Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy.
Amir J Khan, Ala Szczepura, Shea Palmer and 5 others
PMID 35787015WHAT IT FOUND
Facial exercise therapy is supported by recent evidence for improving facial function in Bell's palsy.
However, the review could not combine data because studies varied widely in design, patient severity, and whether exercises were given alone or mixed with other treatments.
Key findings
01All five high-quality studies, including four randomised controlled trials, reported positive effects of facial rehabilitation for patients with facial palsy.
02Evidence for facial exercise therapy alone is limited, as only two of the nineteen new individual studies evaluated it without other concurrent treatments.
03The review could not perform a meta-analysis or determine the specific benefit of therapy at different stages of recovery due to heterogeneity in study designs and patient characteristics.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review could not pool data for a meta-analysis because the nineteen studies used different designs, interventions, and outcome measures. Most studies combined facial exercises with other treatments (like electrical stimulation, laser, or corticosteroids), making it impossible to separate the effect of exercise alone. Six of the seven new systematic reviews identified were rated as critically low quality and were excluded from the final evidence synthesis. There is no clear evidence on how the timing of therapy (acute vs. chronic) or the severity of palsy affects outcomes. No study defined what constitutes a clinically significant improvement, and follow-up periods varied widely from 4 weeks to 12 months.
Declared interests
The authors declared no potential conflicts of interest. The work was funded by the National Institute for Health Research (NIHR) as part of the FRAME project.
The easy way to misread this
Do not assume that facial exercise therapy alone is the proven cause of improvement. Most high-quality studies in this review combined exercises with other treatments like electrical stimulation or laser therapy, so the specific benefit of exercise in isolation cannot be separated from the other components.