Effectiveness of Adjunct Physiotherapy in Enhancing Recovery from Bell’s Palsy: A Quasi- Experimental Study
DOI:
https://doi.org/10.47489/szmc.v39i3.777Keywords:
Bell’s Palsy, Facial Paralysis, Corticosteroids, Physiotherapy, Facial Exercises, Quasi-ExperimentalAbstract
Background: Bell’s palsy (idiopathic facial nerve paralysis) can lead to incomplete recovery and sequelae in a significant minority of patients. While corticosteroids are the mainstay early treatment, the role of adjunct physiotherapy (facial exercises and related rehabilitation) in improving outcomes remains under-investigated, especially in resource settings like Pakistan.
Objective: To compare the degree of recovery in Bell’s palsy patients managed with standard medical therapy alone versus
those receiving additional physiotherapy, in a quasi-experimental hospital-based study.
Methods: A quasi-experimental study was conducted at a tertiary care hospital after approval from the Institutional Review Board. A total of 126 patients with acute unilateral Bell’s palsy were allocated to two groups (63 each). Group A received conventional medical therapy (corticosteroids ± antivirals), while Group B received the same plus structured physiotherapy. Outcomes were the House–Brackmann (H-B) grading and the Facial Disability Index (FDI), assessed at baseline and 3 months. Data were analyzed in SPSS v25 using t-tests, Mann–Whitney U, and chi-square tests; effect sizes and 95% confidence intervals were reported, with p<0.05 considered significant.
Results: Of 126 enrolled patients (mean age 40.3±12.5 years; 54% male), 120 completed the 3-month follow-up (6 lost to follow-up, evenly from both groups). Baseline characteristics (age, sex distribution, side of palsy, and initial H-B severity) were comparable between groups (p>0.2 for all). At 3 months, complete or near-complete recovery (H-B grade I or II) was achieved in 53 patients (84.1%) in Group B, versus 42 patients (66.7%) in Group A (p=0.014). No serious adverse events were noted; all patients tolerated the interventions well.
Conclusion: Adjunct physiotherapy significantly enhanced facial nerve recovery and functional outcomes in Bell’s palsy compared to medical therapy alone, supporting its integration into standard care. Further randomized studies are recommended to confirm these benefits and to optimize physiotherapy protocols for Bell’s palsy.
References
Grohol B, Reno D, Jennings TJ, Fortin GT, Rolfs M. Back to play considerations in a patient with Bell's palsy: a case report and review. Cureus. 2023;15:e35739. https://doi.org/10.7759/cureus.35739
Karlsson S, Arnason S, Hadziosmanovic N, Laestadius Å, Hultcrantz M, Marsk E, Skogman BH. The facial nerve palsy and cortisone evaluation (FACE) study in children: protocol for a randomized, placebo-controlled, multicenter trial, in a Borrelia burgdorferi endemic area. BMC Pediatr. 2021;21:220. https://doi.org/10.1186/s12887-021-02571-w
Ahmad F, Saeed M, Hashmi IR, Ilyas MK, Haroon NF, Abdullah S, et al. Incidence of facial palsy and its impact on quality of life of patients. Pak J Med Health Sci. 2022;16(07):508. https://doi.org/10.53350/pjmhs22167508
Zhang W, Xu L, Luo T, Wu F, Zhao B, Li X. The etiology of Bell's palsy: a review. J Neurol. 2020;267(7):1896-1905. https://doi.org/10.1007/s00415-019-09282-4
Shi J, Lu D, Chen H, Shu M, Xu Y, Qian J, Ouyang K, et al. Efficacy and safety of pharmacological and physical therapies for Bell's palsy: a Bayesian network meta-analysis. Front Neurol. 2022;13:868121. https://doi.org/10.3389/fneur.2022.868121
Hohman MH, Warner MJ, Varacallo MA. Bell palsy. [Updated 2024 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482290/
Choi SY, Kim JM, Jung J, Park DC, Yoo MC, Kim SS, Kim SH, Yeo SG. Review of drug therapy for peripheral facial nerve regeneration that can be used in actual clinical practice. Biomedicines. 2022;10(7):1678. https://doi.org/10.3390/biomedicines10071678
Gagyor I, Madhok VB, Daly F, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2019;9(9):CD001869. https://doi.org/10.1002/14651858.CD001869.pub9
Gronseth GS, Paduga R; American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell’s palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012;79(22):2209-13. https://doi.org/10.1212/WNL.0b013e318275978c
Seemal P, Arshad J, Hameed S, Shafique S, Majeed M. Current practice patterns in the management of Bell's palsy among physiotherapists of Sargodha, Pakistan. Iran Rehabil J. 2024;22(4):639-644. https://irj.uswr.ac.ir/article-1-1590-en.html
Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): an updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil. 2022;36(11):1424-1449. https://doi.org/10.1177/02692155221110727
Vaughan A, Gardner D, Miles A, Copley A, Wenke R, Coulson S. A systematic review of physical rehabilitation of facial palsy. Front Neurol. 2020;11:222. https://doi.org/10.3389/fneur.2020.00222
Ghous M, Yaqoob I, Kanwal M, Malik AN. Effects of Kabat rehabilitation versus taping to reduce facial disability and synkinesis in Bell’s palsy. Rawal Med J. 2018;43(3):543-6. https://rmj.org.pk
Avaid A, Majeed S, Naseem N, Sheraz Z, Tariq K, Bukhari SN. Comparison between proprioceptive neuromuscular facilitation and neuromuscular re-education in patients with Bell’s palsy. Pak J Health Sci. 2022;3(4):171-4. https://thejas.com.pk/index.php/pjhs/article/view/269
Tariq F, Heera SA, Safdar M, Sarwar A, Nasir U, Tariq. Clinical efficacy of rehabilitation in Bell’s palsy. J Health Res Rev. 2024;4(3):1-8. https://doi.org/10.61919/jhrr.v4i3.1309
Kafle DR, Thakur SK. Evaluation of prognostic factors in patients with Bell's palsy. Brain Behav. 2021;11(11):e2385. https://doi.org/10.1002/brb3.2385
Heckmann JG, Urban PP, Pitz S, Guntinas-Lichius O, Gagyor I. The diagnosis and treatment of idiopathic facial paresis (Bell's palsy). Dtsch Arztebl Int. 2019;116:692-702. https://doi.org/10.3238/arztebl.2019.0692
Cardoso JR, Teixeira EC, Moreira MD, Fávero FM, Fontes SV, Bulle de Oliveira AS. Effects of exercises on Bell's palsy: systematic review of randomized controlled trials. Otol Neurotol. 2008;29(4):557-60. https://doi.org/10.1097/MAO.0b013e31816c7bf1
Dalrymple SN, Row JH, Gazewood J. Bell palsy: rapid evidence review. Am Fam Physician. 2023;107(4):415-20. Erratum in: Am Fam Physician. 2024;109(2):105. https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html
Van Landingham SW, Diels J, Lucarelli MJ. Physical therapy for facial nerve palsy: applications for the physician. Curr Opin Ophthalmol. 2018;29(5):469-75. https://doi.org/10.1097/ICU.0000000000000503
Santiago S, Joshua AM, Nayak A, et al. Effectiveness of novel facial stretching with structured exercise versus conventional exercise for Bell’s palsy: a single-blinded randomized clinical trial. Sci Rep. 2024;14:13266. https://doi.org/10.1038/s41598-024-64046-z

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