Outcomes of neuromuscular retraining and adjunctive electrical stimulation in Bell's palsy: a single-centre observational cohort study.

Abstract

Background: Bell's palsy is the most frequent reason for acute unilateral peripheral facial palsy. While some patients recover spontaneously, others experience incomplete recovery, asymmetry of face, synkinesis, disability, and decreased quality of life. The value of different rehabilitation paths in routine clinical practice is unknown.

Purpose: To describe facial recovery outcomes across three routine clinical rehabilitation pathways in adults with Bell's palsy and to examine recovery patterns over 12 months.

Methods: This single-center retrospective cohort study enrolled 500 adult patients with newly diagnosed Bell's palsy and was conducted according to one of the three routine clinical pathways: no rehabilitation, rehabilitation with facial neuromuscular training, and neuromuscular training along with electrostimulation. The clinical evaluations were carried out at the moment of the initial clinical evaluation and then at 1 month, 3 months, 6 months, and 12 months after the index clinical evaluation. The primary outcome was favorable recovery within 6 months, which is considered as House-Brackmann grade I-II.

Results: The average age of participants was 45.3 years (SD 13.9 ) and 56.6% were female. Early application of corticosteroids within 72 h after illness onset was found in 65.4% of cases, but 45.8% of patients received antiviral therapy. By 6 months, favorable recovery rate was 63.0% among patients without rehabilitation, 83.4% among those receiving supervised neuromuscular retraining and 81.7% among patients who underwent a combination of neuromuscular retraining and electrical stimulation. Sunnybrook Facial Grading System scores increased over time in all groups. By 12 months, synkinesis was found less often in the supervised neuromuscular retraining group.

Conclusion: In this single-center observational cohort study, structured rehabilitation pathways were associated with numerically higher observed proportions of favourable recovery than no formal rehabilitation. However, rehabilitation pathways were not randomly allocated and differed according to baseline severity and routine clinical factors. Therefore, these findings describe associations and cannot establish treatment effectiveness, causality, or superiority of one rehabilitation pathway over another.