Impact of Kabat Rehabilitation on Synkinesis and Pain in Bell’s Palsy: A Systematic Literature Review

Abstract

Background: Bell’s palsy is a common cause of acute unilateral facial paralysis, and a substantial proportion of patients develop persistent synkinesis, pain, and functional impairment despite standard medical treatment. Rehabilitation strategies such as Kabat rehabilitation have been increasingly applied, but their effectiveness remains variably reported. Objective: To systematically review the evidence on the effects of Kabat rehabilitation on synkinesis and pain in individuals with Bell’s palsy. Methods: This was a systematic review without meta-analysis. PubMed was searched from database inception to November 2024 for randomized controlled and controlled experimental studies evaluating Kabat rehabilitation in patients with Bell’s palsy. Eligible studies included Kabat rehabilitation as a primary intervention and reported outcomes related to synkinesis and/or pain. Two reviewers independently screened studies and extracted data, with disagreements resolved by consensus. Due to heterogeneity in study designs, interventions, and outcome measures, results were synthesized narratively. Results: Seven studies involving approximately 560 participants were included. Most studies reported improvements in synkinesis and pain following Kabat rehabilitation, either as a standalone intervention or combined with adjunctive therapies. Reductions in synkinesis were reported in five of six studies assessing this outcome, and pain improvement was reported in three of four studies. However, one study found no significant difference between Kabat rehabilitation and neuromuscular electrical stimulation. Overall certainty of evidence was low to moderate, limited by small sample sizes, methodological heterogeneity, and risk-of-bias concerns. Conclusion: Kabat rehabilitation may offer beneficial effects on synkinesis and pain in Bell’s palsy, but evidence is heterogeneous and of limited certainty. High-quality, standardized trials are required to clarify their comparative effectiveness.