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Three Part Question

In [facial nerve palsy] are [facial exercises better than electrical stimulation] at improving [time to function/facial symmetry]?

Clinical Scenario

A 50-year-old presents with Bells' Palsy. You have heard that physiotherapy is an effective treatment but wonder whether facial exercises produce a better outcome than treatment with electrical stimulation.

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 since these described electromyographic feedback (EMG feedback training) which is not a form of electrical stimulation. The remaining paper is shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Farragher D et al, 1987,	40 patients with a 74 months mean interval between onset and starting treatment. Stimulation v no stimulation	Clinical Trial	FPRP (Facial Paralysis Recovery Profile)	p<0.0001	Not randomised
			FPRI (Facial Paralysis Recovery Index)	p<0.0001
			FPRI (Facial Paralysis Recovery Index)	p<0.0001
			FPRP (Facial Paralysis Recovery Profile)	p<0.0001

Comment(s)

No papers were found which involved physiotherapy treatment of Bells' 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 Bells' Palsy. Evidence does exist to justify the use of electrical stimulation in patients with long-term Bells' Palsy, although the study could have been more rigorous.

References

1. Farragher D, Kidd GL, Tallis R. Eutrophic stimulation for Bells' Palsy. Clinical Rehabilitation 1987:1(4):265-71.