Comparison of Proprioceptive Neuromuscular Facilitation (PNF) and Neuromuscular Re-education (NRE) with Conventional Therapy, Home-based Exercise, and Facial Nerve Stimulation in Bell’s Palsy: A PRISMA-Based Comprehensive Systematic Review

Abstract

Background: Bell’s palsy is the most prevalent cause of acute unilateral facial paralysis and often results in functional deficits, facial asymmetry, and psychosocial impairment. While conventional therapy, facial nerve stimulation, and home-based exercise are widely used, advanced physiotherapeutic approaches such as proprioceptive neuromuscular facilitation (PNF) and neuromuscular re-education (NRE) may provide superior functional outcomes. Objective: To systematically compare the effectiveness of PNF and NRE with conventional therapy combined with home-based exercise (HBE) and facial nerve stimulation in improving facial function, disability, and quality of life in patients with Bell’s palsy. Methods: This review was conducted according to PRISMA 2020 guidelines. Electronic databases including PubMed, Scopus, Web of Science, PEDro, and Cochrane Library were searched for studies published between 2000 and 2026. Results: Randomized controlled trials, cohort studies, and interventional studies involving Bell’s palsy patients receiving PNF, NRE, electrical stimulation, conventional therapy, or combinations were included. Evidence consistently suggests that PNF and NRE demonstrate greater improvements in facial symmetry, facial grading scores, disability reduction, and synkinesis management compared to conventional approaches alone. Combined multimodal rehabilitation yielded the most clinically meaningful outcomes, particularly when initiated early. However, heterogeneity in intervention protocols and small sample sizes limit definitive standardization. Conclusion: PNF and NRE appear to offer superior rehabilitation benefits over conventional therapy and home programs alone, particularly in enhancing neuromuscular control and facial function. Larger standardized trials are required to establish optimal rehabilitation protocols.