in Regular
EG = 11; CG = 11
and regular
three
rehabilitation
N(post drop
rehabilitation
weeks
care
out) = 20
care
(1 h/
EG = 10; CG = 10
session)
Age
(EG) = 20 − 55
(32.30 +- 9.911)
Age (CG) = 15–58
(31.30 +- 14.317)
GENDER (EG):
M=8
F=2
GENDER (CG):
M=5
F=5
Outcomes
measurement
tools
EMG
BIOFEEDBACK,
portable
electronic
spirometer
Follow-up
Conclusions
Seven days The study proves that
after
PNF techniques
treatment
effectively facilitate
diaphragm muscle
activity and improve
pulmonary function in
subjects with GBS.
Jadad
1
FIM, WHOQOL12 months
BREF, DASS 21,
PIPP
Higher intensity
rehabilitation
compared with less
intervention reduces
disability in patients
with GBS in later
stages of recovery.
3
PSQI, HADS,
NPRS, Barthel
index
Significant improvement
was observed in sleep
quality with yogic
relaxation, pranayama,
and meditation in GBS
patients.
3
After 15
sessions
FIM: Functional Independence Measure; WHOQOL -BREF: WHO Quality Of Life – bref; DASS 21.: Depression Anxiety Stress Scales short version; PIPP: Perceived
Impact of Problem Profile;HADS: Hospital Anxiety and Depression Scale; PSQI: Pittsburgh Sleep Quality Index; NPRS: Numeric Pain Rating Scale
have been used to evaluate the diaphragm muscle activity
and pulmonary functions [24]; FIM [10] has been administered
to assess the activity limitation; finally, the assessment of
sleep, anxiety, depression, pain, and functional status has
been done through PSQI, HADS, NPRS and Barthel Index [25].
Furthermore, follow-up was done after 12 months in [10],
after 15 sessions in [25], and after intervention on
seventh day [24].
3.3. Risk of bias within study
Jadad Score is used for the qualitative analysis of the trials
included in the systematic review. Based on this assessment, it
was found that two studies [10,25] got a score of three,
revealing high-level quality. The remaining study [24] pre­
sented a score that underlines a low qualitative level. For all
data, see table 2.
3.4. Synthesis of evidence
According to our research, three randomized-controlled trials
were suitable for quantitative analysis. However, it was impos­
sible to perform the metanalysis due to the diversity of out­
comes and follow-up between records. The study of Khan
F. et al. 2011 [10] aimed to evaluate the effectiveness of a highintensity rehabilitation program compared to a low-intensity
rehabilitation program after 12 months in a population of 79
patients with chronic Guillain-Barrè syndrome. After follow-up,
ten patients were lost, and the remaining 69 (treatment n = 35,
control n = 34) were analyzed; significant improvements were
found in FIM total score (p < 0.003) in the treatment group,
compared with the control group. Moreover, significant differ­
ences between both groups have been found in each FIM
motor subscales: mobility/transfers (p = 0.002), locomotion
(p = 0.005), and sphincter control (p = 0.003). No statistically
significant differences were observed between both groups in
EXPERT REVIEW OF NEUROTHERAPEUTICS
secondary outcome measures, except for the PIPP “relationship’
subscale (p = 0.011). In conclusion, a 12-week high-intensity
rehabilitation program consisting of 1-hour sessions 2–3 times
per week of physiotherapy for strengthening, endurance, and
gait training, in addition to occupational and psychological
therapy, appears to help reduce motor disability in patients
with chronic GBS.
The study of Ragupathy S. et al. 2013 [25] wanted to inves­
tigate pranayama and meditation’s effect on regular rehabilita­
tion in 22 patients with GBS. In both groups (study and control),
patients received rehabilitation care; among the interventions
used, physiotherapy included active assisted range of motion,
passive range of motion, stretching of tight muscles, strength­
ening exercises, breathing exercises, and gait training. In addi­
tion to this, the experimental group received 15 sessions of
yoga (1 hour a day) that included quick relaxation technique,
pranayama, and guided meditation (Mind Sound Resonance
TechniqueMSRT). The outcome measures of 20 patients, with
two dropouts, reported significant differences between the
groups in the quality of sleep, measured by the PSQI
(p = 0.048). It was seen that there was a reduction of anxiety
and depression (HADS), pain scores (NPRS), and an improve­
ment in functional status (Barthel.index) in both groups without
statistical differences. The authors argued that the use of yogic
relaxation, pranayama, and meditation techniques, added to
regular rehabilitation, appears to help improve sleep quality.
In the Randomized Controlled Trial of Vidhyadhari B.S.
L. et al. 2015 [24], the purpose was to assess the propriocep­
tive neuromuscular facilitation techniques’ efficacy on pul­
monary function (FEV1/FVC) and diaphragm muscle activity
in a population of 30 patients with Guillain-Barrè syndrome.
The assessment of these parameters was done using EMG
biofeedback machine and portable electronic spirometer. The
experimental group (15 participants) performed PNF exercises
and techniques, such as repeated stabilization and rhythmic
contractions, in addition to diaphragmatic breathing exercises,
for 15 min, three repetitions, three sets, and seven days in one
week. The control group (15 participants) performed exclu­
sively diaphragmatic breathing exercises with the same
volume, intensity, and frequency. In extrapolating the results,
the authors did not provide statistical tables. However, they
declared that significant differences in parameters were found
in both groups before and after the test (p < 0.05), but
compared to the control group, greater changes occurred in
the group of study (p < 0.05). Based on the information
reported, PNF techniques facilitate diaphragmatic activity
and improve pulmonary function in patients with GBS.
Nevertheless, through our research, this is the only study
investigating these symptoms using this specific technique,
and therefore we believe that similar new studies are required.
5
3.5. Study limits
The limits of this study concern the small number of RCTs in
the literature. The heterogeneity of the phase of illness, the
small size of the patients in the trials, and the lack of double
blinding is closely related to the nature of the studies consid­
ered. Another underlining limit is the use of only six databases.
It is important to note that studies included in this review do
not account for the clinical variants of GBS. Finally, the studies’
partial information found that the different timing of followup and their different outcome measures did not permit us to
carry out a qualitative analysis with metanalysis.
4. Expert opinion
Guillain-Barrè syndrome is a rare autoimmune disease that
involves peripheral nerves and is potentially life-threatening
[26]. Some of the patients who survive the acute phase pre­
sent motor and sensitive sequelae, deficits in ambulation,
weakness and pain, which negatively impact daily life activities
[27]. Therefore, a long-term rehabilitation program is needed
to manage the patient’s complications [28], but currently,
there are no defined guidelines on this type of intervention
reported in the literature. The most recent systematic review
investigating this topic was done by Arsenault et al. in 2016 [6]
to evaluate the influence of exercise on patients with GBS;
however, from the analysis of the included studies, having
different research designs, the authors could not draw defini­
tive and standardized conclusions. The analysis of the three
randomized controlled trials showed that, in general, various
types of rehabilitation interventions are correlated to an
improvement in the patient’s well-being. In particular, the
assessment of physical outcomes was pursued by the studies
of Khan F. et al. 2011 [10] and Vidhyadhari B.S.L. et al. 2015
[24], although the authors focused on evaluations of different
parameters. Furthermore, the difference in quality between
the two studies, highlighted by the Jadad scale, prompts us
to consider the rehabilitation program proposed by Khan
F. et al. 2011 [10] with greater authority. Therefore, to reduce
symptoms and to improve activity and participation, it seems
to be useful to increase the intensity within a rehabilitation
program through a greater frequency of therapy sessions
(one hour of therapy three times a week), more types of
interventions (occupational, social, psychological, speech and
physiotherapy therapy) and a greater intensity of physical
exercises (therapy for strengthening, endurance, and gait
training). Moreover, Khan F. et al. 2011 [10] and Vidhyadhari
B.S.L. et al. 2015 [24] also considered bio-psycho-social out­
comes. Although they use different measures and interven­
tions, both studies did not report statistically significant
Table 2. Jadad score.
Randomization
BSL Vidhyadhari et al. 2015
1
Fary khan et al.2011
1
Ragupathy Sendhilkumar et al
1
2013
Method of
randomization
0
1
1
Double
blinding
0
0
0
Method of double
blinding
NA
NA
NA
Description of withdrawals and
dropouts
0
1
1
Total
score
1
3
3
6
S. SULLI ET AL.
differences between them. The different results of the studies
do not allow us to standardize an outlined rehabilitation pro­
tocol since both the outcomes and the proposed interventions
are not comparable. Furthermore, these studies do not con­
sider the different clinical features of Guillain-Barré syndrome
and rehabilitation intervention is not diversified even though
patients may be at different stages of the disease.
Because this condition causes several types of disability,
a multidisciplinary approach seems to be necessary, as sup­
ported by scientific evidence [1]. In fact, Khan F. et al. 2011
[10] is the only randomized controlled trial that evaluated
different outcomes and used a multidisciplinary approach,
and this demonstrates the effectiveness of its intervention.
5. Conclusion
Our review highlighted that there is little quality evidence in
Guillain-Barrè rehabilitation. However, it is performed exten­
sively in clinical practice, and for this reason, prospective
multicenter RCtrials based on patients’ clinical, biological,
and electrophysiological data in addition to myelinating fiber
types and lesion levels are needed.
The main problem in carrying out an effective rehabilitation
protocol for patients with GBS is related to the heterogeneity
of outcome measures and interventions used.
In conclusion, to facilitate comparison between studies,
standardized, specific, sensitive, and valid outcome measures
should be established in the future.
Declaration of interest
The authors have no relevant affiliations or financial involvement with any
organization or entity with a financial interest in or financial conflict with
the subject matter or materials discussed in the manuscript. This includes
employment, consultancies, honoraria, stock ownership or options, expert
testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other
relationships to disclose.
Funding
This paper was not funded.
ORCID
Anna Berardi
http://orcid.org/0000-0003-0670-5303
Giovanni Galeoto
http://orcid.org/0000-0002-9043-5686
References
Papers of special note have been highlighted as either of interest (•) or of
considerable interest (••) to readers.
1. Khan F, Ng L, Amatya B, et al. Multidisciplinary care for GuillainBarré syndrome. Eur J Phys Rehabil Med. 2010;47:607.
•• this review describes the effectiveness of a multidisciplinary
approach in the treatment of adults with GBS.
2. Adams R, Victor M, Ropper A. Principles of Neurology. Vol. 6th.
Massachusetts: McGraw-Hill; 1998.
3. Malek E, Salameh J. Guillain–Barre Syndrome. Semin Neurol.
2019;39:589–595.
4. Kenichi K. Guillain–Barré Syndrome KK. Adv Exp Med Biol.
2019;1190:323–331. doi:10.1007/978-981-32-9636-7_20.
5. McGrogan A, Madle G, Seaman H, et al. The epidemiology of
Guillain-Barré syndrome worldwide. A systematic literature review.
Neuroepidemiol. 2009;32:150–163.
6. Arsenault NS, Vincent P, Bh Y, et al. Influence of Exercise on
Patients with Guillain-Barrè. Physioter Can. 2016;68:367–376
•• this is the most recent review examining the effectiveness of
rehabilitation in patients with GBS.
7. Lennon S, Ramdharry G, Verheyden G. Physical management for
neurological conditions. 4th ed. Australia: Elsevier; 2018.
8. Khan F, Ng L. Guillain-Barré syndrome: an update in rehabilitation.
Int J Thera Rehabil. 2009;16:451–460.
9. Demir SO, Köseoğlu F. Factors associated with health-related qual­
ity of life in patients with severe Guillain – barre´ syndrome. Disabil
Rehabil. 2008;30:593–599.
10. Khan F, Pallant JF, Amatya B, et al. Outcomes of high- and lowintensity rehabilitation programme for persons in chronic phase
after Guillain-Barré syndrome: a randomized controlled trial.
J Rehabil Med. 2011;43:638–646.
•• this is the only rct that analyzes different outcomes, highlight­
ing the various types of disability that may occur in patients
with GBS, using multidisciplinary treatment.
11. Prada V, Massa F, Salerno A, et al. Importance of intensive and
prolonged rehabilitative treatment on the Guillain-Barrè syndrome
long-term outcome: a retrospective study. Neurol Sci. 2020;41
(2):321–327. .
12. Forsberg A, Press R, Einarsson U, et al., Disability and health-related
quality of life in Guillain-Barré syndrome during the first two years
after onset: a prospective study. Clin Rehabil. 19(8): 900–909. 2005..
• this article highlights how GBS in the chronic phase has
a major impact on daily activities, work, social activities and
health-related quality of life.
13. Berardi A, Regoli E, Tofani M, et al.Tools to assess the quality of life
in patients with Parkinson’s disease: a systematic review.
14. Panuccio F, Berardi A, Marquez MA, et al.
15. Galeoto G, Turriziani S, Berardi A, et al. Levels of cognitive function­
ing assessment scale: Italian cross-cultural adaptation and
validation. Ann di Ig. 2020;32:16–26.
16. Tofani M, Candeloro C, Sabbadini M, et al. A study validating the
Italian version of the level of sitting scale in children with cerebral
palsy. Clin Rehabil. 2019;33(11):1810–1818. .
17. Ioncoli M, Berardi A, Tofani M, et al. crosscultural validation of the
community integration questionnaire–revised in an Italian popula­
tion. Occupational Therapy International. 2019;2020:1–7.
18. Berardi A, Saffioti M, Tofani M, et al. Internal consistency and
validity of the Jebsen-Taylor hand function test in an Italian popu­
lation with hemiparesis. NeuroRehabilitation. 2019;45(3):331–339. .
19. Savona A, Ferralis L, Saffioti M, et al. Evaluation of intra- and interrater reliability and concurrent validity of the Italian version of the
Jebsen–Taylor hand function test in adults with rheumatoid arthri­
tis. Hand Therapy. 2019;24(2):48–54. .
20. Galeoto G, Iori F, De Santis R, et al. The outcome measures for
loss of functionality in the activities of daily living of adults after
stroke: a systematic review. Top Stroke Rehabil. 2019;26
(3):236–245.
21. Ruggieri M, Palmisano B, Fratocchi G, et al. validated fall risk
assessment tools for use with older adults: a systematic review.
Physical & Occupational Therapy In Geriatrics. 2019;36(4):331–
353. DOI: 10.1080/02703181.2018.1520381.
22. Galeoto G, Formica MC, Mercuri NB, et al. Evaluation of the psycho­
metric properties of the Barthel Index in an Italian ischemic stroke
population in the acute phase: a cross-sectional study. Funct
Neurol. 2019;34(1):29–34.
23. Miniera F, Berardi A, Panuccio F, et al. Measuring environmental
barriers:Validation and Cultural Adaptation of the Italian Version of
the Craig Hospital Inventory of Environmental Factors (CHIEF)
EXPERT REVIEW OF NEUROTHERAPEUTICS
Scale. Occup Ther Health Care. 2020;34(4):373–385. doi:10.1080/
07380577.2020.1834174.
24. Vidhyadhari BSL, Madavi K. Influence of proprioceptive neuromus­
cular facilitation techniques on diaphragm muscle activity and
pulmonary function in subjects with guillain- barre syndrome.
Indian J Physioter Occup Ther. 2015;9(2):24–28.
25. Ragupathy S, Anupam G, Raghuram N, et al. Effect of pranayama
and meditation as an add-on therapy in rehabilitation of patients
with Guillain-Barré syndrome—a randomized control pilot study.
Disabil Rehabil. 2013;35(1):57–62.
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26. World Health Organization (WHO). The international classification
of functioning, disability and health (ICF). Geneva: WHO; 2001.
27. Khan F, Amatya B, Ng L. Use of the international classification of
functioning, disability and health to describe patient-reported dis­
ability: a comparison of guillain barre syndrome with multiple
sclerosis in a community cohort. J Rehabil Med. 2010;42
(8):708–714.
28. Dua K, Banerjee A. Guillain–Barré syndrome: a review. British
Journal of Hospital Medicine. 2010;71(9):495–498.